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Difficulty: MediumPediatric Infectious Diseases

Match each pediatric clinical presentation to its most likely causative pathogen.

  • A 14-month-old infant develops a maculopapular rash on the trunk immediately following three days of high fever that has now completely resolved.Human herpesvirus 6
  • A 5-year-old boy presents with bright red, indurated cheeks and a lacy, reticular rash on his upper arms after a mild upper respiratory illness.Parvovirus B19
  • A 6-year-old girl has a fever, exudative pharyngitis, an erythematous tongue with enlarged papillae, and a diffuse, blanching rash that feels rough.Streptococcus pyogenes
  • A 3-year-old boy has painful oral ulcers, low-grade fever, and grayish-white vesicles on his palms and soles.Coxsackievirus A16

Answer

The infant with a rash after fever resolution matches Human herpesvirus 6. The boy with bright red cheeks matches Parvovirus B19. The girl with a rough rash and pharyngitis matches Streptococcus pyogenes. The boy with oral ulcers and vesicles on extremities matches Coxsackievirus A16.
Each pediatric exanthem has pathognomonic features that allow for clinical diagnosis. Human herpesvirus 6 causes roseola (fever followed by rash). Parvovirus B19 causes fifth disease (slapped cheeks, lacy rash). Streptococcus pyogenes causes scarlet fever (sandpaper rash, pharyngitis). Coxsackievirus A16 causes hand, foot, and mouth disease.

Step-by-Step Solution

1
Analyze the first clinical presentation (infant with rash appearing only after high fever subsides).
Identify the syndrome as Roseola infantum.
The sudden defervescence followed immediately by a truncal maculopapular rash is pathognomonic for Roseola infantum, caused by Human herpesvirus 6.
2
Analyze the second clinical presentation (bright red cheeks and lacy extremity rash).
Identify the syndrome as Erythema infectiosum (Fifth disease).
The 'slapped cheek' facial rash progressing to a reticular pattern on the arms is the classic manifestation of Parvovirus B19 infection.
3
Analyze the third clinical presentation (rough rash, exudative pharyngitis, and erythematous tongue).
Identify the syndrome as Scarlet fever.
The combination of a sandpaper-like rash, 'strawberry tongue,' and pharyngitis indicates a toxin-mediated infection by Streptococcus pyogenes.
4
Analyze the fourth clinical presentation (oral ulcers and palmar/plantar vesicles).
Identify the syndrome as Hand, foot, and mouth disease.
Painful oral lesions accompanied by vesicles on the distal extremities strongly points to Coxsackievirus A16.

Key Concept

Recognition of classic pediatric exanthems and matching them to their etiology.
Estimated Time:1m 30s
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Topics

Pediatric Infectious Diseases

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