Common Infection and Rashes Flashcards
What causes tonsillitis
Viral - EBV = most common
Bacterial - Strep A
What are the symptoms of tonsillitis
Fever Sore throat Painful swallowing Enlarged tonsils If young can present non-specific with fever / poor feed / abdo pain
What score is used to determine whether viral or bacterial and what does it look like
Centor - suggest more bacterial Tonsillar exudate / pus Cervical LN Fever Hx Absence of cough
How do you Dx tonsillitis
Clinical
Always assess ears - TM and cervical lymphadenopathy
Throat swab NOT routine unless recurrent
When do you admit with tonsillitis
Stridor Resp difficulty Peri-tonsillar abscess Immunocomprised Systemically unwell Dehydrated
How do you treat tonsillitis
10 days penicillin if bacterial, immunocomprised, co-morbid
Clarithroymcin if allergic
Can give delayed prescription and advise to collect if not better in 2-3 days
NOT amox as risk of due to EBV which causes rash
Paracetamol
Ibuprofen
Fluid
Tonsillectomy if recurrent >7
What do you do if not eating or drinking
Oral
Diorlyte (contains sugar and salt)
NG if no IV access
What is risk if too much sugar
Osmotic diuresis leading to more dehydration
Complications of tonsillitis
Peritonsillar abscess Otitis media Scarlet fever RHeumatic fever Post strep GN Post strep reactive arthritis
What are the symptoms of scarlet fever
Malaise
Fever
Tonsillitis
Pinhead exanthema rash - rough / sandpaper (12 hours after fever)
Strawberry tongue (white coat with red papillae)
Desquamation of hands and feet
Cervical lympahdenoapthy
How do you Dx scarlet fever
Throat swab
Start Ax
How do you treat scarlet fever
Penicillin 10 days
Report public health
What are complications of scarlet fever
Otitis media = common Rheumatic fever post 3 weeks GN - 10 days Meningitis Strep toxic shock
What is Kawasaki
Self limiting vasculitis
Occuring in children with COVID 19
What are the symptoms diagnostic of Kawasaki
Fever 5+ days - resistant
4/5 of
Bilateral conjunctivits - non-exudative
Mucous membranes - dry lips / strawberry tongue
Cervical LN
Polymorphous rash
Change of extremities - red fingers or toes peeling (desquamation) / oedema
What are other symptoms of Kawasaki
Peripheral oedema = under appreciated sign
Lethargy
Irritable
Tachycardia
How do you investigate and treat Kawasaki
FBC - anaemia, high WCC and platelet
LFT - hypoalbumin and elevated LFT
Urinanalysis
Increased acute phase reaction - platelet, ESR, neutrophil
Rx
IV Ig to reduce risk of aneurysm 2mg / kg
Aspirin to reduce thrombosis
What should you avoid
Why is aspirin usually CI in kids
Steroid
Risk of Reye’s
What do you do as follow up after Kawasaki
ECHO at 2+6 weeks and 6 months to monitor for coronary aneurysm
If conjunctivitis is unilateral what should you think
Is it orbital cellulitis as usually bilateral
What causes chicken pox
Primary VZV infection
How do you get chicken pox
Can get from someone with shingles
Can’t get shingles if haven’t had chicken pox
Life long immunity if get it once
Virus lays dormant in DRG and CN and can later be reactivated as Shingles or Ramsay Hunt
How do you get shingles
Reactivation of VZV in DRG
Known as herpes zoster
Dermatomal distribution of rash which is painful
What are the symptoms of chicken pox
Mild malaise Fever = often 1st symptom NOT SICK High contagious vesicular rash Macules -> papules ->vesicles -> pustules Typically start on chest / face and spread outward Crust over = non-infectious Itchy
How do you Dx vesicular rash
Clinical Smear of vesicle PCR - fluid / CSF / blood if suspect HSV Blood culture Serology for past infection
Who is at high risk of complications from chicken pox
Immunocompromised
Chemo
Nephrotic
Newborn
What are warning signs of fatal varicella
<1 Immunocompromised High fever New lesions >10 days Inflammed blue or black lesions
What does fatal varicella cause
Skin scar Cataract / microphamia Reduced IQ Microcephaly Limb hypoplasia Pneumintiis in mother
How do you treat chicken pox
Self limitng
Infection control until crust over
Calamine lotion for itch
Paracetamol
What do you do if high risk of complications
IV acyclovir if devleop
IV IG if <10 days from exposure and no Sx
What do you do for shingles (dermatomal distribution of vesicular rash, painful and unilateral)
Oral analgesia
Aciclovir
What do you do if bacterial superinfection on top and what increases risk
Flucloxicillin
Avoid NSAID as increase risk of NF
What are complications of chicken pox
Dehydration Bacterial infection Conjunctivitis Pneumonia Meningitis Encephalitis Myelitis Arthritis HSP DIC Abnormal LFT
What does HSV 1+2 cause
1 = stomatitis / cold sores 2 = genital sores
What does neonatal HSV cause / complications
Neonatal herpes Conjunctivitis Sepsis Meningitis Hepatitis Neuropathy - esp if with HIV
What causes HFMD
Cocksakie (enterovirus)
What can cocksackie also cause
Conjunctivits Pharyngitis Croup Meningoencephalitis Myocarditis Hepatitis
What are the symptoms of HFMD
Prodromal flu Viral URTI Mild unwell Sore throat Fever Exanthema rash + blisters over body which may be itchy Vesicles on HFM (painful and small) after 1-2 days Oral ulcers Anorexia Abdo pain Can get bacterial superinfection on top Rare cause of encephalitis
How do you Dx HFMD
Clinical
Smear vesicle as risk of HSV / VZV
PCR if very unwell
Serology may show past infection s
How do you treat HFMD
Analgesia + hydration
Supportive
DO NOT need exclusion
What causes Roseola infantum / Exanthema Subticum
HSV 6
What are symptoms of Roseola infantum
Fever May have coryza symptoms Maculopapular rash at end of 4th febrile day - starts on limbs Cough Diarrhoea Nagayana spot on uvula and soft palate
How do you treat Roseola infants
Supportive
Fluid and rest
What are complications of Roseola infantum
Febrile convulsion
If immunocompromised Enecphaliis Myocarditis Hepatitis Aspectic meningitis Thrombocytopenia GBS
What causes Slap Cheek / Erythema Infectiosum
Paravirus B19
What are the symptoms of slap cheek
Mild illness FLu Fever Headache Coryza symptoms Malar erythema on face + limbs 1-4 days after which can be itchy 6 weeks to fade
What do you do if exposed in pregnancy and why
IgG and IgM to see if susceptible
Can cause foetal death, hydrops fetalis, IUGR
GN, HSM, myocarditis
What are complications of slap cheek and who is at risk and what do you do for them
Usually none
At risk if immunocompromsied, pregnant, haematological conditions - sickle, thalassaemia, hereditary spherocytosis + haemolytic anaemia
- Serology to confirm Dx
- FBC + reticulocyte to look for aplastic anaemia
Arthritis
Aplastic crisis - if RBC short (sickle cell / thalassaemia)
How do you treat slap cheek
Self -limitng
Infectious prior to rash but not infectious once rash started
Ig and transfusion rarely needed
What causes glandular fever
EBV
CMV rare
What are the symptoms of glandular fever and complications
Anorexia Malaise Fever Lymphadenopathy Sore throat Petechiae on palate White exudate Fatigue Splenomegaly Intense itchy maculopapular rash if amoxicillin
Splenic rupture GN Thrombocytopenia Hameolytic anaemia Chronic fatigue Burkitt's lymphoma
How do you Dx
Monospot test
How do you treat
Abstain exercise 2 weeks as risk of splenic rupture
No Ax
Fluid
What is a clinical scenario of a child with tonsillitis
Fever 2+ days
Rash over face then body
Vomiting 24 hours - no bowel HX
Enlarged tonsils OE
What is Ddx
Tonsillitis
Scarlet fever?
Gastroenteritis - early
EBV - monospot test, enlarged spleen etc
What else could cause vomiting
Gastritis
Ketones
Large tonsils
How do you treat
Paracetamol 15mg / kg 4 hourly max 4 doses
Ibuprofen - anti-inflammatory
If septic / bacterial then won’t improve
Fluid therapy
NG if no access
What should you do for child vomiting
Always check BG
What are the symptoms of measles
Measle virus spread by respiratory droplet
Prodromal fever
Cough / conjuncitivtis / coryza triad
Koplik spot - white on buccal mucosa (pathognomic for measles)
Maculopapula rash on trunk - starts behind ears 4-7 days after fever
How do you Dx measles
IgM detected after rash
How do you Rx measles and when do you admit
Vaccine Vaccine if within 72 hours of contact Supportive Inform public health Admit if immunocompromised
Complications of measles
Sepsis Otitis media Hearing or vision loss Pneumonia Encephalitis Meningitis Febrile convulsion Corneal ulceration Diarrhoea Appendicitis Myocarditis Subacute sclerosis encephalitis 5-10 years later - Rapid onset dementia and neurodegeneration
What are the symptoms of mumps
Flu like prodrome Muscle aches Lethargy Fever Parotid gland / sunmandibular enlargemnet = classic Earache Pain on eating Meningeal signs = common
How do you Dx and treat
PCR saliva
Inform public health
Supportive -rest, fluid, analgesia
Vaccine to prevent
Complications fo mumps
Orchitis = common but infertility rare Arthritis Pancreatitis Meningoencepahlitis Seonsrineural hearing loss
What is Rubella and symptoms
Virus spread by respiratory droplets
Non-specific pink rash - erythematous and macular
Fever
Mild illness
Malaise
Generalised LN - behind ears and back of neck
Arthralgia if older
How do you treat
Vaccine
Supportive
Stay of school 5 days and avoid pregnant women
Inform public health
Complications of rubella
Thrombocytopenia Encephalitis Arthritis Miscarriage if in 1st trimester Congenital Rubella syndrome
What does paediatric HIV cause
PUO LN HSM Persistent diarrhoea Parotid enlargement Maculopapular rash Recurrent VZV / URTI Oral thrush FTT Development delay
What puts you at risk of neonatal candida
LBW Premature Immunocompromised Catheter Central line Broad Ax Parenteral nutrition H2 blocker Steroid Hypoerglycaemia Abdo surgery
What are TORCH infection
Toxoplasmosis Other - chlmydia/. HIV Rubella CMV HSV
What are common Sx of TORCH
SGA / LBW Microcephaly Fever Poor feed Purpuric rash HSM JAundice Anaemia Sensorineural deaf Cerebral palsy Developmental delay
What are extra signs of rubella congenital
Cataract / glaucoma
PDA or VSD
Sensorineural deaf
What are extra signs of congenital toxoplasmosis
Calcification
Hydrocephalus
Anaemia / HSM
How do you Rx
Mx specific
Vaccination
C-section
Avoid invasive
What causes threadworms
Entrobius vermacilus
Swallowing eggs often from water
What are symptoms of threadworms
Pruritus
Vulval in girls
How do you Dx
Sellotape to peri-anal area and send to lab
How do you treat
Mebendazole if >6 months
Anthemetic agent to all household
Hygiene
DDX of neck mass
Thyroglossal cyst
Branchial cyst
Cystic hygroma
LN
What would cause an enlarged LN
Malignancy
Infection
Autoimmune
Iatrogenic
What should you do if neck mass
Look for infection Examine testis as lymphoma spread Look for splenomegaly - EBV Look for other LN Blood - urgent FBC USS if unknown cause Biopsy Refer
What are you looking for in bloods
Cytopenia
Increased LDH
What should you beware of
Cervical LN
Non-tender
Fixed
What is blueberry muffin syndrome
Baby born with blue / purple spots / nodules
Due to extra-medullary erythropoiesis
Bleeding
Malignancy
What causes
Rubella
CMV
Metastatic neuroblastoma
