fever and rash in children

Question 1

measles - presentation

• constitutional sx prodrome
• rash
• other

Answer 1

constitutional sx. (prodrome)

• fever
• malaise
• cough, coryza
• conjunctivitis
• severity increases over 4 days

rashes and lesions
enanthem
- koplik spots in mucosa, day 2 of illness , 2 days before rash (pathognomonic)
exanthem
measles rash ~2 weeks after infection (?day 4)
- erythematous macules
- starts behind ears, neck, hairline
- progresses to face, trunk, arms, legs and feet
- may also have petechiae
- fades from start point to end point, on day 4, slowly

general

• headache
• abdo pain
• vomiting
• diarrhea
• myalgia

Question 2

measles - complications (6)

Answer 2

secondary bacterial infection - otitis media, bronchopneumonia
laryngotracheobronchitis
pneumonitis
post measles encephalomyelitis
subacute sclerosing panencephalitis

or by topdown
subacute sclerosing panencephalitis
post measles myeloencephalitis
otitis media
laryngotracheobronchitis
bronchopneumonia
pneumonitis

Question 3

rubella - presentation

Answer 3

constitutional symptoms

• 1-5 day prodrome of low-grade fever
• malaise
• upper resp symptoms (adults usually. kids don’t tend to get a prodrome)

rash
enanthem
- forchheimer spots; pinpoint petechiae on soft palate
exanthem
- generalized maculopapular rash, lasting 3 days. starts on face, spreads to neck trunk and arms. regresses in the same order it came up

immune rxn
- lymphadenopathy - occipital, postauricular, 1 week after exposure

Question 4

what are koplik spots

Answer 4

blue-white 1mm lesions in mouths of people who have measles. usually turns up day 2 of illness. pathognomonic of measle

Question 5

incubation period for

• measles
• rubella
• chickenpox

Answer 5

measles - 7-14 days
rubella - 12-23 days, usually 14
chickenpox - incubation for 10-21 days, usually 14-17 days

Question 6

congenital rubella syndrome

• when does it occur
• manifestations

Answer 6

occurs in women w/ 1st trimester pregnancies
can cause - miscarriage, fetal death, premature delivery
live birth wtih defects in eyes, ears, and heart

Question 7

scarlet fever - presentation

Answer 7

prodrome

• fever
• sore throat
• headache
• vomiting
• abdo pain

rash
enanthem - strawberry tongue
exanthem
- feels like sandpaper. red, finely punctate, 1-2mm papules that blanch
- starts in neck, axillae, groin and progresses to trunk and extremities

Question 8

what are forchheimer spots, what disease are they associated with

Answer 8

pinpoint petechiae on soft palate, suggests rubella

Question 9

erythema infectiosum - presentation

Answer 9

constitutional sx

• starts with acute febrile illness
• malaise
• resp pharynx sx
• myalgia
• arthralgia
• arthritis

rash

• abrupt occurrence on cheeks (slapped cheek)
• fiery red
• spares mouth, forehead, eyes
• spreads to body on day 1-2

Question 10

roseola infantum - presentation

Answer 10

prodrome
- fevers up to 40C. for 3-5 days, up to 40C then defervesce
- URTI sx.
- abdo pain
- lymphadenopathy
rash
- develops after fever defervesces
- rash for 1-2 days; mostly on trunk, rarely in face or limbs
- small rose-pink or red raised spots (2–5 mm in diameter) that blanch (turn white) when touched
- gets better by 3-5 days

Question 11

chickenpox - presentation

Answer 11

prodrome
- rash
- fever (37.8 - 39.4c) 
- malaise
- sometimes low grade fever and malaise precede the rash
rash
- maculopapules, vesicles and scabs 
- start on face and trunk then progress elsewhere

Question 12

chickenpox

• incubation period
• infectious period

Answer 12

incubation for 10-21 days, usually 14-17 days

infectious for 48h before rash, and stops when all vesicles crust up