2: Infections - Chicken Pox and Viral Rashes Flashcards
What causes chicken pox
VZV
When is chicken pox infectious
2d before rash until 5d after
How long is chicken pox incubated for
2W
How long does the prodrome of chickenpox last
2 days
How does the prodrome of chicken pox present
Fever
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
What is unique about the rash in chicken pox
All stages of the rash are visible at the same time
When is a person with chicken pox infective
2d before rash until 5d after
What is first-line for chicken pox
Advice:
- Calmine lotion
- Keep cool
- Avoid scratching
How long should children with chicken pox be excluded from school
When rash has fully crusted over (usually 5 days)
What should immunocompromised patients or neonates with suspected peripartum exposure be given
IVIG
If an immunocompromised person has chickenpox what is given
Oral acyclovir
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
What is roseola infantum also known as
Exanthem Subitum
3-Day Fever
What causes Roseola Infantum
HHV6
What age does roseola infantum occur
6 months - 2 years
How does roseola infantum present
High-Fever that lasts 3-days
What may fever in roseola infantum be associated with
Nagayama spots of the uvula
What happens when fever ends in roseola infantum
Maculopapular rash onsets
Explain rash in Roseola Infantum
Maculopapular rash starts on trunk and spreads to face and extremities
What is associated with roseola infantum
Febrile Convulsions (15%)
how should roseola infantum be managed
Supportive
What causes hand, foot and mouth disease
Coxsackie A16
How does hand, foot and mouth disease present clinically
Sore throat, Fever
Oral Ulcers
Vesicles on palms and soles
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
25
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
50
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
