exanthema-subitum (LH Indholdsside)

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      <HtmlField Name="PageContent"><![CDATA[<h2>Diagnose<a href=" " data-type="book-reference" data-value="Tremblay C; Brady MT. Roseola infantum (exanthema subitum). www.uptodate.com: Wolters Kluwer; 2023" data-value-piped="Tremblay C; Brady MT|Roseola infantum (exanthema subitum)|www.uptodate.com|Wolters Kluwer|2023" data-url="reference-link" title="Tremblay C; Brady MT. Roseola infantum (exanthema subitum). www.uptodate.com: Wolters Kluwer; 2023">1</a></h2>
<h3>Diagnostiske kriterier</h3>
<ul>
    <li>Stilles almindeligvis p&aring; sygehistorie og det klassiske symptombillede</li>
</ul>
<h3>Sygehistorie</h3>
<ul>
    <li>Inkubationstid 9-10 dage</li>
    <li>Efter inkubationstiden bliver barnet akut sygt med feber p&aring; ca. 39-40 gr. C. Der er sparsomme fokale symptomer og god almentilstand, men b&oslash;rnene kan ind imellem v&aelig;re relativt sv&aelig;rt medtaget og irritable</li>
    <li>Andre klassiske symptomer, som ses hos de fleste, kan v&aelig;re cervical og postauricul&aelig;r lymfeadenitis og r&oslash;de trommehinder</li>
    <li>26 % har en eleveret fontanelle og p&aring; baggrund af h&oslash;j feber og p&aring;virket almentilstand, vil meningitis kunne v&aelig;re en differentialdiagnose, som skal overvejes</li>
    <li>4 % f&aring;r feberkramper i forbindelse med infektionen, som kan v&aelig;re henvendelses&aring;rsagen</li>
    <li>Efter 3-5 dages feber (deraf navnet) falder temperaturen abrupt og spontant. Samtidig med at temperaturen falder abrupt, kommer&nbsp;et diskret blegr&oslash;dt maculopapul&oslash;st eksantem til syne og forsvinder i l&oslash;bet af 1-2 d&oslash;gn. Eksantemet starter typisk p&aring; nakke og hals og vandrer nedad og bliver universelt. Udsl&aelig;ttet er ofte blegt, kl&oslash;r ikke og kan v&aelig;re vanskeligt at opdage &nbsp;&nbsp;&nbsp;</li>
</ul>
<h4>Penicillinallergi</h4>
<ul>
    <li>Penicillin givet i den febrile periode kan mist&aelig;nkes for at v&aelig;re &aring;rsag til udsl&aelig;ttet</li>
    <li>Forts&aelig;ttes penicillinbehandlingen i nogle dage (hvilket den b&oslash;r), vil diagnosen afklares, ogs&aring; da de fleste allergiske udsl&aelig;t er kl&oslash;ende</li>
</ul>
<h3>Kliniske fund<a href="EditorPage.aspx?da=core&amp;id=%7BB85778B0-22BC-4380-B704-09734E6AB2AC%7D&amp;ed=FIELD1774989971&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H1774990036&amp;mo&amp;pe=0&amp;fbd=1" data-type="book-reference" data-value="Tremblay C; Brady MT. Roseola infantum (exanthema subitum). www.uptodate.com: Wolters Kluwer; 2023" data-value-piped="Tremblay C; Brady MT|Roseola infantum (exanthema subitum)|www.uptodate.com|Wolters Kluwer|2023" data-url="reference-link" title="Tremblay C; Brady MT. Roseola infantum (exanthema subitum). www.uptodate.com: Wolters Kluwer; 2023" style="font-size: 13px;">1</a></h3>
<h4>Makulopapul&oslash;st eksantem</h4>
<ul>
    <li>Eksantem med diskrete blegr&oslash;de elementer med diameter p&aring; 2-5 mm</li>
    <li>Eksantemet forsvinder ved tryk og konfluerer ikke</li>
    <li>Mest udtalt p&aring; hals og krop, men forekommer ogs&aring; p&aring; proksimale ekstremiteter og i ansigtet</li>
</ul>
<p><img alt="Krop med exanthema subitum, den fjerde børnesygdom." title="Udslæt ved tre-dages-feber" src="AC3ED1FFAF014C3682A0F3BB1156057C-107-150" style="height: 150px; width: 107px;" height="150" width="107"></p>
<h4>Andre fund inden eksantemets frembrud</h4>
<ul>
    <li>Lymfadenitis cervicalt</li>
    <li>Otitis</li>
    <li>Irritabilitet</li>
    <li>Eleveret fontanelle</li>
    <li>Steril pyuri</li>
</ul>
<h3>Supplerende unders&oslash;gelser i almen praksis</h3>
<ul>
    <li>Almindeligvis un&oslash;dvendig, men serologi er mulig</li>
    <li>Almindelige blodpr&oslash;ver vil vise lav CRP, neutropeni og lymfocytose - tydende p&aring; viral genese</li>
    <li>Ved mistanke om urinvejsinfektion vil almindelige blodpr&oslash;ver og negativ urinstix for nitrit v&aelig;re vejledende</li>
</ul>
<h3>Andre unders&oslash;gelser hos specialist</h3>
<ul>
    <li>Ved mistanke om alvorlig sygdom evt. lumbalpunktur og/eller bloddyrkning</li>
</ul>
<h3>Differentialdiagnoser</h3>
<ul>
    <li><a href="~/link.aspx?_id=C46237BAA27E4EA9968302DD4861E4EF&amp;_z=z">Rubella; r&oslash;de hunde</a></li>
    <li><a href="~/link.aspx?_id=9258C698263D4B32965B08A283B64E6E&amp;_z=z">Penicillinallergi</a></li>
    <li><a href="~/link.aspx?_id=E945B9FA70F74D11BB52780D9D1E419E&amp;_z=z">Scarlatina</a></li>
    <li><a href="~/link.aspx?_id=D6ED0FE267FA400FBB7043B10407C1CC&amp;_z=z">Erythema infectiosum; lussingesyge</a></li>
    <li><a href="~/link.aspx?_id=119A486E7B53479F8AC32D6F69452AEB&amp;_z=z">Morbilli; m&aelig;slinger</a></li>
</ul>
<h2>Behandling<a href="EditorPage.aspx?da=core&amp;id=%7BB85778B0-22BC-4380-B704-09734E6AB2AC%7D&amp;ed=FIELD1774989971&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H1774990036&amp;mo&amp;pe=0&amp;fbd=1" data-type="book-reference" data-value="Tremblay C; Brady MT. Roseola infantum (exanthema subitum). www.uptodate.com: Wolters Kluwer; 2023" data-value-piped="Tremblay C; Brady MT|Roseola infantum (exanthema subitum)|www.uptodate.com|Wolters Kluwer|2023" data-url="reference-link" title="Tremblay C; Brady MT. Roseola infantum (exanthema subitum). www.uptodate.com: Wolters Kluwer; 2023" style="font-size: 13px;">1</a></h2>
<h3>Behandlingsm&aring;l</h3>
<ul>
    <li>Symptomlindring og feberd&aelig;mpende tiltag</li>
</ul>
<h3>Generelt om behandlingen</h3>
<ul>
    <li>Almindeligvis un&oslash;dvendig med behandling</li>
</ul>
<h3>H&aring;ndtering i almen praksis</h3>
<ul>
    <li>Vurderes, evt. smertestillende&nbsp;[DliActiveSubstance;6381;paracetamol]</li>
</ul>
<h3>R&aring;d til patienten</h3>
<ul>
    <li>Instruktion i at sikre sufficient v&aelig;skeindtag</li>
</ul>
<h4>B&oslash;rnehave/dagpleje</h4>
<ul>
    <li>B&oslash;rn kan komme i vuggestue, b&oslash;rnehave eller skole, n&aring;r de ikke har feber, og almentilstanden tillader det, selv om de fortsat har udsl&aelig;t</li>
</ul>
<h3>Medicinsk behandling</h3>
<ul>
    <li>Antipyretisk behandling i feberfasen kan lindre barnets symptomer</li>
</ul>
<h3>Anden behandling</h3>
<ul>
    <li>Ingen kendt</li>
</ul>
<h3>Forebyggende behandling</h3>
<ul>
    <li>Ingen kendt</li>
</ul>
<h2>Henvisning</h2>
<ul>
    <li>Patienten behandles i almen praksis og henvises ved p&aring;virket almentilstand</li>
</ul>
<h2>Opf&oslash;lgning</h2>
<h3>Plan</h3>
<ul>
    <li>Vigtig at differentiere exanthema subitum fra l&aelig;gemiddeludsl&aelig;t og derved undg&aring; uretm&aelig;ssigt at karakterisere barnet som l&aelig;gemiddelallergiker</li>
    <li>Ingen opf&oslash;lgning i &oslash;vrigt</li>
</ul>
<h2>Sygdomsforl&oslash;b, komplikationer og prognose<a href="EditorPage.aspx?da=core&amp;id=%7BB85778B0-22BC-4380-B704-09734E6AB2AC%7D&amp;ed=FIELD1774989971&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H1774990036&amp;mo&amp;pe=0&amp;fbd=1" data-type="book-reference" data-value="Tremblay C; Brady MT. Roseola infantum (exanthema subitum). www.uptodate.com: Wolters Kluwer; 2023" data-value-piped="Tremblay C; Brady MT|Roseola infantum (exanthema subitum)|www.uptodate.com|Wolters Kluwer|2023" data-url="reference-link" title="Tremblay C; Brady MT. Roseola infantum (exanthema subitum). www.uptodate.com: Wolters Kluwer; 2023" style="font-size: 13px;">1</a></h2>
<h3>Sygdomsforl&oslash;b</h3>
<ul>
    <li>Inkubationstid p&aring; 9-10 dage</li>
    <li>Sygdommen forl&oslash;ber almindeligvis over 3-5 dage med feber og 1-2 dage med eksanthem</li>
</ul>
<h3>Komplikationer</h3>
<ul>
    <li>Feberkramper</li>
</ul>
<h3>Prognose</h3>
<ul>
    <li>Forl&oslash;bet er som regel helt ukompliceret, og patienten bliver rask uden behandling</li>
</ul>
<h2>Baggrundsoplysninger</h2>
<h3>Definition&nbsp;</h3>
<ul>
    <li>Exanthema subitum </li>
    <li>Kaldes ogs&aring; tredagesfeber eller roseola infantum </li>
    <li>Sygdommen er en viral eksantemsygdom</li>
</ul>
<h3>Forekomst</h3>
<ul>
    <li>Ses n&aelig;sten udelukkende hos b&oslash;rn mellem 6 m&aring;neder og 3 &aring;r og rammer drenge og piger ligeligt</li>
    <li>I &gt; 90 % af alle tilf&aelig;lde er patienterne under 2 &aring;r, med et peak mellem 7 og 13-m&aring;neders alder&nbsp;</li>
    <li>N&aelig;sten alle vil v&aelig;re smittet inden 3-&aring;rsalderen </li>
    <li>Optr&aelig;der prim&aelig;rt sporadisk og giver ikke epidemier, m&aring;ske pga. h&oslash;j frekvens af subklinisk sygdom </li>
    <li>Forekommer hele &aring;ret med en lille overv&aelig;gt for&aring;r/efter&aring;r</li>
</ul>
<h3>&AElig;tiologi og patogenese</h3>
<ul>
    <li>Skyldes langt overvejende humant herpesvirus 6 (HHV-6), langt sj&aelig;ldnere ogs&aring; HHV-7, enterovirus, adenovirus og parainfluenzavirus</li>
    <li>Sandsynlig smitsom s&aring; l&aelig;nge udsl&aelig;ttet varer. HHV-6 kan man muligvis udskille hele livet, som asymptomatisk b&aelig;rer efter overst&aring;et infektion</li>
    <li>Transmissionen foreg&aring;r ved dr&aring;besmitte</li>
</ul>
<h3>Disponerende faktorer</h3>
<ul>
    <li>Manglende immunitet overfor HHV-6&nbsp;</li>
    <li>"Rigtig alder" </li>
    <li>T&aelig;t omgang med symptomfrie smitteb&aelig;rere</li>
</ul>
<h3>ICPC-2</h3>
<p>[ICPC]</p>
<h3>ICD-10/SKS-koder</h3>
<p>[ICD10]</p>
<h2>Patientinformation</h2>
<h3>Hvad du b&oslash;r informere patient/p&aring;r&oslash;rende om</h3>
<ul>
    <li>En ufarlig og hurtigt forbig&aring;ende virusinfektion</li>
    <li>Udsl&aelig;ttet kommer, n&aring;r feberen forsvinder</li>
    <li>Almentilstand og feber afg&oslash;r, om de kan g&aring; i b&oslash;rnehave</li>
</ul>
<h3>Link til patientinformation</h3>
<ul>
    <li><a href="~/link.aspx?_id=5350315321A34687B1E0A1E100689256&amp;_z=z">Tredagesfeber</a></li>
</ul>
<h2>Link til vejledninger</h2>
<ul>
    <li>Forl&oslash;bsbeskrivelser og pakkeforl&oslash;b [ICPC]</li>
</ul>]]></HtmlField>
      <HtmlField Name="Resume"><![CDATA[<h2>Resum&eacute;</h2>
<h3>Diagnose</h3>
<ul>
    <li>Klassisk sygehistorie med 3-5 dages h&oslash;j feber for&aring;rsaget af virusinfektion</li>
    <li>Herefter falder temperaturen abrupt, og der kommer et diskret blegr&oslash;dt maculopapul&oslash;st eksantem. Mest udtalt p&aring; hals og krop, men forekommer ogs&aring; p&aring; proksimale ekstremiteter og i ansigtet. Forsvinder i l&oslash;bet af 1-2 d&oslash;gn</li>
    <li>Almentilstanden vil typisk v&aelig;re god, n&aring;r egen l&aelig;ge s&oslash;ges pga. udsl&aelig;t&nbsp;</li>
</ul>
<h3>Behandling</h3>
<ul>
    <li>Lindrende behandling, smertestillende evt. paracetamol</li>
</ul>
<h3>Henvisning</h3>
<ul>
    <li>Ved p&aring;virket almen tilstand skal barnet henvises til lokal B&oslash;rne- og Unge afdeling</li>
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]]></Media>
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