2: Infections - Chicken Pox and Viral Rashes Flashcards by Grace Poole

What causes chicken pox

VZV

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When is chicken pox infectious

2d before rash until 5d after

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How long is chicken pox incubated for

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How long does the prodrome of chickenpox last

2 days

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How does the prodrome of chicken pox present

Fever

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Describe exanthem of chicken pox

Rash that starts on the trunk and spreads to face and extremities
All stages of the rash are visible on the body at the same time
Sevre pruritus
Fever, headache, myalgia

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What is unique about the rash in chicken pox

All stages of the rash are visible at the same time

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When is a person with chicken pox infective

2d before rash until 5d after

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What is first-line for chicken pox

Advice:

Calmine lotion
Keep cool
Avoid scratching

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How long should children with chicken pox be excluded from school

When rash has fully crusted over (usually 5 days)

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What should immunocompromised patients or neonates with suspected peripartum exposure be given

IVIG

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If an immunocompromised person has chickenpox what is given

Oral acyclovir

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What drug should NOT be given in chickenpox and why

NSAIDs as it increases risk secondary infection with Group A streptococcus which can cause necrotising fasciitis

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What is roseola infantum also known as

Exanthem Subitum

3-Day Fever

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What causes Roseola Infantum

HHV6

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What age does roseola infantum occur

6 months - 2 years

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How does roseola infantum present

High-Fever that lasts 3-days

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What may fever in roseola infantum be associated with

Nagayama spots of the uvula

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What happens when fever ends in roseola infantum

Maculopapular rash onsets

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Explain rash in Roseola Infantum

Maculopapular rash starts on trunk and spreads to face and extremities

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What is associated with roseola infantum

Febrile Convulsions (15%)

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how should roseola infantum be managed

Supportive

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What causes hand, foot and mouth disease

Coxsackie A16

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How does hand, foot and mouth disease present clinically

Sore throat, Fever
Oral Ulcers
Vesicles on palms and soles

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What is used to manage hand, foot and mouth

Supportive | Advise: maintain fluid-intake

Explain school exclusion in hand, foot and mouth

Do not need school exclusion

What age group does measles occur

<12 months

What are the stages of measles

Pro-Drome Exanthem Recovery

What is a way to remember the prodrome of measles

3C's Conjunctivitis Coryza Cough

What will be present in prodrome of measles

Kopliks spots

What are koplik spots

White spots on an erythematous base in the mouth

How does exanthem of measles present

- Fever - Generalised lymphadenopathy - Rash that starts behind the ears and then spreads to the remaining body. It starts as patchy and then becomes confluent

Describe the rash in measles

Starts as blotchy and then becomes confluent

What is the recovery phase of measles

Rash fades leaving brown discolouration

What are two pathognomic features of measles

Rash starts behind the ears | Koplik spots

How is measles prevented

MMR

When is MMR vaccine given

1-year | 3-4 years

Is measles notifiable

Yes

How is measles managed

Maintain Fluid | NSAIDs/paracetamol for symptomatic relief

How long should child with measles be off school

4-days

What is the most common complication of measles

Otitis media

What is the most common cause of death in measles

Pneumonia

What neurological disorder can measles acutely present with

Encephalitis | Febrile Convulsions

What long-term neurological disorder can measles cause

Sub-acute sclerosing encephalitis

How does subacute sclerosing encephalitis present `

Progressing neurological dysfunction

What ophthalmological condition can measles cause

Keratoconjunctivitis

In which age group does mumps occur

5-14 years

What causes mumps

Parmyxovirus

When is mumps most infectious

3d before until 9d after parotid gland swelling

Describe clinical presentation of mumps

Pro-Drome: - Fever - Swelling of the parotid gland = presents with tenderness, ear ache and unilateral swelling

What tests are positive in first-week of mumps

IgM | Salivary PCR

What tests are positive in later stages of mumps

Viral Culture FBC - Lymphocytosis Amylase - raised

How is mumps prevented

MMR vaccine at 1-year and 3-4 years

Is mumps a notifiable disease

Yes

What is used to treat mumps

Paracetamol as anti-pyretic

What are 4 complications of mumps

- Orchitis - Unilateral hearing loss - Pancreatitis - Aseptic meningoencephalitis

What % males with mumps develop orchitis

Describe hearing loss in mumps

Unilateral SNHL

When does rubella occur

Childhood

In what months is rubella more common

Winter and Spring

What causes rubella

Togaviridae

What % of rubella is asymptomatic

Which patients with rubella are more likely to be asymptomatic

Younger patients more likely to have milder disease compared to older children and adults

Explain presentation of pro-drome or rubella

- Sub-occipital and post-auricular lymphadenopathy - Fever - Headache - Conjunctivitis - Mild sore throat

What is a key-feature of prodrome of rubella

Sub occipital and post auricular lymphadenopathy

Describe exanthem of rubella

- Non confluent rash starts on the face and migrates to the trunk

How is rubella prevented

MMR at 1-year and 3-4years

How is rubella managed

Supportive

What are two complications of rubella

TTP | If pregnant women acquires rubella - can cause congenital rubella syndrome

What is slapped cheek syndrome referred to as

Erythema Infectiosum

What age does slapped cheek syndrome occur

5-15 years

What causes slapped cheek syndrome

Parvovirus B19 Syndrome

When are individuals with slapped cheek syndrome infectious

Before virus onset

Explain clinical presentation of children with slapped cheek syndrome

Coryzal symptoms. Then followed by erythematous rash of the face, sparing peri-oral region, spreads to trunk

Describe rash in slapped cheek

Starts on face, spreads too trunk. Starts as confluent, becomes maculopapular and then develops to reticular appearance

When is the rash in slapped cheek more prominent

In heat or sunlight

What complication do 10% of children with slapped cheek develop

Symmetrical poly arthritis

When will symmetrical poly arthritis resolve

3-4 Weeks

Describe management of slapped cheek

Supportive. If poly arthritis develops a short course of prednisolone is given

When can parvovirus B19 impact pregnancy

Before 20W

What does parvovirus B19 before 20W cause

Hydrops foetalis

In patients with sickle cell disease what can parvovirus B19 infection cause

Transient aplastic crisis - due to suppressing erythropoiesis for 1W