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2H Pedia > FEVER AND RASH > Flashcards

FEVER AND RASH Flashcards

1
Q

_________: 4 serotypes
•Carried by Aedes aegypti
•

A

•Dengue virus

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2
Q

____________ is usually associated with secondary dengue infections

A

Dengue hemorrhagic fever

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3
Q
  • Etilogy: RNA virus (Paramyxoviridae Family)
  • Mode of Transmission: by droplet spray during the prodromal period
  • Period of communicability: 4 days before & 4 days after the onset of the rash
A

RUBEOLA (MEASLES)

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4
Q

Pathognomonic Sign:
•Koplik spots
Øgrayish white dots with red border opposite the lower molars
Øappear before the prodrome

A

RUBEOLA/ MEASLES

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5
Q

WHAT ARE THE 3C’s prodrome in rubeola/ measles?

A

•prodrome: high-grade fever + 3 C’s (conjunctivitis, cough, coryza) for 3-5 days

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6
Q
  • @ height of fever: maculopapular rash appears on the hairline or face and spreads cephalocaudally
  • Rash fades downward à branny desquamation and disappears within 7-10 days
A

RUBEOLA/ MEASLES

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7
Q

•Vitamin A:
–single dose
–100,000 IU orally for 6 mo-1 yr
–200,000 IU for > 1 yr old
–Especially indicated for hospitalized patients & with complications (ophthalmologic evidence of vitamin A deficiency & malnourished patients)

A

Rubeola/ measles

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8
Q

Measles: Complications

A
  • Otitis media
  • Pneumonia
  • Encephalitis (Subacute sclerosing panencephalitis)
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9
Q
  • Caused by: altered measles virus harbored intracellularly in CNS
  • Occurs 7-10 years post measles infection
A

Subacute sclerosing panencephalitis

(SSPE)

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10
Q

What happens in the stage 1 of SSPE?

A
  • Stage 1
  • Subtle changes in behavior & deterioration of schoolwork, decreased attention span, temper outbursts
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11
Q

What happens in the stage 2 of SSPE?

A
  • Stage 2
  • Massive, repetitive myoclonic jerks esp. of the axial muscles
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12
Q

What happense in the stage 3 of SSPE?

A
  • Stage 3
  • Choreo-athetosis, rigidity, dystonia, decreased sensorium, dementia, stupor, coma
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13
Q

What happens in stage 4 of SSPE?

A
  • Stage 4
  • loss of central control for breathing, heart rate, blood pressure
  • è death
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14
Q
  • Due to RNA virus of Togaviridae family
  • Spread by oral droplet or transplacentally to the fetus
  • Period of highest communicability: 5 days before & 6 days after the onset of the rash
A

German Measles/ Rubella

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15
Q

•Forchheimer spots
Ødiscrete rose spots on the soft palate
Øjust before the onset of rash
20% of patients

A

Rubella: Clinical Manifestations

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16
Q

The Rash

  • can be the first symptom to appear
  • maculopapular rash begins on the face and spreads quickly cephalocaudally
  • Duration: 3 days
  • w/o desquamation

•low grade fever for 1-3 days
•retroauricular, posterior cervical & suboccipital lymphadenopathy (begins 24 hrs before the rash and remains for 1 week)
•Polyarthritis esp.in older girls

A

RUBELLA

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17
Q

RNA virus

(Togaviridae Family→ replicates in the respiratory epithelium
•spreads to regional lymph nodes→spreads to regional lymph nodes

A

RUBELLA

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18
Q

Risk for congenital defects & disease is greatest with primary maternal infection during the 1st trimester

A

Congenital Rubella

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19
Q
  • Intrauterine growth retardation
  • Congenital cataracts
  • Microcephaly
  • Structural heart defects like PDA
  • “blueberry muffin” skin lesions
  • Sensorineural Hearing Loss
  • Motor and mental retardation
A

Congenital Rubella

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20
Q
  • Human herpesvirus type 6
  • Aka Exanthem Subitum, Sixth disease
A

ROSEOLA

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21
Q

•High grade fever for 3-5 days
•Rash appears coincident with resolution of fever
•Rash: small, evanescent morbilliform, blanching, pink (rose-colored) rash
•Appears on trunk è to face & extremities
lasts for 1-3 days

A

ROSEOLA

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22
Q

•Nagayama spots: ulcers at uvulopalatoglossal junction
•Mild injection of pharynx, palpebral conjunctivae, or tympanic membranes
•Enlarged suboccipital nodes
•
Pathophysiology: Unknown

A

ROSEOLA

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23
Q
  • _____________is a neurotropic human herpes virus
  • Chickenpox: primary infection

•Period of communicability: 1-2 days before the rash until all lesions have crusted

A

Varicella zoster virus

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24
Q

•_________ activation of latent sensory ganglion neurons

A

Herpes Zoster (shingles):

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25
Q
  • The Rash
  • Trunk àother parts of the body
  • Macule/papuleà vesicleà crust
  • In various stages are of evolution
A

Varicella

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26
Q

Pathogenesis:

Human herpes virus

  • Inoculates in mucosa of the upper respiratory tract and tonsilar lymphoid tissue
  • spreads to reticuloendothelial system
  • Viremia è Cutaneous lesions
A

Varicella

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27
Q
  • The Rash
  • same as varicella with severe pain & tenderness along the posterior nerve roots
A

Herpes Zoster

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28
Q
  • The Rash
  • same as varicella with severe pain & tenderness along the posterior nerve roots
A

herpes zoster

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29
Q

Human herpes virus

  • Transported via sensory axons to the dorsal root ganglia (during 10 infection)
  • Latent infection in neurons and satellite cells
  • reactivatiionè rash within dermatomal distribution
A

Herpes Zoster

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30
Q

What are the secondary complications of Varicella?

A
  • secondary bacterial infection
  • encephalitis or meningitis
  • Pneumonia
  • glomerular nephritis
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31
Q
  • Fetuses infected at 6-12 wks of gestation have maximal interruption of limb development à short & malformed limbs covered with cicatrix – skin lesion with zigzag scarring
  • Fetuses infected at 16-20 wks of gestation - eye & brain involvement
A

Congenital Varicella

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32
Q
  • Most common cause: Coxsackievirus A16
  • Enterovirus 71: more severe
A

HAND, FOOT & MOUTH DISEASE (HFMD

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33
Q

The Rash

ØTender maculopapular, Ulcerative intraoral lesions on tongue & buccal mucosa
Øvescicular, pustular lesions on hands & feet

A

HFMD

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34
Q

What are the complications of HFMD

A

•Complication: myocarditis, pericarditis, shock

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35
Q
  • parvovirus B19
  • Common in 5-15 years old
  • Transmission: large droplet spread & blood transfusion
A

ERYTHEMA INFECTIOSUM

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36
Q
  • Fifth disease
  • Incubation period: 16-17 days
  • Infectious stage: low grade fever, malaise, rhinorrhea
  • post-infectious stage: Rash, joint pains
A

ERYTHEMA INFECTIOSUM

37
Q

Parvoviris B19

  • Viremia
  • Fever, Malasie,
  • rhinorrhea

Attacks erythroid cell line
•Fall in hemoglobin
•transient arrest of erythropoiesis

A

ERYTHEMA INFECTIOSUM: Infectious stage

38
Q

ERYTHEMA INFECTIOSUM

Fall in Hemoglobin and arrest of eryhtropoiesis is DANGEROUS for:

A
  1. Immunocompromisedà chronic infection (chronic anemia)
  2. chronic hemolytic diseaseà transcient aplastic crisis
  3. pregnant women (fetus) à fetal anemiaàfetal demise
39
Q

Tx for Erythema Infectiosum

  1. Immunocompromisedà chronic anemia: __________
  2. chronic hemolytic diseaseà transcient aplastic crisis: ____________
  3. pregnant women (fetus) à fetal anemia: ______
A
  1. IVIG
  2. PRBC transfusion
  3. in-utero rbc transfusion
40
Q

ERYTHEMA INFECTIOSUM:
Post infectious stage

A
  • Th-1–mediated cellular immune response→
  • production of specific immunoglobulin M (IgM) antibodies→
  • formation of immune complexes→
  • deposition of the immune complexes in the skin, joints

Rash, Arthralgia

41
Q

RASH: 3 phases

I: “slapped-cheek” è macular erythema on trunk & proximal extremities è Central clearing

II: lacy, reticulated appearance

•Fades without desquamation

III: wax & wane in 1-3 weeks

A

Erythema Infectiosum

42
Q
  • Neisseria meningitidis
  • Groups A, B, C, W135, Y – more common
  • 6-12 months age group
  • Secretions from colonized upper RT of patients & asymptomatic carriers

•Mode of transmission: person to person through infected droplets
•Period of communicability: until 24 hours after start of antibiotics
•Asymptomatic colonization to fulminant sepsis
•

A

MENINGOCOCCEMIA

•Mode of transmission: person to person through infected droplets
•Period of communicability: until 24 hours after start of antibiotics
•Asymptomatic colonization to fulminant sepsis
•

43
Q

•Clinical Manifestations

•Abrupt onset of fever, chills, headache, vomiting
•Rapid worsening of symptoms within hours
•Diffuse adrenal hemorrhage, DIC, coma and death à Waterhouse-Friderichsen syndrome
•
•

A

MENINGOCOCCEMIA

44
Q
A

Menigococcemia

45
Q
A

N. meningitis

46
Q

Rocky Mountain Spotted Fever (RMSF)
causative agent is________ –intracellular bacteria
•Ticks: natural host, reservoir, vectors

A

Rickettsia rickettsii

47
Q

Rocky Mountain Spotted Fever Clinical features
•What is the Triad: ____________
•Calf muscle pain and tenderness
•GIT: nausea, vomiting, diarrhea, abdominal pain

A

Fever, headache, rash

48
Q
A

RMSF

49
Q

The rash
–Discrete, pale, rose-red blanching maculopapules on ankles, wrist, lower limbs, spread to trunk
– petechiael or hemorrhagic
– echymoses, necrotic (in severe cases)

A

RMSF

50
Q

Rocky Mountain Spotted Fever Treatment
_____________ (drug of choice)

A
51
Q

_________________
RITTER DISEASE
•Common in less than 5 yrs old
•Most common cause: phage group 2 staphylococci, particularly strains 71 and 55

A

Staphylococcal Scalded Skin Syndrome (SSSS)

52
Q

: Clinical Manifestations
•Rash may be preceded by malaise, fever, irritability, and exquisite tenderness of the skin
•Scarlatiniform erythema develops diffusely and is accentuated in flexural and periorificial areas
•The conjunctivas are inflamed and occasionally become purulent

A

SSSS

53
Q

The Rash
•Brightly erythematous skin  wrinkled appearance  blisters and erosions
•Circumoral erythema, radial crusting and fissuring around the eyes, mouth, and nose

A

SSSS

54
Q

Nikolsky sign = areas of epidermis may separate in response to gentle shear force
•Large sheets of epidermis may peel away

 moist, glistening, denuded areas

 secondary cutaneous infection
•Desquamative phase begins after 2–5 days of cutaneous erythema
•Healing occurs without scarring in 10–14 days

A

SSSS

55
Q

SSSS: Treatment

A
  • Antibiotics: Oxacillin
  • Clindamycin may be added to inhibit bacterial protein (toxin) synthesis
  • The skin should be gently moistened and cleansed
  • Application of an emollient provides lubrication and decreases discomfort
56
Q
  • Menstruating women 15-25 yo
  • Use of tampons
  • Non-menstrual TSS: nasal packing, wound infection, sinusitis, tracheitis, pneumonia, emphysema, abscess, osteomyelitis, burns
A

Staphylococcal Toxic Shock Syndrome

57
Q

Staphylococcal Toxic Shock Syndrome: Diagnostic Criteria

A

Major Criteria (all required)
Acute Fever >38.8C
Hypotension
Rash (erythroderma w/ convalescent desquamation)

58
Q

Staphylococcal Toxic Shock Syndrome: Diagnostic Criteria

A

Minor Criteria (3 or more)
Mucous membrane inflammation
Vomiting, diarrhea
Renal abnormalities
Liver abnormalities
Muscle abnormalities
CNS abnormalities
Thrombocytopenia (<100,000/mm3)

59
Q

Staphylococcal Toxic Shock Syndrome: Diagnostic Criteria
Exclusionary Criteria

A

Absence of another explanation
Negative blood culture (except for Staph.aureus)

60
Q
A

SSSS

61
Q
A

pathogenesis Scarlet and SSSS

62
Q

____________: Clinical Manifestations
•The Rash
–begins around the neck and spreads over the trunk and extremities
–papular, erythematous rash that blanches on pressure and feels rough (sandpapery)
–lasts 3–4 days fades desquamation

A

Scarlet Fever

63
Q

__________: Clinical Manifestations
•Fever
•Pharyngitis
•Strawberry tongue

A

Scarlet Fever

64
Q
A

Scarlet Fever: Strawberry tongue

65
Q

________________
•Fever, rash
•Shock
•Multiorgan system failure

A

Streptococcal Toxic Shock Syndrome

66
Q

Streptococcal Toxic Shock Syndrome: Cinical Criteria
•Hypotension + 2 or more of the ff:

A

Renal impairment
Coagulopathy
Hepatic impairment
Acute Respiratory Distress Syndrome
Generalized erythematous macular rash
Soft tissue necrosis

67
Q

_____________
Definition:
___________ is an autoimmune disease affecting the heart and extra- cardiac sites (joints, brain, skin and others)
•Develops 2-3 weeks after an acute episode of pharyngitis
Group A Strep (GAS)

A

Rheumatic Fever (RF)

68
Q

Jone’s Criteria f

What are the major classification?

A
  • Carditis
    (friction rub, murmur, cardiomegaly, CHF)
  • Arthritis
    (migratory polyarthritis, swollen, red, tender)
  • Chorea
  • Subcutaneous nodules
  • Erythema marginatum
69
Q

Jone’s Criteria

What are the minor classification?

A
  • Fever
  • Arthralgia
  • Acute phase reactants (ESR, C-reactive protein, leukocytosis)
  • Prolonged P-R interval on ECG
70
Q

___________
•2 Major Criteria
•OR
•1 Major + 2 Minor Criteria + supporting evidence of antecedent Group A streptococcal infection

A

Jones Criteria

71
Q

__________
characterized by the development of Aschoff’s Bodies within the myocardium
Gross features:
•Aschoff bodies are multiple tiny nodules (1-2 mm in diameter)

A

Carditis:

72
Q

Microscopic features:

  1. Fibrinoid necrosis ( destroyed fragmented collagen)
  2. Surrounded by lymphocytes and histiocytes &
  3. Aschoff cells (large mononuclear or multinuclear macrophages)
A

Aschoff’s body

73
Q
A

Rheumatic Mitral Valve

74
Q
A

Erythema Marginatum

75
Q
A

secondary prevention RF

76
Q

_______________
•Acute febrile vasculitis
•Affects medium-sized artery w/ striking predilection for the coronary arteries
•20% of untreated cases develop coronary artery aneurysm
•Unknown cause

A

KAWASAKI DISEASE

77
Q

KAWASAKI

Fever x 5 days + 4 of the ff:

A

CONJUNCTIVA –bilateral, non-exudative
RASH -
ADENOPATHY – unilateral, cervical, >1.5cm
STRAWBERRY TONGUE, erythema of oropharyngeal mucosa, dry cracked lips
HANDS & FEET EDEMA
CRASH & BURN

78
Q

_____________
•The Rash
–Maculopapular
–Erythema multiforme or
–Scarlatiniform

A

KAWASAKI DISEASE

79
Q

__________
•Conjunctivitis
•Strawberry tongue
•Perineal desquamation

A

KAWASAKI DISEASE

80
Q

Periungual desquamation

A

Kawasaki Disease

81
Q

KAWASAKI DISEASE Clinical Phases
Phase
Symptoms
Timing
ACUTE Febrile

A

•CRASH & BURN
•Perineal desquamation
•Myocarditis
1st-2nd week of illness

82
Q

What is the SUBACUTE phase of Kawasaki?

A
  • Fever has resolved
  • Irritability, conjunctivitis,anorexia
  • Periungual desquamation of fingers and toes
  • Arthritis
  • CORONARY ARTERY ANEURYSM
83
Q

What is the CONVALESCEN phase of Kawasaki?

A

CONVALESCENT
•Clinical signs and symptoms have abated
•ESR and CRP still elevated
Until 6-8 weeks after onset

84
Q
  • Main symptom: Arthritis
  • Systemic-onset JRA: fever and rash
  • Other types: oligoarthritis and polyarthritis
A

Juvenile Rheumatoid Arthritis (JRA)

85
Q

Systemic-onset _____________ Clinical Features
•Fever
•Rash
•Arthritis
•Visceral involvement
•Hepatosplenomegaly, lymphadenopathy, serositis
•(+)Koebner phenomenon

A

JRA

86
Q

Systemic-onset JRA Clinical Features
•The rash
–Transient/Evanescent (<1hr)
–Faint, erythematous, salmon-colored, macular, linear or circular on trunk and proximal extremities
–Non-pruritic

A

JRA

87
Q
A

Systemic-onset JRA Clinical Features

88
Q
A

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