2. Infectious Rashes Flashcards
Name the 6 bacterial rash causing infections in children studied?
Meningococcus (Neisseria meningitidis) Impetigo (+Bullous Impetigo) Scalded Skin Syndrome Scarlet Fever Acute Rheumatic Fever Necrotising Fasciitis
Name the 9 viral rash causing infections in children studied?
Measles Rubella Glandular Fever (Infectious Mononucleosis) Hand-foot-and-mouth disease (Coxsakie Virus) Erythema Infectiosum (5th Disease) Varicella (Chicken Pox) Herpes Zoster (Shingles) HSV – Herpes Simplex Virus Molluscum Contagiosum
Name the 2 Fungal rash causing infections of children studied?
Tina (Versicolor, corposis, cruris, capitis+kerion, barbae, pedis).
Candidiasis (Oral, paronychia, intertrigo)
Name the Other Rash Causing Disease Studied?
Erythema Multiforme
Steven-Johnson Syndrome
Tuberculsosis (Skin Manifestation)
Scabies (Sarcoptes scabies)
Non blanching petechial rash, present no matter what the degree of sickness?
Meningococcus
What is the the test for meningococcus?
Glass Slide Test
Give the course of a meningococcal rash?
Can be begin as petechiae
Within few hours progress to florid purpura
What is the Tx for meningococcus?
IV Antibiotics (cephalosporin)
IM Penicillin if in GP
Always admit.
Close monitoring for progression to spesis-shock-DIC
What is the Ddx for a meningococcal like, petechial rash?
Echo-virus (entero-virus or coxsackie)
What is the most common causative agent of impetigo? Second most common?
Staph Aureus (2nd = Group A Strep (often strep pyogenes))
What is impetigo commonly known as and why?
School Sores
Highly Contagious
What is the Tx for impetigo?
Topical Antibiotics Oral Antibiotics (if severe or widespread)
Erythema around eyes and mouth, then over the rest of the body.
Staphylococcal Scalded Skin Syndrome
Describe the different aetiologies of Scalded Skin Syndrome
Caused by Staph Aureus (Exfoliative Toxin)
Also a complication of burns
May be a severe manifestation of impetigo bullosa.
In whom is Scalded Skin Syndrome most common?
Children, mostly those <2yrs.
What is the Tx for Scalded Skin Syndrome?
IV Flucloxacillin (MRSA positive? = Vancomycin) Hydration (fluids) critical
Strawberry Tongue? Usually proceeded by a sore throat?
Scarlet Fever
What is the causative agent in scarlet fever?
Toxin producing strep pyogenes
Other group A strep
What is the mode of infection in scarlet fever?
Through the URT
Hence sore troat
What is the Tx for scarlet fever?
Oral Penicillin 10/7
Erythema marginatum, lasting <1 day?
Acute Rheumatic Fever
What is the diagnostic criteria for Acute Rheumatic Fever
Jones Criteria
Recent GAS infection + 2 major OR 1 major and 2 minor
Major: Carditis, Polyarthritis, Chorea, Erythema Marginatum, Subcutaneous nodule.
Minor: Arthralgias, fever, history of ARF, increase in ESR (erythrocyte sedimentation rate), CRP (C-reactive protein), WBC or Prolonged PR interval.
Rare infection of the deeper layers of skin and subcutaneous tissues, easily spreading across the fascial plane within the subcutaneous tissue.
Necrotising Fasciitis
Tx for necrotising fasciitis?
Treated immediately with surgical debridement and large doses of intravenous antibiotics
Spots in the oral cavity, 2-3 day (sometimes) before a morbilliform rash, fever, conjunctivial suffusion, cough, and coryza
Measles
What is a morbilliform rash?
Macular lesions that are red and usually 2–10 mm in diameter but may be confluent in places. Usually measles, Ddx kawasaki, meningococcus petechiae, rubella, echovirus, drug reaction
What is the causative agent in measles?
RNA Myxovirus
What is the name of the spots found in the oral cavity 2-3 days before viral symptoms in measles?
Koplik Spots
What are the possible complication of Measles?
Measles Meningitis
Pneumonia
Death
Subacute Sclerosing Pan-encephalitis
What is Subacute sclerosing pan-encephalitis?
AKA Measles encephalitis. SSPE is a rare and chronic form of progressive brain inflammation caused by a persistent infection with measles virus (which can be a result of a mutation of the virus itself). The condition primarily affects children and young adults. It has been estimated that about 1 in 10,000 people infected with measles will eventually develop SSPE.
What is the Tx for Measles?
Supportive.
Fine, pink rash. Begins on the face, the trunk and then the arms and legs. Enlarged occipital lymph nodes.
Rubella, a contagious viral infection
Fever, Sore throat, Lymphadenopathy, +/- splenomegaly usually a truncal rash in the form of a macular or maculopapular rash?
Glandular Fever/Infectious Mononucleosis/Kissing Disease
What is the causative agent in glandular fever?
EBV
What assures the presence of a rash in glandular fever?
Amoxicillin given.
What is the Tx for glandular fever.
Supportive. Bedrest not necessary.
Appearance of slapped cheeks?
Erythema Infectiosum (5th Disease)
What is the causative agent in erythema infectiosum?
Parvovirus B19
When is erythema infectiosum more likely to present?
Epidemic occur, spring time.
How long does erythema infectiosum last?
2-3 weeks
What are the Ddx’s for the appearance of slapped cheeks?
Kawasaki Disease
What other pathologies can Parovirus B19 cause?
In pregnancy = fetal anaemia/fetal hydrops/fetal compromise
What is the causative agent in chicken pox?
VZV –Varicella Zoster Virus – Highly contagious
What are the complications of this highly infectious virus?
Usually benign but sometimes…
varicella pneumonitis
cerebellar ataxia
sepsis (GAS, S aureus)
What is the Tx for Varicella?
Treatment especially important in the immunocompromised host.
Give IV Aciclovir if rash, VZIG (variclla zoster immune globulin) if exposed.
Maternal rash develops <7 days before delivery or up to 2 days post delivery. What is the condition? What are the risks?
Varicella Neonatorum
Risks= Disseminated herpes and death for baby.
Is there a chicken pox vaccine?
Vaccine exists (unfortunately not yet part of Irish immunisation schedule)
Vesicular eruption in dermatomal distribution, with pain and/or paresthesia?
Herpes Zoster (Shingles)
What is herpes zoster?
Reactivation of latent herpes varicella virus, within a sensory ganglion.
What risks are associated with shingles in the immunocompromissed?
Dissemination of the virus
What are the symptoms of primary Herpes Simplex Virus?
Fever
followed by a sore throat and mouth and submandibular or cervical lymphadenopathy.
In children, gingivostomatitis and odynophagia are also observed.
Painful vesicles develop on the lips, the gingiva, the palate, or the tongue and are often associated with erythema and edema.
The lesions ulcerate and heal within 2-3 weeks.
What is eczema herpeticum?
Disseminated herpes simplex it is a complication of atopic eczema
Who is at increased risk of diseminated herpes simplex?
Immunocompromised patients
Patients with atopic eczema.
What is the Tx for disseminated HSV/Eczema Herpeticum?
Systemic Aciclovir required +/- antibiotics
A usually painless but sometimes itchy rash, flesh-colored, dome-shaped, and pearly in appearance. They are often 1–5 millimeters in diameter, with a dimpled center.
Molluscum Contagiosum
What is the Tx for molluscum contagiosum?
Last about 18 months without the need for treatment
What are the features of Tinea Versicolor
It is a yeast infection.
Planar manifestation
Hypo-Pigmentation (white appearance)
What are the features of Tinea Capitis?
Ringworm of the scalp.
Dermatophyte invades hair shaft also (Alopecia), ergo only hair bearing skin affected.
Well demarcated, scaly lesions.
What is Tinea Capitis Kerion?
An inflammatory reaction to tinea capitis
A boggy exudative area
African prevalence.
What is the Tx for Tinea Capitis?
Topical therapy NOT sufficient
Systemic Rx with PO Griseofulvin/Terbinafine
What is tinea corporis?
Tinea of non-hair bearing skin
What are the 3 dermatophytes which cause Tinea corporis?
Trichophyton Rubrum
Microsporum Canis
Epidermophyton
What are the features of a rash caused by Tine Corporis?
Circular with red scaly edge
What is the Tx for Tinea Corporsis?
Topical Antifungal
Where doe candida paronychia occur
Where the nail and skin meet at the side or the base of a finger or toenail.
Where is candida intertrigo likely to occur?
Neck creases, groin area. (Folds of skin)
What is the treatment for candida infection?
Topical Antifungal
What are the signs as symptoms of Kawasaki Disease?
Fever >5 days Conjunctivitis Puffy palms of hands+soles of feet Rash also affecting the groin Cracked lips Strawberry tongue Enlarge Lymph Nodes Very Irritable Child
What is the aetiology of kawasaki’s?
unknown, possibly viral
What are some of the potential complications of Kawasaki Disease?
Vasculitis
Coronary aneurysm risk (all need echo)
What is the treatment for Kawasaki’s?
IV Immunoglobulin Treatment
High dose aspirin
What is Erythema Multiforme?
Erythema multiforme (EM) is an acute, self-limited, and sometimes recurring skin hypersensitivity reaction associated with certain infections, medications, and other various triggers
Describe the mild form of erythema multifome rash?
The mild form usually presents with mildly itchy (but itching can be very severe), pink-red blotches, symmetrically arranged and starting on the extremities.
It often takes on the classical “target lesion” appearance, with a pink-red ring around a pale center. Resolution within 7–10 days is the norm.
What is the most common causative agent of Erythema multiforme?
HSV
What other causative agents exist for erythema multiforme?
Mycoplasma pneumoniae.
-also Coxsackie, Echovirus, H. capsulatum
DRUG RELATED
Immune-mediated rxn reation
Penicillins, sulfonamides, phenytoin, Distaclor
What is erythema multiforme major?
A life threatening form of EM. Has a spectrum (consensus classification) which includes Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis)
Describe the features of erythema multiforme major?
Spectrum exists:
Erythema multiforme major—typical targets or raised, edematous papules distributed acrally with involvement of one or more mucous membranes; epidermal detachment involves less than 10% of total body surface area (TBSA)
SJS/TEN—widespread blisters predominant on the trunk and face, presenting with erythematous or pruritic macules and one or more mucous membrane erosions; epidermal detachment is less than 10% TBSA for Stevens-Johnson syndrome and 30% or more for toxic epidermal necrolysis.
What are the manifestation of tuberculosis?
TB cutaneous (scrofula = lymphadenitis of the cervical lymph nodes associated with tuberculosis)
BCGoma (reaction)
Other granuloma forming mycobacterium- M. avium
Severe itching, especially at night, for infants the head, neck, palms and soles? (Also at the interdigital webs, wrist folds, elbows, axillae, feet, thighs, genitalia).
Scabies (Sarcoptes Scabies)
What is the Tx for scabies?
5% Permethrin cream
Applied from the neck to the feet.
Washed off 8-14 hours later.
