Fever and rash syndromes in children Flashcards
What is an elevated solid lesion <1cm?
Papule
What is an elevated solid lesion >1cm?
> 1cm nodule
> > 2cm plaque
What is a flat area of altered colour/texture <1cm?
Maculae
What is a flat area of altered colour/texture >1cm?
Patch
What is a fluid filled lesion <1cm?
Vesicle
What is a fluid filled lesion >1cm?
Bullae
What is a pus filled lesion <1cm?
Pustule
What is a pus filled lesion >1cm?
Abscess
What is extravasation of blood <1cm?
Petechiae (pinhead)
Purpura
What is extravasation of blood >1cm?
Ecchymoses
Haematoma
What is dermal edema <1cm?
Wheal
What is dermal edema >1cm?
Angioedema
Name types of non-infectious fever/rash syndromes
Allergic (immune-mediated)
Inflammatory/rheumatological
Oncological
Name types of allergic/immune mediated fever/rash syndromes
Urticaria
Erythema multiform
SJS and TEN
Name infectious causes of urticarial rash
Bacteria
- m pneumonia
- GAS
- shigella
- meningococcus
- yersinia
Viruses
- EBV
- HBV
- HIV
- enteroviruses
Other
- parasites
- insect bites
What is the most common infectious cause of erythema multiform?
HSV
What are the features of DRESS (drug reaction with eosinophilia and systemic symptoms)?
Extensive skin rash
Visceral organ involvement
Lymphadenopathy
Eosinophilia
Atypical lymphocytosis
Which antibiotics are high risk for DRESS?
Vancomycin
Sulfonamides
Minocycline
RIPE
Name rheumatological causes of fever/rash syndromes
Juvenile idiopathic arthritis
Kawasakii
SLE
Dermatomyositis
HSP
MIS-c
Haematophagocytic lymphohistiocytosis
What is MIS-c?
Multisystem inflammatory syndrome associated with covid 19
What is the diagnostic criteria for Kawasaki?
- Fever for at least 5 days
- 4 of the following clinical features
- bilateral bulbar conjunctival injection without exudate
- erythema and lip cracking, strawberry tongue, erythema of oral and pharyngeal mucosa - Cervical lymphadenopathy
- Maculopapular diffuse erythroderma or erythema multiform-like
- Erythema and edema of hands and feet +/- nail desquamation
What is the diagnostic criteria for hemophagocytic lymphohistiocytosis?
5 of the following
- fever >38.5
- splenomegaly
- peripheral cytopenia
- hypertriglyceridema +/- hypofibrinogenaemia
- hemophagocytosis in BM, spleen, liver, LN
- low or absent NK cell activity
- ferritin >500ng/ml
- elevated soluble CD25
- elevated CXCL9
Name common causes of viral exanthems
Measles (rubeola)
Rubella (German measles)
Roseola (exanthema subitum HHV6)
Fifth disease (erythema infectiosum parvovirus B19)
Chickenpox (VZV)
Enterovirus
EBV (mononucleosis)
Gianotti-Crosti syndrome (EBV, HBV, coxsackie)
What is the method of transmission of measles?
Droplet spread
What are the clinical features of measles?
Maculopapular rash
Koplik spots
Conjunctivitis
Coryza
Cough
Name complications of measles
Respiratory
- pneumonia
- 2ndary bacterial infection
- OM
Neurological
- febrile seizures
- encephalitis
- SSPE
Other
- diarrhoea
- hepatitis
- appendicitis
- corneal ulceration
- myocarditis
How is chickenpox transmitted?
Respiratory droplets
What are the clinical features of chickenpox?
Central vesicular rash that progresses to peripheries (itchy) for 3-5d
What are complications of chickenpox?
Bacterial superinfection
CNS
- cerebellitis
- encephalitis
- aseptic meningitis
Immunocompromised
- pneumonitis
- dissemination
Name common bacterial exanthems
Scarlet fever
SSS
TSS
Meningococcemia
Rickettsia
What are the linear petechial feature of scarlet fever rash called?
Pastia’s line
What skin quality is associated with scarlet fever?
Sandpaper
Which toxin causes SSS?
Epidermolytic exotoxin
Which sign is seen in SSS?
Nikolsky
What are the clinical signs of TSS?
Fever
Rash
Desquamation
Hypotension
Multisystem organ involvement
