Childhood Infections: Measles, Mumps, Rubella, Foot Hand and Mouth, Kawasaki's Disease, Parvovirus

Question 1

Spread
Incubation period
Infectious period of
-measles
-mumps
-rubella

Answer 1

Measles

• droplets
• incubation - 10-14 days
• Infectious - prodrome - 4 days post rash

Mumps

• droplets
• incubation - 14-21 days
• infectious - 7 days before - 9 days post parotid swelling

Rubella

• droplets
• incubation - 14-21 days
• infectious - 7 days before symptoms - 4 days post rash

Question 2

Presentation of

• measles
• mumps
• rubella

Answer 2

Measles

• Prodrome - irritable, fever, conjunctivitis
• Rash - behind ears => whole body (maculopapular)
• Koplik spots

Mumps

• Prodrome
• Parotid swelling (earache, pain on eating)

Rubella

• Prodrome
• Rash - face => whole body, fades by day 3-5 (maculopapular)
• Suboccipital, postauricular LN

Question 3

Diagnosis and management

• measles
• mumps
• rubella

Answer 3

IgM AB but normally a clinical disgnosis

Supportive
-rest, hydration, paracetamol for discomfort
Notify PHE

Question 4

Pregnancy and rubella

• diagnosis
• management
• complications

Answer 4

Rubella - highest risk during 1st trimester

• test for maternal IgM
• MMR to non immune mothers post birth

Complications

• sensorineural deafness
• congenital cataracts, heart disease
• growth retardation

Question 5

Complications of

• measles
• mumps
• rubella

Answer 5

Measles

• otitis media - MOST COMMON
• pneumonia - MOST COMMON CAUSE OF DEATH
• encaphalitis

Mumps

• orchiditis
• transient hearing loss
• meningoencephalitis

Rubella

• arthritis
• low platelets
• encephalitis
• myocarditis

Question 6

Spread
Incubation period
Infectious period of
-Parvovirus
-Scarlet fever
-Hand foot and mouth

Answer 6

Parvovirus

• Droplet
• Incubation - up to 14 days
• Infectious - before rash appears

Scarlet fever (GAS toxins)

• droplets
• Incubation - 2-4 days
• Infectious - 6 days before symptoms - 1 day after first ABx dose

Hand, foot, mouth disease (coxsackie)

• droplet
• Incubation - within 1wk
• infectious - 5 days of symptom onset

Question 7

Presentation of

• parvovirus
• scarlet fever
• hand foot and mouth

Answer 7

Parvovirus

• prodrome
• slapped cheek rash => no longer contagious
• in adults - no rash, presents as arthritis

Scarlet fever

• prodrome
• sandpaper raised rash
• strawberry tongue with white coating
• cervical LN

Hand foot and mouth

• prodrome
• painful sores

Question 8

Diagnosis and management

• parvovirus
• scarlet fever
• hand foot and mouth

Answer 8

Clinical diagnosis

Supportive
-rest, hydration, paracetamol for discomfort
Notify PHE

Scarlet fever - specifics

• penicilin/azithromycin
• can return to school 24hrs after starting ABx

Hand foot and mouth - specifics
-can return to school when they feel better

Question 9

Complications of

• scarlet fever
• parvovirus
• hand foot and mouth

Answer 9

Parvovirus

• pancytopenia in IC
• aplastic crisis in sickle cell

Scarlet fever

• otitis media - MOST COMMON
• acute glomerulonephritis

Question 10

Differences between scarlet fever vs Kawasaki disease

-management of Kawasaki

Answer 10

Both present very similarly

Scarlet fever

• caused by GAS toxin
• prodrome, cervical LN, strawberry tongue, sandpaper rash
• mouth sparing
• fever reactive to antipyretics

Kawasaki disease - clinical diagnosis

• inflammatory medium vessel vasculitis => coronary artery aneurysm if not treated
• conjunctivitis, lip cracking, strawberry tongue, red peeling, edematous palms and soles
• fever unreactive to antipyretics
• fever lasts longer 5 days+
• U5 years old

Management

• High dose aspirin
• IVIG
• echocardiogram => coronary artery aneurysm screening