Fever and a Rash Flashcards
What do papular and macular rashes have in common? What is different?
Both are blanching
Papular is raised, macular is flat
DDx for fever and petechiae and purpura?
Infection
- Viral - enterovirus
- Bacteria - meningococcal, pneumococcal, Hib
Non-infectious
- HSP
- ITP & disorders of platelet function
- HUS
- Leukaemia, bone marrow infiltration
- Traumatic/mechanical
- Cough, torniquet
What are some factors that indicate a fever + petechiae is bacterial sepsis?
Unwell
Abnormal white cell count
Purpura
What are some other presenting features of meningococcal?
Leg or muscle pain
Rigors
Cold hands and feet
Purpura
How is meningococcal Ix?
Blood cultures
CSF
PCR
?Skin biopsy
How is meningococcal Mx?
Abx: 3rd gen cephalosporins
Intensive supportive management
Notifiable disease
Chemoprophylaxis less than 24 hours - rifampicin, ceftriaxone (pregnancy) - for household contacts
What is the role of rifampicin in meningococcal?
Decolonisation
What are the complications of meningococcal?
Shock DIC Adrenal haemorrhage Gangrene Developmental delay Hearing loss
What is the organism in roseola?
Human herpes virus 6
What is the rash in roseola?
Non-pruritic, painless
Maculopapular
Typically confined to the trunk
What is roseola associated with?
Febrile convulsions
When does the rash appear in slapped cheek?
At the end
What is the course of slapped cheek?
Prodrome: fever, diarrhoea, coryza
Rash once well
What is a complication of slapped cheek?
Arthritis
Myocarditis
Transient Aplastic crisis
Hydrous fetalis
What are the 3 C’s of measles? And other symptoms?
Conjunctivitis
Coryza
Cough
Fever
Koplik’s spot
Rash
What is the natural history of measles?
10 days of asymptomatic period
4 days of infectious prodrome
Rash up to 10 days
What are the complications of measles?
Pneumonitis and pneumonia - 55% (staph usually) Encephalitis - 1/1000 Subacute sclerosing panencephalitis Death in 1/300 Foetal death
How do you protect susceptible measles contacts?
MMR vaccination if within 72 hour
Ig if between 72 and 7 days
- If less than six months, no Ig unless mother is case or has no immunity
How does rubella present?
Prodrome: fever, sore throat, red eyes, headache, malaise, lymphadenopathy (peri-auricular)
Erythematous, fine maculopapular rash
Face > body > limbs
Mild illness
What do you worry about with rubella?
Congenital rubella
How does scarlet fever present?
Acute pharyngitis
Widespread sandpaper like rash with peri-oral sparing
What causes scarlet fever?
Strep pyogenes
How does toxic shock present? What causes it?
Toxin mediated rash
Toxins from Staph aureus, Group A strep
Tampon use
How is toxic shock Mx?
Circulatory support
Abx
- IV penicillin, fluc, clindamycin, Ig
What are the features of kawaski’s?
Desquamation of finger tips and genitals Rash hands and feet Conjunctivitis Cervical lymphadenopathy Strawberry tongue Dry cracked lips
What the mnemonic for KD?
C - Conjunctivitis
O - Oedema
L - Lymphadenopathy
D - Dry cracked lip, desquamation
S - Strawberry tongue
O - Ongoing fever
R - Rash
E - Erythema
A - Aspirin E - Echocardiogram I - Ig O - anti-steptolysin O U - Up to date with vaccinations
What are some complications of KD?
Coronary aneurysms
How does chicken pox present?
Prodrome: fever, malaise, anorexia
Rash: pruritic macules, papules, chest
How is chickenpox treated?
Aciclovir
- Only if neonate, immunocompromised, pneumonia, older kids
When get secondary prophylaxis?
Pregnant women
Neonates whose mother develops peri-delivery
What is erysipelas?
Infection of upper dermis and superficial lymphatics
What is the classic sign of necrotising fasciitis?
Pain out of keeping with clinical signs
