27. Fever and rash Flashcards
Difference between petechiae and purpura?
petechiae <3mm, purpura 3mm-10mm
Case: 11mth old, previously well, immunisations up to date.
Fever and rash this morning, one vomit.
Fever is petechial, over lower limbs.
Invx?
- blood culture, meningococcal pcr
- coag studies?
- FBE for wbcs or thrombocytopenia (rash could be thrombocytosis)
- CRP
- ESR
consider LP
Viral causes of meningitis
enterovirus
bact causes of meningitis
meningococcus
pneumococcus
HIB
What is Kawasaki’s disease?
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.
What are the signs and symptoms of Kawasaki disease?
- 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
What is the most important thing about Kawasaki?
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
what is the treatment for Kawasaki?
IV gammaglobulin and aspirin
other common features of kawasaki?
- aseptic meningitis
- diarrhoea
- mild hepatitis
- gallbladder hydrops
- sterile pyuria
- otitis media
- arthritis
invx necessary in Kawasaki?
FBE for neutrophilia, thrombocytosis (too many), anaemia
Echo
What causes TSS?
toxin produced by Staph aureus or Group A Strep
- tampon use or skin and soft tissue infections
Clinical features of TSS
- fever
- renal impairment
- coagulopathy
- acute resp distress syndrome
- macular rash
- soft tissue necrosis- necrotising fasciitis, myositis, gangrene
Invx for TSS
blood cultures
managment TSS
- 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
clindamycin uses?
aerobic staph and strept;
anaerobics G-ves
Diseases caused by group A strept?
- pharyngitis
- impetigo (school sores)
- bacteraemia
- pneumonia
- nec fasc
- myositis
- Osteomyelitis
- perianal cellulitis
- endocarditis
- streptococcal TSS
3 important complications of GAS infection
- scarlet fever
- rheumatic fever
- acute post-strept glomerulonephritis
use of fluclox?
narrow spectrum beta lactam- susceptible G+s and staph (but not MRSA)
4 key differentials for fever and petechiae
- infection: viral - enterov, influenza; bacteria - neisseria meningitidis, strep pneu, hib
- HSP
- ITP
- Leukaemia
most common cause of meningitis. how many serogroups?
neisseria meningitidis, G-ve diplococcus, 13 serogroups
presentations of meningococcal disease
- meningitis
- meningococcaemia
- arthritis
- pneumonia
- pharyngitis
- petch/purpura in most
invx for meningococcal disease
blood culture
csf
> meningococcal pcr
tx meningococcal disease
3rd gen cephalosporins
intensive supportive management
dexameth
complications of meningococcal disease (4)
- DIC
- adrenal haemorrhage
- gangrene
- neuro dev sequelae- hearing loss
What is scarlet fever?
a delayed type skin reactivity to erythrogenic toxin from strep pyogenes
clinical features of scarlet fever
- acute pharyngitis
- rash- diffuse blanching erythema with papular elevations (‘sandpaper)
- ## head and neck desquamation
cause of rheumatic fever
GAS pharyngitis
5 major signs for diagnosis rheu fever
- migratory arthritis - large joints
- carditis, vavulitis
- CNS involvement - eg sydenham chorea
- erythema marginatum- pink rings
- sub cut nodules
4 minor signs for rheu fever
- arthralgia
- fever
- elevated acute phase reactants
- prolonged PR
Treatment of rheu fever
- eradicate GAS carriage - penicilin
- aspirin for carditis/arthritis
- IM benzathine penicillin every month
incubation of varicella
10-21 days
clinical features of VZV
- prodrome - fever, malaise, anorexia
- rash - pruritic macules/vesicles/crust
complications of VZV (infants, immunocomp)
- progressive > eye involvement, coagulop, thrombocytopaenia
- pneumonia
- on top bact - eg nec faci
- enceph
- hepatitis
treatment if VZV complications
acyclovir
exposure to VZV- pregnant women, neonate, immune def> treat with what?
zoster Ig within 96 hrs of exposure
What is parvovirus/slapped check disease?
Caused by parvovirus B19, a DNA virus spread by respiratory droplet
>
fever, headach, coryza
slapped cheek rash
later> diffuse macular erythema trunk and limbs
What has usually happened by the time the parvo rash has appeared?
viraemia has usually resolved and child usually feels well
Roseola?
DNA virus
- asympt salivary shedding
- high fever 3-5 days
- rash only after fever resolves- blanching maculopapular
complications of roseola infantum
seizures
aseptic meningtis
encephalitis
thrombocytopenic purpura
Hand foot mouth disease is caused bywhat? what are the clinical features?
- 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
Causes of impetigo/school sores?
- non bullous: Staph aur and GAS
- bullous: Staph aureus
tx impetigo
topical mupirocin
systemic - fluclox, penicillin
What is erysipelas?
An infection of the superficial lymphatics and upper dermis, usually caused by GAS.
It is more superficial than cellulitis
cellulitis infects what?
deeper dermis and subcut fat.
tx of cellulitis/erysipelas
fluclox, cephalexin
culture pus if present, blood if afebrile,
consider MRSA (clindamycin)
organisms causing periorbital cellulitis
staph a, strep pyogenes, strep pneumoniae. Hib less common
features of orbital cellulitis
- opthalmoplegia (limitation of eye movement)
- chemosis (swelling of conjunctiva)
- proptosis (exophthalmus)
- decreased acuity
- headache
Management of periorbital cellulitis
- test and record visual acuity if possible
- full eye exam- movements, look for proptosis
- consider hosp admission for IV cefotaxime and/or fluclox
management for orbital celluliits
- CT orbits ASAP
- blood cultures
- IV fluclox +/- cefotaxime
- involve ENT/opthal
cefotaxime targets?
broad spec - + and - bact S aureus but not MRSA- clindamycin for MRSA strep pneu e coli hib n mening
What is necrotising fasciitis?
rapidly spreading infection of deep layer of superficial fascia
causes of nec fasc
GAS Staph a pseudomonas aeruginosa clostridium perfrinnens anaerobes - bacteroides
Clinical features of fasc
- fever
- pain
- constitutional unwellness out of proportion to cutaneous signs
management
- low threshold for surg referral for radical debridement
- supportive
- IV antibx
Clinical features measles
- prodrome: high fever, cough, coryza, conjunctivitis
- rash - cephalocaudal maculopap
- koplik spots (pathognomonic)
- clinical improvement 48 hrs after rash
what are koplik spots?
prodromic (bf main rash) clustered white lesions on buccal mucosa
tx measles
- supportive
- antibiotics if superinfection
- vit A
