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paediatrics > 27. Fever and rash > Flashcards

27. Fever and rash Flashcards

1
Q

Difference between petechiae and purpura?

A

petechiae <3mm, purpura 3mm-10mm

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2
Q

Case: 11mth old, previously well, immunisations up to date.
Fever and rash this morning, one vomit.
Fever is petechial, over lower limbs.
Invx?

A
  • blood culture, meningococcal pcr
  • coag studies?
  • FBE for wbcs or thrombocytopenia (rash could be thrombocytosis)
  • CRP
  • ESR
    consider LP
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3
Q

Viral causes of meningitis

A

enterovirus

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4
Q

bact causes of meningitis

A

meningococcus
pneumococcus
HIB

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5
Q

What is Kawasaki’s disease?

A

Kawasaki disease is an uncommon illness that mostly affects kids under 5.
It is caused by vasculitis - inflammation of blood vessels throughout the body - and the cause of this is unknown.

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6
Q

What are the signs and symptoms of Kawasaki disease?

A
  • high fever (>39) that continues for at least 5 days
  • Cervical lymphadenopathy
  • rash
  • red, shiny or dry, cracked lips
  • red lumpy (strawberry) tongue
  • conjunctivities -red eyes- without dischardge
  • swollen red hands or feet
  • unusual nappy rash
  • joint pains
  • extreme irritability
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7
Q

What is the most important thing about Kawasaki?

A

It can cause inflammation of the arteries that supply blood to the heart, which can result in an aneurysm that may cause heart problems in the future

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8
Q

what is the treatment for Kawasaki?

A

IV gammaglobulin and aspirin

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9
Q

other common features of kawasaki?

A
  • aseptic meningitis
  • diarrhoea
  • mild hepatitis
  • gallbladder hydrops
  • sterile pyuria
  • otitis media
  • arthritis
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10
Q

invx necessary in Kawasaki?

A

FBE for neutrophilia, thrombocytosis (too many), anaemia

Echo

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11
Q

What causes TSS?

A

toxin produced by Staph aureus or Group A Strep

- tampon use or skin and soft tissue infections

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12
Q

Clinical features of TSS

A
  • fever
  • renal impairment
  • coagulopathy
  • acute resp distress syndrome
  • macular rash
  • soft tissue necrosis- necrotising fasciitis, myositis, gangrene
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13
Q

Invx for TSS

A

blood cultures

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14
Q

managment TSS

A
  • remove tampon/drain lesion/debridement
  • circulatory support
  • initial broad spectrum and clindamycin
    then:

GAS: IV penicillin and clindamycin
MSSA: IV fluclox and clindamycin
MRSA: IV vancomycin and clindamycin

  • IV Ig
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15
Q

clindamycin uses?

A

aerobic staph and strept;

anaerobics G-ves

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16
Q

Diseases caused by group A strept?

A
  • pharyngitis
  • impetigo (school sores)
  • bacteraemia
  • pneumonia
  • nec fasc
  • myositis
  • Osteomyelitis
  • perianal cellulitis
  • endocarditis
  • streptococcal TSS
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17
Q

3 important complications of GAS infection

A
  • scarlet fever
  • rheumatic fever
  • acute post-strept glomerulonephritis
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18
Q

use of fluclox?

A

narrow spectrum beta lactam- susceptible G+s and staph (but not MRSA)

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19
Q

4 key differentials for fever and petechiae

A
  • infection: viral - enterov, influenza; bacteria - neisseria meningitidis, strep pneu, hib
  • HSP
  • ITP
  • Leukaemia
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20
Q

most common cause of meningitis. how many serogroups?

A

neisseria meningitidis, G-ve diplococcus, 13 serogroups

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21
Q

presentations of meningococcal disease

A
  • meningitis
  • meningococcaemia
  • arthritis
  • pneumonia
  • pharyngitis
  • petch/purpura in most
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22
Q

invx for meningococcal disease

A

blood culture
csf
> meningococcal pcr

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23
Q

tx meningococcal disease

A

3rd gen cephalosporins
intensive supportive management
dexameth

24
Q

complications of meningococcal disease (4)

A
  • DIC
  • adrenal haemorrhage
  • gangrene
  • neuro dev sequelae- hearing loss
25
Q

What is scarlet fever?

A

a delayed type skin reactivity to erythrogenic toxin from strep pyogenes

26
Q

clinical features of scarlet fever

A
  • acute pharyngitis
  • rash- diffuse blanching erythema with papular elevations (‘sandpaper)
  • ## head and neck desquamation
27
Q

cause of rheumatic fever

A

GAS pharyngitis

28
Q

5 major signs for diagnosis rheu fever

A
  • migratory arthritis - large joints
  • carditis, vavulitis
  • CNS involvement - eg sydenham chorea
  • erythema marginatum- pink rings
  • sub cut nodules
29
Q

4 minor signs for rheu fever

A
  • arthralgia
  • fever
  • elevated acute phase reactants
  • prolonged PR
30
Q

Treatment of rheu fever

A
  • eradicate GAS carriage - penicilin
  • aspirin for carditis/arthritis
  • IM benzathine penicillin every month
31
Q

incubation of varicella

A

10-21 days

32
Q

clinical features of VZV

A
  • prodrome - fever, malaise, anorexia

- rash - pruritic macules/vesicles/crust

33
Q

complications of VZV (infants, immunocomp)

A
  • progressive > eye involvement, coagulop, thrombocytopaenia
  • pneumonia
  • on top bact - eg nec faci
  • enceph
  • hepatitis
34
Q

treatment if VZV complications

A

acyclovir

35
Q

exposure to VZV- pregnant women, neonate, immune def> treat with what?

A

zoster Ig within 96 hrs of exposure

36
Q

What is parvovirus/slapped check disease?

A

Caused by parvovirus B19, a DNA virus spread by respiratory droplet
>
fever, headach, coryza
slapped cheek rash
later> diffuse macular erythema trunk and limbs

37
Q

What has usually happened by the time the parvo rash has appeared?

A

viraemia has usually resolved and child usually feels well

38
Q

Roseola?

A

DNA virus

  • asympt salivary shedding
  • high fever 3-5 days
  • rash only after fever resolves- blanching maculopapular
39
Q

complications of roseola infantum

A

seizures
aseptic meningtis
encephalitis
thrombocytopenic purpura

40
Q

Hand foot mouth disease is caused bywhat? what are the clinical features?

A
  • coxsackie A16 and enterovirus 71
  • mild low grade fever
  • vesicles/ulcers on tongue, buccal mucosa
  • maculopapular/vesicular lesions on hands/feet/buttocks
  • resolves 2-3 days
41
Q

Causes of impetigo/school sores?

A
  • non bullous: Staph aur and GAS

- bullous: Staph aureus

42
Q

tx impetigo

A

topical mupirocin

systemic - fluclox, penicillin

43
Q

What is erysipelas?

A

An infection of the superficial lymphatics and upper dermis, usually caused by GAS.
It is more superficial than cellulitis

44
Q

cellulitis infects what?

A

deeper dermis and subcut fat.

45
Q

tx of cellulitis/erysipelas

A

fluclox, cephalexin
culture pus if present, blood if afebrile,
consider MRSA (clindamycin)

46
Q

organisms causing periorbital cellulitis

A

staph a, strep pyogenes, strep pneumoniae. Hib less common

47
Q

features of orbital cellulitis

A
  • opthalmoplegia (limitation of eye movement)
  • chemosis (swelling of conjunctiva)
  • proptosis (exophthalmus)
  • decreased acuity
  • headache
48
Q

Management of periorbital cellulitis

A
  • test and record visual acuity if possible
  • full eye exam- movements, look for proptosis
  • consider hosp admission for IV cefotaxime and/or fluclox
49
Q

management for orbital celluliits

A
  • CT orbits ASAP
  • blood cultures
  • IV fluclox +/- cefotaxime
  • involve ENT/opthal
50
Q

cefotaxime targets?

A 
broad spec - + and - bact
S aureus but not MRSA- clindamycin for MRSA
strep pneu
e coli
hib
n mening
51
Q

What is necrotising fasciitis?

A

rapidly spreading infection of deep layer of superficial fascia

52
Q

causes of nec fasc

A 
GAS
Staph a
pseudomonas aeruginosa
clostridium perfrinnens
anaerobes - bacteroides
53
Q

Clinical features of fasc

A
  • fever
  • pain
  • constitutional unwellness out of proportion to cutaneous signs
54
Q

management

A
  • low threshold for surg referral for radical debridement
  • supportive
  • IV antibx
55
Q

Clinical features measles

A
  • prodrome: high fever, cough, coryza, conjunctivitis
  • rash - cephalocaudal maculopap
  • koplik spots (pathognomonic)
  • clinical improvement 48 hrs after rash
56
Q

what are koplik spots?

A

prodromic (bf main rash) clustered white lesions on buccal mucosa

57
Q

tx measles

A
  • supportive
  • antibiotics if superinfection
  • vit A

paediatrics (29 decks)

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