Mucocutaneous Manifestations of Viral Diseases

583 Pages·2002·52.16 MB·English

by  Stephen Tyring

Mucocutaneous Manifestations of
VIRAL DISEASES
edited by
Stephen K. Tyring
University of Texas Medical Branch
Calveston, and
University of Texas Medical Branch
Center for Clinical Studies
Houston, Texas, USA
Associate Editor
Angela Yen -Mo ore
University of Texas Southwestern Medical Center
Dallas, Texas, USA
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Preface
The skin is the window of the body. Many viral diseases that serves as a central resource for each of the viral
express themselves through changes in skin appearance, diseases described. It should be of interest to physicians
eruptions on the skin, swelling, and so forth. Often the worldwideaswehaveincludedmanydiseasespreviously
skinbecomesawarningofinternalmanifestationssignal- known only in third-world, developing countries. Given
ing the physician to look beyond the window for other the global aspects of international transportation, social
impacts. The contributors to Mucocutaneous Manifesta- exchange, and political boundaries, it is entirely feasible
tions of Viral Diseases interact on a regular basis with that one or more of these rarer viral diseases could
other dermatologists and virologists, or combinations present itself at any physician’s office in the world.
thereof.Thebookisanoutgrowthofthosedailyconsulta- Animal vectors and reservoirs are often immigrants on
tions and discussions with other colleagues in various baggage or agricultural products. Each chapter includes,
fields of medicine. As family practitioners are increas- as appropriate, a timeline of infection and progress of
ingly being called upon to provide the diagnosis and thedisease,numerousqualitycolorillustrationsofcharac-
treatmentofawider varietyofillnesses(thosepreviously teristic epidermal and cellular manifestations, a means
referred to a specialist), a quick reference is needed. to reference the differential diagnosis of viral diseases
This book not only helps distinguish the cutaneous mani- from other infectious or noninfectious diseases, a brief
festationsofonevirusfromanother,butalsohelpsdiffer- taxonomy and history of the disease, incidence among
entiate viral diseases from other infectious and noninfec- gender and age groups by geographical region, pathogen-
tiousdiseases.Itisintendedforinternists,dermatologists, esis, clinical manifestations, dermatopathology, labora-
pediatricians, and family practitioners worldwide. tory findings, differential diagnosis, and treatment/pro-
The goal of this book is to enhance the expertise of phylaxis. To the extent possible, we have used tabular
physiciansinthediagnosis,treatment,andpathogenesisof information for quick reference by the physician.
viral diseases that express their presence in the skin and Mucocutaneous Manifestations of Viral Diseases is
itsaffiliatedmembranes.Noothertextcurrentlyaddresses unique in that it covers the field of viral diseases having
theissuesoftheskinmanifestationsofviraldiseases.Pho- mucocutaneousmanifestationsandoffersthequalitycolor
tographstoaiddiagnosesareusuallyblackandwhiteand photographs associated with an atlas. The book also
of limited use to the physician. Many color atlases only serves as a bibliography for physicians wishing to
encompassoneorafewviraldiseases,leavingthepracti- broaden their knowledge of the primary literature. I envi-
tionerwithadesireformoredetailand/orabetterexplana- sion the physician using the color photographs in consid-
tion of possible mimics of the diseases. ering possible diagnoses. The differential diagnosis sec-
The contributing authors and I have provided a text tion helps the physician narrow the search for the virus
iii
iv Preface
causingtheepidermalinsult.Thetextwouldthenprovide deeply appreciate the efforts of the following individuals
suggestions as to which laboratory tests might be useful in their extremely valuable roles:
to confirm diagnosis. Finally, it outlines the appropriate
CharleneHofffortypingandretypingthemanuscripts;
treatment, including specific types of antiviral drugs and
Linda Roberts for helping to coordinate the efforts of
vaccines.
many individuals;
Insummary,itishopedthatthebookwillfillavoidin
TriciaJ.Brown,M.D.,forassuringthescientificinteg-
themedicalliteratureandprovideavaluableresourcetoa
rity of the text;
variety of practicing physicians worldwide.
Nancy Bell, Ph.D., for all aspects of the editing and
production process; and
Angela Yen-Moore, M.D., for proofreading the entire
ACKNOWLEDGMENTS text and helping to rewrite chapters for consistency
and clinical accuracy.
Publicationofthisbookwouldnothavebeenpossiblewith- Most of all, I wish to thank my wife, Patricia Lee, M.D.,
out the combined efforts of many individuals. Therefore, forhersupport,encouragement,anddedicationthroughout
Iwishtothankthecontributorsforwriting,rewriting,and thelongjourneythatledtothepublicationofMucocutane-
updating their manuscripts. Likewise, I wish to thank my ous Manifestations of Viral Diseases.
colleaguesonsixcontinentsforcontributingqualityphoto-
graphs of the clinical manifestations of viral diseases. I Stephen K. Tyring
Contents
Preface iii 9. Human Herpesvirus 7 213
Contributors vii Tricia J. Brown and Angela Yen-Moore
10. Human Herpesvirus 8 219
1. Cutaneous Virology 1 Tricia J. Brown, Angela Yen-Moore,
Stephen K. Tyring and Stephen K. Tyring
2. Cutaneous Resistance to Viral Infections 25
11. Herpes B Virus 235
Omeed M. Memar, Pedram Geraminejad,
Paul Rockley and Stephen K. Tyring
Istvan Arany, and Stephen K. Tyring
12. Human Papillomaviruses 247
3. Poxviruses 39
Claire P. Mansur
Dayna G. Diven
4. Herpes Simplex Virus 69 13. Parvovirus B19 295
Richard J. Whitley and John W. Gnann, Jr. Karen Wiss and Tricia J. Brown
5. Varicella-Zoster Virus (Herpes 3) 119 14. Cutaneous Manifestations of HIV Infection 307
Monica McCrary, Tricia J. Brown, and Clay J. Cockerell and Philip R. Cohen
Stephen K. Tyring
15. Colorado Tick Fever 397
6. Epstein-Barr Virus 145
Michael R. Weir and Tracey E. Weir
Dennis M. Walling, Angela Yen-Moore, and
S. David Hudnall
16. Measles 403
Vera Y. Soong and Tricia J. Brown
7. Cytomegalovirus 173
Istvan Boldogh, Janak A. Patel, Stephen K.
Tyring, and Tasnee Chonmaitree 17. Marburg and Ebola Hemorrhagic Fevers 421
Michael R. Weir and Tracey E. Weir
8. Human Herpesvirus 6 197
Samuel A. Shube, Andrea M. Dominey, and 18. Bunyaviridae and Arenaviridae 429
Tricia J. Brown Michael R. Weir and Tracey E. Weir
v
vi Contents
19. Cutaneous Manifestations of Enterovirus 22. Rubella (German Measles) 519
Infections 455 Lourdes Tamayo, Edith Garcia-Gonzalez,
Wesley King Galen and Tricia J. Brown
23. Hepatitis Viruses 529
20. Flaviviridae 473
A. Michele Hill, Catherine C. Newman,
Michael R. Weir and Tracey E. Weir
Tricia J. Brown, and Sharon S. Raimer
21. Togaviridae 503
Michael R. Weir and Tracey E. Weir Index 551
Contributors
Istvan Arany, Ph.D. Department of Internal Medicine, WesleyKingGalen,M.D. ClinicalFaculty,TulaneUni-
University of Arkansas School of Medicine, Little Rock, versity, New Orleans, and Louisiana State University
Arkansas, USA School of Medicine, New Orleans, Louisiana, USA
EdithGarcia-Gonzalez,M.D. DepartmentofDermatol-
IstvanBoldogh,D.M.&B.,Ph.D. DepartmentofMicro-
ogy, Instituto Nacional de Perinatolog´ıa, Mexico City,
biology and Immunology, University of Texas Medical
Mexico
Branch, Galveston, Texas, USA
Pedram Geraminejad, M.D. Department of Dermatol-
Tricia J. Brown, M.D. Department of Dermatology,
ogy,UniversityofIllinoisatChicagoSchoolofMedicine,
University of Oklahoma Health Sciences Center, Okla-
Chicago, Illinois, USA
homa City, Oklahoma, USA
John W. Gnann, Jr., M.D. Departments of Medicine
Tasnee Chonmaitree, M.D. Departments of Pediatrics andMicrobiology,UniversityofAlabamaatBirmingham
andPathology,UniversityofTexasMedicalBranch,Gal- School of Medicine, Birmingham, Alabama, USA
veston, Texas, USA
A. Michelle Hill, M.D. Division of Dermatology, De-
Clay J. Cockerell, M.D. Departmant of Dermatology, partmentofMedicine,KansasUniversitySchoolofMedi-
UniversityofTexasSouthwesternMedicalCenter,Dallas, cine, Kansas City, Kansas, USA
Texas, USA
S.DavidHudnall,M.D. DepartmentofPathology,Uni-
versityofTexasMedicalBranch,Galveston,Texas,USA
Philip R. Cohen, M.D. Department of Dermatology,
Universityof Texas—HoustonMedical School,Houston,
Claire P. Mansur, M.D. Department of Dermatology,
Texas, USA
TuftsUniversity,Boston,andNewEnglandMedicalCen-
ter, Boston, Massachusetts, USA
Dayna G. Diven, M.D. Department of Dermatology,
University of Texas Medical Branch, Galveston, Texas,
Monica McCrary, M.D. Department of Dermatology,
USA
Medical College of Georgia, Augusta, Georgia, USA
AndreaM.Dominey,M.D. RockwoodClinic,Spokane, Omeed M. Memar, M.D., Ph.D. Academic Dermatol-
Washington, USA ogy & Skin Care Institute, Chicago, Illinois, USA
vii
viii Contributors
CatherineC.Newman,M.D. DepartmentofDermatol- cine,UniversityofTexasMedicalBranch,Galveston,and
ogy, University of Texas Medical Branch, Galveston, University of Texas Medical Branch Center for Clinical
Texas, USA Studies, Houston, Texas, USA
JanakA.Patel,M.D. DepartmentofPediatrics,Univer- DennisM.Walling,M.D. DepartmentofInternalMedi-
sity of Texas Medical Branch, Galveston, Texas, USA cine, University of Texas Medical Branch, Galveston,
Texas, USA
Sharon S. Raimer, M.D. Departments of Dermatology
and Pediatrics,University ofTexas MedicalBranch, Gal- MichaelR.Weir,M.D. DepartmentofPediatrics,Scott
veston, Texas, USA andWhiteClinicandMemorialHospital,Temple,Texas,
USA
Paul Rockley, M.D. Private Practice, Cosmetic, Laser,
and Classic Dermatology, North Miami Beach, Florida, TraceyE.Weir,M.D. DepartmentofEmergencyMedi-
USA cine, Brackenridge Hospital, Austin, Texas, USA
SamuelA.Shube,M.D. DepartmentofRadiology,Boca Richard J. Whitley, M.D. Departments of Pediatrics,
Raton Community Hospital, Boca Raton, Florida, USA Microbiology, and Medicine, University of Alabama at
Birmingham School of Medicine, Birmingham, Alabama,
VeraY.Soong,M.D. DepartmentofDermatology,Uni- USA
versity of Alabama at Birmingham School of Medicine,
Birmingham, Alabama, USA KarenWiss,M.D. DepartmentofDermatology,Univer-
sityofMassachusettsMedicalSchool,Worcester,Massa-
Lourdes Tamayo, M.D. Department of Dermatology, chusetts, USA
Instituto Nacional de Pediatr´ıa, Mexico City, Mexico
AngelaYen-Moore,M.D. DepartmentofDermatology,
Stephen K. Tyring, M.D., Ph.D. Departments of Der- UniversityofTexasSouthwesternMedicalCenter,Dallas,
matology,Microbiology/Immunology,andInternalMedi- Texas, USA
1
Cutaneous Virology
Stephen K. Tyring
University of Texas Medical Branch, Galveston, Texas, USA,
and University of Texas Medical Branch Center for Clinical Studies, Houston, Texas, USA
Viraldiseasesmayproducemucocutaneousmanifestations issuspectedtobeofviraletiology.Itpresentsinchildren
either as the result of viral replication in the epidermis or 6monthsto5yearsofageinwinterandspring.Therash
as a secondary effect of viral replication elsewhere in the isunilateralonthetrunk,oftenintheaxillaeorlargeflex-
body.Mostprimaryepidermalviralreplicationsresultfrom uresofthelimbs(Figs.1–2and1–3).Itspreadscentrifu-
three groups of viruses: human papillomaviruses (HPV), gally and to the contralateral side over 2 to 4 weeks and
herpesviruses,andpoxviruses.Secondaryskinlesionsare resolves in 6 weeks. Red, 3-mm papules appear first, fol-
producedbyvirusfamiliessuchasretroviruses,paramyxo- lowed by a scarlatiniform or eczematous rash. There are
viruses, togaviruses, parvoviruses, and picornaviruses. no constitutional symptoms, but an enlarged lymph node
Rhabdoviruses, rotavirus, reoviruses, and the like rarely is usually observed at the primary site. Viruses that are
induceskinlesionsandarebeyondthescopeofthisbook. suspected, but not proved to be of etiologic significance,
Likewise, the mucocutaneous manifestations, if any, of include parainfluenza 2 or 3 and adenoviruses.
subviralagents,suchasviroidsandprions,havenotbeen Conversely,severalnewviraldiseasesorviraldiseases
well described and are not discussed further. in new geographic areas have been described recently.
Anumberofcutaneousdiseasesappeartobeviralexan- ThesediseasesincludeWestNile, Nipah,andRiftValley
themas, but no virus has been proved to be the etiologic fever viruses. When cutaneous manifestations of such vi-
agent in some of these diseases. For example, pityriasis ruses are reported, the description in the general medical
rosea (PR) is an acute, self-limiting cutaneous eruption literature rarely is more specific than ‘‘rash’’ or ‘‘skin
with a distinctive course. The initial lesion, the herald rash.’’Morespecificdescriptionsinthedermatologylitera-
patch,isfollowedafter1to2weeksbyageneralizedsec- turemightaidinthemorerapiddiagnosisofthesediseases.
ondary rash that typically lasts about 6 weeks (Fig. 1–1).
Like most viral infections, PR shows seasonal variability
with an increased incidence in autumn and winter and a CLINICAL MANIFESTATIONS
decreasedincidenceinsummer.Aprecedingupperrespira-
toryinfectionisoftennotedwithPR,asareclustersofcases Viral infections can result in a wide spectrum of skin le-
intimeandspace.Mostrecently,PRwashypothesizedto sions. HPV infection frequently results in verrucous pap-
beduetoinfectionwithhumanherpesvirustype7(HHV- ules,buttherangeofpresentationsincludeserythematous
7),butcontrolledstudieshavefailedtosupportthishypoth- maculesinepidermodysplasiaverruciformis,smoothpap-
esis. ules in bowenoid papulosis, and fungating Buschke-Lo-
Likewise,asymmetricalperiflexuralexanthemofchild- wenstein tumors. The primary lesions in herpes simplex
hood(APEC)orunilaterallaterothoracicexanthem(ULE) virus(HSV),varicella-zostervirus(VZV),andmanycox-
1