ENT, Eyes and Skin r/v, including viral exanthems Flashcards
features of chickenpox rash?
rash comes in crops for 3-5 days:
papules-vesicles-pustules-crusts
start on head and trunk, progress to peripheries
itchy
lesions may occur on palate
if new lesions appear beyond 10 days then suggests defective cellular immunity
cause of chickenpox?
primary infection with VZV (human herpesvirus 3)
complications of chickenpox?
in otherwise healthy children:
-secondary bacterial infection: staph, group A strep, can lead to TSS or nec fascit, consider sec bacterial infection if onset of new fever or persistent high fever after 1st few days.
- encephalitis: usually VZV-assoc. cerebellitis-usually about 1wk after rash onset, child ataxic with cerebellar signs, usually resolves within 1 mnth, can be generalised encephalitis, can be aseptic meningitis.
- purpura fulminans: result of vasculitis in skin and SC tissues. increased clotting risk in relation to VZV antiviral antibodies.
immunocompromised: -haemorrhagic lesions
- pneumonitis, viral pneumonia
- progressive and disseminated infection
- DIC
- nephritis
- arthritis
- pancreatitis
cause of measles?
RNA paramyxovirus
spread by droplets
presentation of measles?
prodrome: fever, irritable, conjunctivitis, cough
Koplik spots (before rash): white spots on buccal mucosa
RASH: discrete maculopapular rash starting from behind ears, spreads to involve whole body, becomes blotchy and confluent, may desquamate in 2nd week. develops 3 days after start of prodrome.
pt infective from prodrome until 4 days after rash starts
complications of measles?
encephalitits-typical occurrence 1-2wks following onset of illness-headache, lethargy, irritability, proceeds to convulsions and coma.
subacute sclerosing panencephalitis-may px 5-10 yrs following initial illness
febrile convulsions
keratoconjunctivitis and corneal ulceration
giant cell pneumonia
secondary bacterial infecton and otits media
tracheitis
myocarditis
hepatitis
appendicitis
diarrhoea
management of contacts of patient with measles?
if a child not immunised and comes into contact, then MMR vaccine should be given within 72hr
complications of mumps?
acute pancreatitis
infertility
complications of encephalitis that has developed as a result of measles?
seizures
deafness
hemiplegia
severe learning difficulties
what is subacute sclerosing pancencephalitis?
rare illness that develops 5-10 years after measles infection
those affected usually had measles under the age of 2
caused by variant of measles virus that persists in CNS
px-loss of neurological function, progresses over several yrs to dementia and death
high levels of measles Ab in blood and CSF, characteristic EEG abnormalities
measles tment?
symptomatic
infected children in hosptials need to be isolated
antiviral ribavirin may be use in immunocompromised children
Vit A given in developing countries to modulate immune response-children often Vit A deficient
typical presentation of hand foot and mouth disease?
mouth ulcers followed by a rash classically affecting hands and feet but also face, buttocks, legs and genitals
other features=fever, anorexia, sore throat, abdo pain, cough
occurs in outbreaks e.g. at nursery
cause of hand foot and mouth disease?
viral infection-pircornaviridae family-mostly coxsackie A16 and enterovirus 71
tx hand foot and mouth disease?
simple tment measures-analgesia, antipyretic, hydration
keep child off school if unwell
reassure no link to disease in cattle
likely cause of infection in an infant aged between 9 and 12 months with high fever, assoc. febrile convulsions and after a few days develops maculopapular rash on the chest?
herpes virus 6=roseola infantum
may be assoc. diarrhoea and cough
viral cause of ‘slapped cheek syndrome’?
parvovirus B19-rash characteristically on cheeks then spreads
most common complication of scarlet fever?
otitis media
cause of scarlet fever?
Group A haemolytic strep
viral cause of roseola infantum?
human herpesvirus 6
features of roseola infantum?
high fever, followed a few days later by maculopapular rash-affects trunk and limbs, not itchy
febrile convulsions
cough
diarrhoea
what is a port wine stain?
this appears as a flat purple/dark red patch on the skin, commonly on the face, from birth (although may become more noticeable with time), which is unlikely to resolve on its own (may need laser therapy)
result of malformed dilated capillaries
features of scarlet fever?
- fever
- malaise
- tonsillitis
- strawberry tongue (also seen with kawasaki disease)
- rash-fine punctate erythema (pin head), generally appears 1st on torso, although children often have a flushed face and perioral pallor. desquamation occurs later in course of illness.
scarlet fever management?
- throat swab normally taken but antibiotic treatment should be started immediately
- oral penicillin V (azithromycin if pen allergic)
- children can return to school 24hrs after starting antibiotics
- notifiable disease
scarlet fever complications?
- otitis media
- rheumatic fever-20 days post infection
- acute glomerulonephritis-10 days after infection
supportive management of chickenpox advised?
- keep cool, trim nails
- calamine lotion
- school exclusion until all vesicles have crusted over
*note immunocompromised patients should get VZIG, and if chickenpox develops IV aciclovir should be considered.
most common type of juvenile idiopathic arthritis: joint inflammation for at least 6 wks in child under 16yrs of age, with all other causes excluded?
oligoarticular:
child often under the age of 6 with 1-4 joints affected-swelling, stiffness and reduced movement, limited pain
child otherwise well
commonly knee and ankle
how is JIA diagnosis made?
clinical diagnosis investigations: FBC-normocytic anaemia, raised WCC, mild thromobcytosis raised ESR, CRP ANA RF, HLA-B27 viral or bacterial serology joint aspiration if suspect septic arthritis
JIA drug management?
- NSAIDs
- intra-articular steroids
- PO steroids for quick symptom relief, but risk of growth suppression and bone demineralisation. Topical steroids for eye involvement (*risk of glaucoma, cataracts-posterior subcapsular)
- MTX-1st line if multiple affected joints
- sulfasalazine and leflunoamide
- etanercept
complications of JIA?
- joint contractures and deformities
- uveitis, can cause blindness, need regular -ophthalmological r/v
- growth restriction-related to degree of inflammation
- osteoporosis
- psychosocial problems
