Child Health Derm/Infections Flashcards
Head lice (also known as pediculosis capitis or ‘nits’) is a common condition in children caused by
parasitic insect Pediculus capitis
Head lice are small insects that live only on humans, they feed on our
blood
Head lice are spread by
direct head-to-head contact
Head lice hen newly infected, cases have no symptoms but itching and scratching on the scalp occurs ? weeks after infection.
hen newly infected, cases have no symptoms but itching and scratching on the scalp occurs 2 to 3 weeks after infection.
Head lice Diagnosis
fine-toothed combing of wet or dry hair
Head lice mx
a choice of treatments should be offered - malathion, wet combing, dimeticone, isopropyl myristate and cyclomethicone
Head lice treatment is only indicated if living lice are found
true
household contacts of patients with head lice do not need to be treated unless they are also affected
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School exclusion is advised for children with head lice
true
Hand, foot and mouth disease is a self-limiting condition
true
Hand, foot and mouth disease is caused by
intestinal viruses of the Picornaviridae family (most commonly coxsackie A16 and enterovirus 71)
Hand, foot and mouth disease is very contagious and typically occurs in outbreaks at nursery
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Hand, foot and mouth disease sx
mild systemic upset: sore throat, fever
oral ulcers
followed later by vesicles on the palms and soles of the feet
Hand, foot and mouth disease mx
symptomatic treatment only: general advice about hydration and analgesia
reassurance no link to disease in cattle
Hand, foot and mouth disease children do not need to be excluded from school
true
children who are unwell should be kept off school until they feel better
Kawasaki disease is
a type of vasculitis which is predominately seen in children
Whilst Kawasaki disease is uncommon it is important to recognise as it may cause potentially serious complications, including
coronary artery aneurysms.
Kawasaki disease sx
high-grade fever which lasts for > 5 days. Fever is characteristically resistant to antipyretics
conjunctival injection
bright red, cracked lips
strawberry tongue
cervical lymphadenopathy
red palms of the hands and the soles of the feet which later peel
Kawasaki disease is a clinical diagnosis as there is no specific diagnostic test.
true
Kawasaki disease mx
high-dose aspirin
intravenous immunoglobulin
echocardiogram
Scarlet fever is a reaction to
erythrogenic toxins produced by Group A haemolytic streptococci (usually Streptococcus pyogenes).
Scarlet feveris more common in children aged
2 - 6 years with the peak incidence being at 4 years.
Scarlet feverspread via
respiratory route
Scarlet feverScarlet fever has an incubation period of 2-4 days and typically presents with:
fever: typically lasts 24 to 48 hours malaise, headache, nausea/vomiting sore throat 'strawberry' tongue rash
Scarlet fever - describe rASH
fine punctate erythema (‘pinhead’) which generally appears first on the torso and spares the palms and soles
rough ‘sandpaper’ texture
desquamination occurs later in the course of the illness,
Scarlet feverDiagnosis
a throat swab is normally taken but antibiotic treatment should be commenced immediately, rather than waiting for the results
Scarlet fever mx
oral penicillin V for 10 days / azithromycin if allergic
Scarlet fever when can children go back to school
children can return to school 24 hours after commencing antibiotics
Scarlet fever is a notifiable disease
true
Scarlet fever is usually a mild illness but may be complicated by:
otitis media
rheumatic fever
acute glomerulonephritis
invasive complications (e.g. bacteraemia, meningitis, necrotizing fasciitis) are rare but may present acutely with life-threatening illness
Roseola infantum (also known as exanthem subitum, occasionally sixth disease) is a common disease of infancy caused by
human herpes virus 6 (HHV6).
Roseola infantum typically affects
typically affects children aged 6 months to 2 years.
Roseola infantum sx
high fever: lasting a few days, followed later by a
maculopapular rash
Nagayama spots: papular enanthem on the uvula and soft palate
febrile convulsions occur in around 10-15%
diarrhoea and cough are also commonly seen
Roseola infantum school exclusion is not needed.
true
Seborrhoeic dermatitis is a relatively common skin disorder seen in children. It typically affects
the scalp (‘Cradle cap’), nappy area, face and limb flexures.
Cradle cap is an early sign which may develop in the first few weeks of life. It is characterised by
erythematous rash with coarse yellow scales.
Cradle cap mx
Management depends on severity
mild-moderate: baby shampoo and baby oils
severe: mild topical steroids e.g. 1% hydrocortisone
Seborrhoeic dermatitis in children tends to resolve spontaneously by around
8 months of age
Chickenpox school exclusion
Advise that the most infectious period is 1–2 days before the rash appears, but infectivity continues until all the lesions are dry and have crusted over (usually about 5 days after the onset of the rash).
Chickenpox immunocompromised patients and newborns with peripartum exposure should receive
varicella zoster immunoglobulin (VZIG). If chickenpox develops then IV aciclovir should be considered
Chickenpox A common complication is secondary bacterial infection of the lesions - what increases risk?
NSAIDs
Chickenpox - infected lesions usually due to?
commonly may manifest as a single infected lesion/small area of cellulitis, in a small number of patients invasive group A streptococcal soft tissue infections may occur resulting in necrotizing fasciitis
Chickenpox rare complications
pneumonia
encephalitis (cerebellar involvement may be seen)
disseminated haemorrhagic chickenpox
arthritis, nephritis and pancreatitis may very rarely be seen
Measles sx?
Prodrome: irritable, conjunctivitis, fever
Koplik spots
rash starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
Koplik spots are associated with rubella
FALSE - measles
Koplik spots: white spots (‘grain of salt’) on buccal mucosa
Mumps sx
Fever, malaise, muscular pain
Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%
Rubella sx
Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular
Erythema infectiosum is also known as
slapped cheek
Erythema infectiosum caused by?
parvovirus B19
Erythema infectiosum sx
Lethargy, fever, headache
‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces
Causes of a napkin (‘nappy’) rash include
Irritant dermatitis Candida dermatitis Seborrhoeic dermatitis Psoriasis Atopic eczema
Commonest cause of nappy rash?
Irritant dermatitis
Describe the following type of nappy rash - Irritant dermatitis
The most common cause, due to irritant effect of urinary ammonia and faeces
Creases are characteristically spared
Describe the following type of nappy rash -Candida dermatitis
Typically an erythematous rash which involve the flexures and has characteristic satellite lesions
Describe the following type of nappy rash - Seborrhoeic dermatitis
Erythematous rash with flakes. May be coexistent scalp rash
Describe the following type of nappy rash - Psoriasis
A less common cause characterised by an erythematous scaly rash also present elsewhere on the skin
Describe the following type of nappy rash - Atopic eczema
Other areas of the skin will also be affected
Nappy rash mx
disposable nappies are preferable to towel nappies
expose napkin area to air when possible
apply barrier cream (e.g. Zinc and castor oil)
mild steroid cream (e.g. 1% hydrocortisone) in severe cases
management of suspected candidal nappy rash is with a topical imidazole. Cease the use of a barrier cream until the candida has settled
Measles mx
mainly supportive
admission may be considered in immunosuppressed or pregnant patients
notifiable disease → inform public health
Most common measles complication
otitis media
Most common cause of death in measles
pneumonia
Measles - which complicationtypically occurs 1-2 weeks following the onset of the illness
encephalitis
Measles - which rare complication may present 5-10 yrs post illness
subacute sclerosing pancencephalitis.
Measles management of contacts?
if a child not immunized against measles comes into contact with measles then MMR should be offered (vaccine-induced measles antibody develops more rapidly than that following natural infection)
this should be given within 72 hours
Infestation with threadworms (Enterobius vermicularis, sometimes called pinworms) is extremely common amongst children in the UK. Infestation occurs after swallowing eggs that are present in the environment.
true
Threadworm infestation is asymptomatic in around 90% of cases, possible features include:
perianal itching, particularly at night
girls may have vulval symptoms
Threadworm infestation diagnosis?
Sellotape to the perianal area and sending it to the laboratory for microscopy to see the eggs. However, most patients are treated empirically and this approach is supported in the CKS guidelines.
Threadworm mx
CKS recommend a combination of anthelmintic with hygiene measures for all members of the household
mebendazole is used first-line for children > 6 months old. A single dose is given unless infestation persists
Meningitis in children: organisms
Neonatal to 3 months
Group B Streptococcus: usually acquired from the mother at birth. More common in low birth weight babies and following prolonged rupture of the membranes
E. coli and other Gram -ve organisms
Listeria monocytogenes
Meningitis in children: organisms
1 month to 6 years
Neisseria meningitidis (meningococcus) Streptococcus pneumoniae (pneumococcus) Haemophilus influenzae
Meningitis in children: organisms
Greater than 6 years
Neisseria meningitidis (meningococcus) Streptococcus pneumoniae (pneumococcus)
Contraindication to lumbar puncture
any signs of raised ICP
Signs of raised ICP
focal neurological signs papilloedema significant bulging of the fontanelle disseminated intravascular coagulation signs of cerebral herniation
Antibiotics for menignitis?
< 3 months: IV amoxicillin (or ampicillin) + IV cefotaxime
> 3 months: IV cefotaxime (or ceftriaxone)
menignitis mx
- Antibiotics
- Steroids
- Fluids - treat any shock, e.g. with colloid
- Cerebral monitoring - mechanical ventilation if respiratory impairment
- Public health notification and antibiotic prophylaxis of contacts
ciprofloxacin
Describe steroid use in menigitis mx
dexamethsone should be considered if the lumbar puncture reveals any of the following:
frankly purulent CSF
CSF white blood cell count greater than 1000/microlitre
raised CSF white blood cell count with protein concentration greater than 1 g/litre
bacteria on Gram stain
Describe steroid use in menigitis mx
NICE advise against giving corticosteroids in children younger than
Describe steroid use in menigitis mx
Rotavirus vaccine - what type
it is an oral, live attenuated vaccine
Rotavirus vaccine 2 doses are required. when ?
2 doses are required, the first at 2 months, the second at 3 months
Rotavirus vaccine the first dose should not be given after 14 weeks + 6 days and the second dose cannot be given after 23 weeks + 6 days due to a theoretical risk of
intussusception
In contrast to adults, the development of a urinary tract infection (UTI) in childhood should prompt an investigation for possible underlying causes and damage to the kidneys
true
UTI causative organisms
E. coli (responsible for around 80% of cases)
Proteus
Pseudomonas
UTI predisposing factors
Incomplete bladder emptying
Vesicoureteric reflux
Poor hygiene
Urinary tract infections (UTI) are more common in boys until 3 months of age (due to more congenital abnormalities) after which the incidence is substantially higher in girls.
true
UTI presentation infants
poor feeding, vomiting, irritability
NICE guidelines for checking urine sample in a child
if there are any symptoms or signs suggestive or a UTI
with unexplained fever of 38°C or higher
an alternative site of infection but who remain unwell
Urine collection method
clean catch is preferable
if not possible then urine collection pads should be used
cotton wool balls, gauze and sanitary towels are not suitable
invasive methods such as suprapubic aspiration should only be used if non-invasive methods are not possible
UTI mx
infants less than 3 months old should be referred immediately to a paediatrician
children aged more than 3 months old with an upper UTI should be considered for admission to hospital
children aged more than 3 months old with a lower UTI should be treated with oral antibiotics for 3 days according to local guidelines, usually trimethoprim, nitrofurantoin, cephalosporin or amoxicillin. Parents should be asked to bring the children back if they remain unwell after 24-48 hours
antibiotic prophylaxis is not given after the first UTI but should be considered with recurrent UTIs
