Childhood infections & Immunisation schedule Flashcards
Childhood infections
Chickenpox
Symptoms: Fever initially, itchy rash starting on the head/trunk before spreading.
Progression of Rash: Initially macular, then papular, and finally vesicular.
Systemic Upset: Usually mild.
Measles
Prodrome: Irritability, conjunctivitis, fever.
Koplik Spots: White spots (‘grains of salt’) on the buccal mucosa.
Rash: Starts behind the ears, spreads to the whole body. Initially a discrete maculopapular rash, later becoming blotchy and confluent.
Mumps
Symptoms: Fever, malaise, muscular pain.
Parotitis: Unilateral initially, becoming bilateral in 70% of cases. Symptoms include ‘earache’ and ‘pain on eating.’
Rubella
Rash: Pink maculopapular rash, starting on the face and spreading to the whole body. Typically fades within 3–5 days.
Lymphadenopathy: Suboccipital and postauricular lymph nodes are affected.
Erythema Infectiosum
Other Names: Fifth disease, ‘slapped-cheek syndrome.’
Cause: Parvovirus B19.
Symptoms: Lethargy, fever, headache.
Rash: ‘Slapped-cheek’ appearance, spreading to proximal arms and extensor surfaces.
Scarlet Fever
Cause: Reaction to erythrogenic toxins produced by Group A haemolytic streptococci.
Symptoms: Fever, malaise, tonsillitis.
Characteristic Signs:
‘Strawberry’ tongue.
Rash: Fine punctate erythema sparing the area around the mouth (circumoral pallor).
Hand, Foot, and Mouth Disease
Cause: Coxsackie A16 virus.
Symptoms: Mild systemic upset, sore throat, fever.
Characteristic Signs: Vesicles in the mouth, on the palms, and on the soles of the feet.
Fever initially
Itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular
Systemic upset is usually mild
Chickenpox
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
Measles
Fever, malaise, muscular pain
Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%
Mumps
Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular
Rubella
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
Erythema Infectiosum
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
Scarlet Fever
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
Hand, Foot, and Mouth Disease
common 6 months - 2 years
fever followed later by rash
febrile seizures common
Roseola infantum
Measles vs Rubella Rash
Measles is characterised by prodromal symptoms, Koplik spots. maculopapular rash starting behind the ears and conjunctivitis
Rubella is characterised by fever, lymphadenopathy and rash that begins on the face and spreads downwards. Given that the rash, in this case, started behind the ears, measles is the more likely option. The presence of Koplik spots also points towards measles.
Kawasaki’s disease is characterised by fever >5 days, conjunctivitis, strawberry tongue, cervical lymphadenopathy, desquamation of digits and rash.
Chickenpox is characterised by vesicles.
Scarlet fever is characterised by sandpaper rash and strawberry tongue.
Measles Mgt:
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
Ophthalmia neonatorum
Suspected ophthalmia neonatorum should be referred for same-day ophthalmology/paediatric assessment
Purulent discharge and conjunctival inflammation are suggestive of ophthalmia neonatorum, rather than nasolacrimal duct obstruction. Give advice about eyelid hygiene and gentle massage is therefore not the correct answer.
Ophthalmia neonatorum simply means infection of the newborn eye.
Responsible organisms include
Chlamydia trachomatis
Neisseria gonorrhoeae
Pneumonia in children
In pneumonia amoxicillin is first line for all children who are not allergic to penicillin
Pathophysiology
S .pneumoniae is the most likely causative agent of a bacterial pneumonia in children
The British Thoracic Society published guidelines in 2011 on the management of community acquired pneumonia in childhood. Key points are summarised below:
Treatment
Amoxicillin is first-line for all children with pneumonia
Macrolides may be added if there is no response to first line therapy
Macrolides should be used if mycoplasma or chlamydia is suspected
In pneumonia associated with influenza, co-amoxiclav is recommended
Childhood immunisation schedule
Meningitis B vaccine
Three doses are now given at:
2 months
4 months
12-13 months
Causative orgs
Streptococcus pneumonia is more likely to be the cause of pneumonia or otitis media.
Staphylococcus aureus is more likely to cause skin infections such as impetigo.
Herpes is a viral infection causing oral or genital ulcerations and whitlow.
Acute epiglottitis is caused by Haemophilus influenzae type B (Hib). Since 1992 Hib has been included in the childhood vaccination programme and is now thankfully rare. It can also cause other serious infections including meningitis and septicaemia etc.
Haemophilus influenzae type A is a rare disease.
Staphylococcus aureuscommonly causes skin infections including abscesses, respiratory infections such as sinusitis, and food poisoning.
Streptococcus pneumoniae commonly causes bronchitis, otitis media ans sinusitis.
Meningococcal type B is the most common cause meningococcal disease in the UK and is routinely vaccinated against in the national childhood vaccination programme.
Scarlet fever vs Kawasaki disease
Scarlet fever is the correct answer. This is a typical presentation of scarlet fever. Specifically, remember the ‘coarse red rash’ and ‘strawberry tongue’. Manage with 10 days of phenoxymethylpenicillin or azithromycin if there is a suspected allergy to penicillin.
Kawasaki disease is different in that the fever typically lasts 5 days or longer. It also presents with an erythematous polymorphous rash, strawberry tongue, cervical lymphadenopathy, bilateral conjunctivitis, oedema, erythema, and skin peeling of the hands and feet.
