TABLE 70.3 GIANOTTI–CROSTI SYNDROME: INFECTIOUS DISEASE ASSOCIATIONS Viral Bacterial Other inflammatory triggers Epstein–Barr virus (most common), cytomegalovirus, enteroviruses, influenza and parainfluenza viruses, hepatitis viruses (B, C), herpes simplex virus, human herpes virus 6, human immunodeficiency virus, pox virus, respiratory syncytial virus, rotavirus Bartonella henselae, Borrelia burgdorferi, Neisseria meningitidis, Streptococcus pyogenes Postimmunization (various) GIANOTTI–CROSTI SYNDROME (PAPULAR ACRODERMATITIS OF CHILDHOOD, PAPULOVESICULAR ACROLOCATED SYNDROME) Gianotti–Crosti syndrome (GCS) is a self-limited reactive phenomenon clinically characterized by a blanchable papular and occasionally vesicular exanthem characteristically distributed on the cheeks of the face, the buttocks, as well as acral locations (arms and legs) ( Fig 70.18 ) These lesions exhibit variable pruritus Early European and Japanese reports found an association between GCS and hepatitis B virus infection, but cases in the United States have been associated with other organisms, most notably EBV ( Table 70.3 ) Evaluation for a specific etiology is often not necessary unless the history or physical examination point to a specific etiology such as EBV or group A beta-hemolytic streptococcal infection, for which treatment may be necessary Antihistamines may reduce the pruritus but topical steroids may be of limited benefit As with ULE, it is interesting to note that infection with molluscum contagiosum can trigger a GCS-like eruption This reactive GCS-like phenomenon likewise, is of often shorter duration and is typically responsive to topical steroid treatment, in contrast to conventional GCS CONCLUSION Viral syndromes and papulosquamous disorders are a highly heterogeneous group of skin disorders While they share similar clinical characteristics with one another, an awareness of their distinguishing features and their natural histories will help in providing the patient a more accurate diagnosis, and direct appropriate therapy accordingly Suggested Readings and Key References Aronson PL, Yan AC, Mittal MK, et al Delayed acyclovir and outcomes of children hospitalized with eczema herpeticum Pediatrics 2011;128(6):1161–1167 Berger EM, Orlow SJ, Patel RR, et al Experience with molluscum contagiosum and associated inflammatory reactions in a pediatric dermatology practice: the bump that rashes Arch Dermatol 2012;148(11):1257–1264 Ganguly S A randomized, double-blind, placebo-controlled study of efficacy of oral acyclovir in the treatment of pityriasis rosea J Clin Diagn Res 2014;8(5):YC01–YC04 Harms M, Feldmann R, Saurat JH Papular-purpuric “gloves and socks” syndrome J Am Acad Dermatol 1990;23:850–854 Knöpfel N, Noguera-Morel L, Latour I, Torrelo A Viral exanthems in children: a great imitator Clin Dermatol 2019;37(3):213–226 Moon AT, Castelo-Soccio L, Yan AC Emergency department utilization of pediatric dermatology (PD) consultations J Am Acad Dermatol 2016;74(6):1173–1177 Sugarman JL, Hersh AL, Okamura T, et al Empiric antibiotics and outcomes of children hospitalized with eczema herpeticum Pediatr Dermatol 2011;28(3):230–234 CHAPTER 71 ■ RESPIRATORY DISTRESS DEBRA L WEINER, J KATE DEANEHAN INTRODUCTION Respiratory distress is one of the most common chief complaints of children seeking medical care It accounts for nearly 10% of pediatric emergency department visits and 20% of visits of children younger than years Twenty percent of patients admitted to the hospital and 30% of those admitted to intensive care units are admitted for respiratory distress Primary respiratory processes account for approximately 5% of deaths in children younger than 15 years and 20% in infants In addition, respiratory distress contributes substantially to deaths in patients with other primary processes Respiratory arrest is one of the five leading causes of death in pediatric patients Respiratory distress is usually reversible, but failure to treat the condition may result in cardiac arrest with longterm neurologic sequelae or death PATHOPHYSIOLOGY The primary goals of respiration are to meet metabolic demands for O2 and to eliminate CO2 Secondary functions include acid–base buffering, host defense, and hormonal regulation Exchange of O2 and CO2 between the lungs and the blood occurs at the alveolocapillary membrane and depends on adequate and appropriately matched ventilation and perfusion Control of respiration is mediated by central and peripheral neural mechanisms Respiration is an intrinsic brainstem function of the respiratory centers of the medulla It is further influenced by the cerebellum, which alters respiration with postural change; by the hypothalamus, which controls respiration on a moment-to-moment basis; by the limbic system, which modulates respiration in response to emotion; and by the motor cerebral cortex, which controls volitional respiratory activity, including hyper- and hypoventilation and speech Impulses are transmitted from the brain via the vagus and spinal nerves to the larynx, trachea, bronchi, bronchioles, and acini; the glossopharyngeal to the pharynx; the hypoglossal (CN XII) to the tongue; and the spinal accessory (CN XI) to accessory muscles Cervical nerves (C2 to C4), the phrenic nerve (C3 to C5), and the intercostal nerves (T1 to T12), innervate accessory muscles, the respiratory diaphragm, and intercostal muscles, respectively Respiratory distress results from dysfunction or disruption of the respiratory tract and/or systems that control or modulate respiration Respiratory failure is the inability to meet the metabolic demand for O2 (hypoxia) or to eliminate CO2 (hypercapnia) Criteria for defining respiratory failure vary widely; one set of criteria is presented in Table 71.1 Hypoxia can be categorized on the basis of mechanism Arterial hypoxemia results from an inability to deliver adequate O2 to the blood, low atmospheric PO2 , diffusion impairment, anatomic or physiologic shunt, or increased metabolic demand Anemic hypoxia is the result of the blood’s inability to deliver adequate O2 to tissues as a result of decreased hemoglobin oxygen-carrying capacity Hypokinetic, ischemic, or stagnant hypoxia also results in an inability of the blood to transport O2 to the tissues Histotoxic hypoxia results from inability to metabolize O2 at the tissue level as a result Hypercapnia often contributes to respiratory failure as a result of hypoxemia and is less commonly the primary cause Infants are at an increased risk of respiratory distress compared with children and adults because of anatomic and physiologic differences ( Table 71.2 ) These differences result in greater risk of airway obstruction, less efficient respiratory effort, limited respiratory reserve, and dysfunction of CNS respiratory control DIFFERENTIAL DIAGNOSIS Establishing a diagnosis for respiratory distress in part depends on localizing the pathology to a particular organ system In addition to primary respiratory etiologies, disease or dysfunction of other organ systems may indirectly result in respiratory disturbance by compromising respiratory system function or by stimulating compensatory respiratory mechanisms ( Tables 71.3 to 71.5 ) Treatment of the underlying cause is essential for definitive treatment of the respiratory distress Respiratory System Respiratory distress may be caused by upper or lower airway obstruction or by disorders of the parenchyma or interstitium Upper airway obstruction is common in infants and young children in part because of their airway anatomy and physiology (see Chapter 75 Stridor ) The hallmark of complete upper airway obstruction is inability to phonate (i.e., no speech, cry, or cough) Manifestations of upper airway obstruction may also include nasal flaring, stertor or snoring, gurgling, drooling, dysphagia, hoarseness, stridor, retractions, and paradoxical chest/abdominal wall movement In neonates, common causes include nasal ... with eczema herpeticum Pediatrics 2011;128(6):1161–1167 Berger EM, Orlow SJ, Patel RR, et al Experience with molluscum contagiosum and associated inflammatory reactions in a pediatric dermatology... great imitator Clin Dermatol 2019;37(3):213–226 Moon AT, Castelo-Soccio L, Yan AC Emergency department utilization of pediatric dermatology (PD) consultations J Am Acad Dermatol 2016;74(6):1173–1177... most common chief complaints of children seeking medical care It accounts for nearly 10% of pediatric emergency department visits and 20% of visits of children younger than years Twenty percent