Child with Fever and Rash Flashcards
What are the criteria for diagnosis of Kawasaki disease?
- Fever > 5 days AND 4 of:
- Bilateral non-purulent conjunctivitis
- Mucosal changes - oropharyngeal erythema/dry lips/strawberry tongue (enanthem)
- Cervical lymphadenopathy - unilateral. Often absent
- Polymorphous rash (exanthem)
- Peripheral changes - oedema and erythema of the hands and feet, desquamation
What investigations would you perform in a child suspected of Kawasaki disease? How would you manage them?
- Investigations: FBE (neutrophilia, thrombocytosis, anaemia), echocardiogram (exclude coronary involvement)
- Complications: coronary aneurysms - 25% progress to this if untreated
- Treatment: IVIG, aspirin
What is the presentation of a child with toxic shock syndrome? What does management involve?
- Hypotension
- Fever, renal impairment, coagulopathy, ARDS, maculopapular rash, soft tissue necrosis
- Blood cultures, find and drain/debride/remove focus, give fluids, antibiotics, IVIG
What are the 3 toxin syndromes caused by Staphylococcus
- Food poisoning
- Toxic-shock syndrome (enterotoxin/TSS-toxin)
- Scalded skin syndrome (desquamative toxin)
What is scalded skin syndrome? How does it present and how is it managed?
- Presentation
- Fever
- Diffuse, blanching erythema in mechanically stressed areas
- Sterile, large, flaccid blisters
- Nikolsky sign - top layers shear from bottom when rubbed
- Desquamation (non-scarring)
- Investigation (clinical diagnosis so the rest is just confirmatory)
- Blood, urine, nasopharyngeal, umbilical skin culture
- Skin biopsy
- Management: IV flucloxacillin/clindamycin, fluids
How can meningococcal disease present?
- Presentations - meningitis, meningococcaemia, arthritis, pneumonia, pharyngitis, petechial rash
How is meningococcal disease treated? What can the complications be if it isn’t?
- Treatment
- Cephalosporins (3G)
- Steroids (not for meningitis)
- Chemoprophylaxis of contacts (rifampicin, ceftrixaone), isolation, notification
- Complications - shock, DIC, adrenal haemorrhage, gangrene, neurodevelopmental sequelae
What causes scarlet fever? How does this present?
- Pathogenesis - second exposure to Strep toxin causes delayed type 4 hypersensitivity reaction
- Presentation
- Pharyngitis
- Rash - diffuse, blanching, erythematous with sandpaper appearance
- Head, neck, trunk and extremity distribution with perioral/palmar/plantar sparing. Desquamation of trunk and extremities
How is rheumatic fever diagnosed? How is it managed?
- 2 major criteria or 1 major, 1 minor
- Major - migratory arthritis, carditis/valvitis, CNS involvement e.g. chorea, erythema marginatum, subcutaneus nodules
- Minor - arthralgia, fever, elevated acute phase reactants, prolonged PR interval
- Management - antibiotics (benpen monthly) and aspirin acutely
How is varicella infection prevented?
- Vaccination
- VZV IG given within 96 hours of exposure to pregnant women and those that develop varicella infection 7 days before or 2 after delivery
How does parvovirus-B19 infection present?
- 4-28 day incubation
- School-age children, preceding flu-like illness
- Slapped-cheek appearance and lacy, reticular extensor rash (palmar-plantar sparing)
How does roseola infantum present?
- 5-15 days incubation
- High fever for 3-5 days THEN rash on neck and trunk spreading to extremities. Blanching maculopapular or macular rash, disappears in a few days
How does hand-footand-mouth disease present?
- 3-5 days incubation, faeco/mucosal spread
- Low grade fever, then oropharyngeal vesicles/ulcers, maculopapular/vesicular lesions on hands, feet, buttocks. Resolves in a few days
What is impetigo? How does it present and how is it treated?
- Superficial skin infection
- Presentation
- 2-5 years old
- Following trauma, vesicle/pustule formation that forms a golden crust and resolves without scarring
- Treatment
- Topical muciprocin, systemic flucloxacillin/penicillin
What is the typical appearance of cellulitis?
- Erythema, oedema, warmth (fever and chills with erysipelas)
