Acute Paediatric Illness, Fever and Rash Flashcards
What is exanthem?
a skin eruption occurring as a sign of a generalized disease
What is an enanthem?
an eruption on the mucous membranes that occurs in the context of generalized disease
What are the clinical characteristics of exanthema and enanthems?
macular, maculopapular, vesicular, urticarial, petechial, or diffusely erythematous
Macules?
are flat, nonpalpable circumscribed lesions
Papules?
are <1 cm, circumscribed palpable lesions
Morbilliform?
measles like rash
Petechiae?
are pinpoint lesions (<3 mm), and purpura are larger lesions
Vesicular rashes?
raised lesions containing clear fluid
Bullae?
vesicles exceeding 1 cm in diameter
Pustules?
cloudy fluid composed of serum and inflammatory cells
Nodules?
discrete, raised, firm, well-demarcated lesions
What causes petechiae and purpura?
Extravasation of red blood cells from the vasculature into the skin
Maculopapular lesions become?
may coalesce into a more confluent morbilliform (measles-like) eruption
What is scarlatiniform?
A rash with multiple small papules that feels like sandpaper
Name common bacterial exanthems?
- scarlet fever
- staphylococcal scalded skin syndrome
- toxic shock syndrome
- meningococcemia
What is scarlet fever?
a bacterial illness that develops in some people who have strep throat
- the bacteria sometimes make a toxin which causes a rash (the scarlet of scarlet fever)
Cause of scarlet fever?
group A streptococcus
Features of scarlet fever?
- Diffuse, blanching erythema with “sandpaper” feel
- Erythema in flexural creases (Pastia lines)
- Desquamation occurs in fine, thin flakes as the acute phase of the illness resolves and is proportional to the intensity of the exanthem - May exfoliate
- flushed face
- perioral pallor
Complications of scarlet fever?
- Peritonsillar abscess
- rheumatic fever
- glomerulonephritis
Prevention/treatment of scarlet fever?
Prevent rheumatic fever with penicillin within 10 days of onset of pharyngitis
What is staphylococcal scalded skin syndrome?
a response to a toxin produced by a staphylococcal infection and is characterised by peeling skin
Cause of staphylococcal scalded skin syndrome?
Staphylococcus aureus producing exfoliative toxin
Features of SSSS?
- Sudden onset
- tender erythroderma progressing to diffuse flaccid bullae
- significant perioral and perinasal peeling
- eventual diffuse exfoliation (positive Nikolsky sign)
- conjunctivitis
- purulent rhinorrhea
What is Nikolsky sign?
is a skin finding in which the top layers of the skin slip away from the lower layers when rubbed
Complications of SSSS?
Shock
Treatment of SSSS?
Treat with intravenous antibacterial active against S. aureus
What is toxic shock syndrome?
multisystem diseases manifested by sudden onset of fever, chills, hypotension and rash
Cause of toxic shock syndrome?
- S. aureus producing toxic shock syndrome toxin-1 (TSST-1) and staphylococcal enterotoxins (SEs)
- Group A streptococcus producing Streptococcus pyogenes exotoxins (SPEs)
Features of TSS?
- Diffuse sunburn-like erythroderma
- hypotension
- diarrhea
- emesis
- mental status changes
- late desquamation
- fever
- chills
- myalgias
- headache
- orthostatic dizziness
Complications of TSS?
- Shock
- multisystem organ dysfunction/failure
Treatment of TSS?
- Intravenous antibacterial active against S. aureus
- penicillin if group A streptococcus suspected
- clindamycin
What is meningococcemia?
blood stream infection caused by Neisseria meningitidis
Causes of meningococcemia?
Neisseria meningitides
Features of meningococcemia?
- Erythematous
- nonconfluent
- discrete papules (early)
- petechiae
- purpura present on trunk, extremities, palms, soles
Complications of meningococcemia?
- Shock
- meningitis
- pericarditis
- arthritis
- endophthalmitis
- gangrene
- disseminated intravascular coagulation
Treatment/prevention of meningococcemia?
- Contacts: rifampin
- general: vaccine
- treat with ceftriaxone, cefotaxime, penicillin (if sensitive
Name common viral exanthems?
- measles (rubeola)
- rubella (German measles)
- mononucleosis
- fifth disease (erythema infectiosum)
- chickenpox (varicella)
Describe measles (rubeola)?
Transmitted by Respiratory droplet
Prodrome: High fever, cough, coryza, conjunctivitis, 2–4 days
Features of measles rubeola?
- Maculopapular (confluent)
- begins on face, spreads to trunk; lasts 3–6 days - Brown color develops
- fine desquamation
- toxic, uncomfortable appearance
- photophobia
Note: rash may be absent in human immunodeficiency virus infection
Complications of measles rubeola?
- Febrile seizures
- otitis
- pneumonia
- encephalitis
- laryngotracheitis
- thrombocytopenia
- delayed subacute sclerosing panencephalitis
Prevention of measles rubeola?
General: measles vaccine at 9-11m and 15-23m
- The World Health Organization recommends treatment with vitamin A in all patients with measles
Describe rubella (German measles)?
- Transmitted by respiratory droplets
- Prodrome: Malaise, fever <101°F, posterior auricular, cervical, occipital adenopathy, 0–4 days
Features of rubella German measles?
- Discrete, nonconfluent, rose-colored macules and papules
- begins on face and spreads downward
- lasts 1–3 days
Complications of rubella?
- Arthritis
- thrombocytopenia
- encephalopathy
- fetal embryopathy
Prevention of rubella?
General: rubella vaccine at 9-11m and 15-23m
Exposure: possibly immune serum globulin
Describe mononucleosis?
Cause: Epstein–Barr virus
Transmission: Close contact, saliva, blood transfusion
Clinical features of mononucleosis?
- Fever
- adenopathy
- eyelid edema
- sore throat
- hepatosplenomegaly
- malaise
- atypical lymphocytosis
- Maculopapular or morbilliform on trunk, extremities - often elicited by simultaneous administration of ampicillin or allopurinol
Complications of mononucleosis?
- Anemia
- thrombocytopenia
- aplastic anemia
- hepatitis;
- rarely lymphoproliferative syndrome
Describe fifth disease (erythema infectiosum)?
Transmission: Respiratory droplets; blood transfusion, placenta
Prodrome: Headache, malaise, myalgia; often afebrile
Features of fifth disease?
- Local erythema of cheeks (slapped cheek appearance)
- pink red erythema of trunk and extremities
- ± pruritus
- rash may lag prodrome by 3–7 days
- lasts 2–4 days, may recur 2–3 wk later
Complications of fifth disease?
- Arthritis
- aplastic crisis in patients with chronic hemolytic anemia (e.g., sickle cell)
- fetal anemic hydrops
- vasculitis
Describe chickenpox (varicella)?
Cause: varicella
Transmission: Respiratory droplet
Features of chickenpox?
- Pruritic papules
- vesicles in various stages
- 2–4 crops and then crusts
- distributed on trunk and then face, extremities
- lasts 7–10 days
- recurs years later in dermatomal distribution (zoster, shingles)
Complications of chickenpox?
- Staphylococcal or streptococcal skin infection
- arthritis
- cerebellar ataxia
- encephalitis
- thrombocytopenia
- Reye syndrome (with aspirin)
- myocarditis
- nephritis, hepatitis, pneumonia
- dissemination in immunocompromised
Treatment of chickenpox?
Acyclovir therapy for immunosuppressed and possibly normal patients (controversial)
- contagious 1–2 days after rash (usually no longer contagious when all lesions are crusted and no new lesions appear)
Other viruses that cause fever and rash?
- Enteroviruses
- Epstein–Barr virus (EBV)
- Cytomegalovirus
- Adenovirus
- Hepatitis B virus
- Human herpesvirus types 6 and 7
