Clipp 11: 4 y/o with fever and lymphadenopathy Flashcards
Derm term for flat, discolored spot
macular
Small, well defined solid palpable bump
papular
Small, well-defined, fluid containing bump
vesicle
Small, well-defined bump containing purulent material
pustle
Small, raised, differentiated patch or area on a body surface
plaque
Shedding of the outer layer of skin surface
Desquamation
Another name for meningiococcemia?
Meningitis with Nisseria Meningiditis
May cause upper respiratory tract infection, pharyngitis, conjunctivitis, tonsillitis, or otitis media
Potential for more severe infections in immunocompromised hosts
Adenovirus Infection
Fever > 5 days
Cervical adenopathy
Nonpurulent conjunctivitis
Nonspecific ("polymorphic") rash
Swelling and erythema of extremities
Mucosal inflammationKawasaki disease
Vasculitis
Fever
Chills, malaise
Rash (often petechial)
May lead to shock and DIC (often rapidly progressing)
Meningococcemia Bacterial infection (Neisseria meningitidis)
After a prodrome of fever (over 38.3 C, or 101 F), cough, coryza, and conjunctivitis, this maculopapular rash starts on the neck, behind the ears, and along the hairline.
The rash spreads downward, reaching the feet in two or three days.
The initial rash appears on the buccal mucosa as red lesions with bluish white spots in the center (known as Koplik spots). These have frequently disappeared by the time the patient presents to medical attention.
Measles
Fever
Headache
Rash (typically starts on ankles and wrists and progresses centrally and to palms and soles; may be macular or papular at first, quickly becoming petechial; in 5% of cases, there may be no rash)
Myalgias
Rocky Mountain spotted fever (RMSF)
Tick-borne bacterial infection (Rickettsia rickettsii)
Fever
A diffuse, erythematous, finely papular rash (described as having a “sandpaper” texture) is pathognomonic
Rash often begins at neck, axillae, and groin and then spreads over trunk and extremities, typically resolving within four or five days
Scarlet fever
Group A strep
Severe, pruritic rash (erythema multiforme)
Fever
Mucosal changes (e.g., stomatitis)
Conjunctivitis
SJS
Fever lasting 3-5 days
Nonspecific rash (which may include the palms and soles)
May also cause conjunctivitis, oral ulcers, diarrhea, aseptic meningitis
Enteroviral infection
Coxsackievirus, echovirus, enterovirus
“Chicken pox:” rash starts on trunk and spreads to extremities and head
Each lesion starts as an erythematous macule, then forms a papule followed by a vesicle before crusting over
Lesions at various stages of development are seen in the same area of the body
Immunization is effective in preventing this infection
Varicella
Also called 5th disease
Low grade fever followed by a rash, which starts as a facial erythema to the face (“slapped cheek” appearance), which can spread to the trunk and extremities and appears lacy
Can lead to pain and swelling of the extremities, as well as development of aplastic anemia
Erythema Infectiosum Viral infection (parvovirus B19)
“Exanthem subitum:” erythematous macules start on trunk and spreads to arms and neck (less commonly face and legs)
Rash is typically preceded by 3-4 days of high fevers, which end as the rash appears
Usually occurs in children under age 2 years
Roseola Viral infection (human herpesvirus 6)
Causes of unilateral cervical lymphadenopahty
Reactive cervical adenitis (with oral infection) Kawasaki Disease Bacterial Cervical Adenitis Cat Scratch Disease Mycobacterial Infection
Ddx for strawberry tongue? (3)
Strep Pharyngitis
Kawasaki Disease
Toxic Shock Syndrome
3 phases of Kawasaki Disease
Acute phase: onset through ~10 days. Fever and clinical findings are present, with serologic evidence of systemic inflammation (elevated acute phase reactants).
Subacute phase: 10 days through ~3 weeks. Fever resolves and clinical findings largely subside (often with peeling of hands and feet). Serologic evidence of inflammation continues.
Convalescent phase: 3 weeks through 6-8 weeks. All clinical findings have resolved. Continued serologic evidence of inflammation.
Although Kawasaki Disease is a panvasculitis, it has a predilection for what sized vessels?
Small and medium –> affects coronary vasculature
At what phase of Kawasaki Disease do coronary aneurysms develop?
The greatest risk for the development of CA aneurysms is in the subacute phase of illness (beyond 10 days), and aneurysms almost always develop within four weeks of the onset of the disease. Aneurysms that form during this time are at risk for thrombosis due to the concurrent thrombocytosis.
What monitoring should be done on patients with kawasaki disease?
Cardiac echo
Standard tx for Kawasaki Disease?
Aspirin and IVIG
What antipyretic should be used in the tx of Kawasaki?
Ibuprofen- because it antagonizes the irreversible platelet inhibition of aspirin
Follow up care for Kawasaki?
Cardiology in 1-2 weeks
Low dose aspirin for 6-8 weeks
What are children taking aspirin at risk for if they are infected with a virus?
Reye’s syndrome
A 5-year-old female, previously healthy, presents with an erythematous, vesicular rash on the palms and soles and a high fever for several days. Upon examination, she is also found to have ulcers in her mouth. A few days later, the fever and rash resolve. What is the most likely pathogen?
Enterovirus- cocksackie A
