Childhood infections

Question 1

How does chickenpox present?

Answer 1

Fever initially
Itchy rash starting on head/trunk before spreading
Initially macular then papular then vesicular
Systemic upset is usually mild

Question 2

Mx of chickenpox?

Answer 2

keep cool, trim nails
calamine lotion
paracetamol for fever
stay off of school until lesions have crusted over

immunocompromised patients and newborns with peripartum exposure = varicella zoster immunoglobulin (VZIG)
if chickenpox develops then IV aciclovir should be considered

Question 3

Complications of chickenpox?

Answer 3

secondary bacterial infection of lesions
pneumonia
encephalitis (cerebellar involvement may be seen)
disseminated haemorrhagic chickenpox

Question 4

how do measles present?

Answer 4

Prodrome: irritable, conjunctivitis, fever
Koplik spots: white spots (‘grain of salt’) on buccal mucosa
Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent

Question 5

Management of measles?

Answer 5

supportive
notifiable disease

Question 6

Give some complications of measles

Answer 6

otitis media: the most common complication
pneumonia: the most common cause of death
encephalitis: typically occurs 1-2 weeks following the onset of the illness

Question 7

How do mumps present?

Answer 7

Fever, malaise, muscular pain
Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%

Question 8

how does rubella present?

Answer 8

Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular

Question 9

how does erythema infectiosum present?

Answer 9

Also known as fifth disease or ‘slapped-cheek syndrome’
Caused by parvovirus B19
Lethargy, fever, headache
‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces
does not require exclusion from school

Question 10

how does scarlet fever present?
how is it diagnosed?

Answer 10

Reaction to erythrogenic toxins produced by Group A haemolytic streptococci
Fever, malaise, tonsillitis
‘Strawberry’ tongue
Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)

dx: a throat swab is normally taken but antibiotic treatment should be commenced immediately, rather than waiting for the results

Question 11

mx of scarlet fever?

Answer 11

oral penicillin V for 10 days
azithromycin if penicillin allergy
children can return to school 24 hours after commencing antibiotics
notifiable disease

Question 12

How does hand foot and mouth present?
Mx?

Answer 12

Caused by the coxsackie A16 virus
Mild systemic upset: sore throat, fever
Vesicles in the mouth and on the palms and soles of the feet

mx: symptomatic tx, do not need to be excluded from school