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LMCC Study - Peds > Infections characterized by fever and rash > Flashcards

Infections characterized by fever and rash Flashcards

1
Q

What are Koplik spots?

A
  • gray-white, sand grain sized dots on the buccal mucosa opposite the lower molars
  • Pathognomonic of measles
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2
Q

What causes the measles?

A

Measles virus

- Single stranded RNA virus

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3
Q

What are the four phases of measles infection?

A

1) Incubation (8-12 days)
2) Prodrome (3 days) CCCPK
- Cough
- Conjunctivitis
- Coryza (inflammed mucosa in the nose)
- Photophobia
- Koplik spots
- Often High fever (over 40)
3) Exanthematous rash
4) Recovery
- Macular rash begins above hairline and speads caudally over most of body

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4
Q

What is the treatment for measles?

A

Supportive care

  • Hydration
  • Antipyretics
  • Vitamin A supplementation x 2 days
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5
Q

What is the most common cause of death in a patient with the measles?

A
  • Bronchopneumonia
  • Encephalitis
  • Late deaths due to panencephalitis (immune encephalitis 8-10 years after infection)
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6
Q

In Ontario when are children vaccinated for measles?

A
  • 12 months of age with MMR vaccine

- Between 4 and 6 with MMRV vaccine

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7
Q

What are contraindications to the measles vaccine?

A
  • Immunocomprimised
  • Immunosuppressive dose of corticosteroids
  • Pregnancy
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8
Q

German measles or 3-day measles is another name for what?

A
  • Rubella
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9
Q
  • What causes Rubella?
A
  • Rubella virus

- Single stranded RNA virus

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10
Q

How are measles spread? When is someone contagious?

A
  • Highly contagious
  • Transmitted by droplets or by airborne route
  • Infectious period is 1-2 days before symptoms until the rash has been present for 4-5 days
  • Boot camp says 5d before and 4d after rash IMPORTANT
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11
Q

How is rubella spread? When is someone contagious?

A
  • Most contagious through direct or droplet contact with nasopharyngeal secretions
  • Contagious from 7 days before until 14 days after the appearance of rash (most from 2 days before to 5-7 days after)
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12
Q

What is congenital rubella syndrome?

A

Refers to the variable constellation of birth defects associated with intrauterine rubella infection
- Including: Hearing impairment, growth restriction congenital heart defects, cataracts, congenital cataracts, pigmentary retinopathy and more

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13
Q

What is the incubation period for post natal rubella?

A

14-21 days (2-3 weeks)

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14
Q

What are the clinical manifestations of rubella?

A

1) Lymphadenopathy
- RETROAURICULAR and PREAURICULAR
- posterior cervical
- posterior occipital
2) Maculopapular rash
- Begins on face
- Spreads to body
- Lasts 3 DAY RASH
- Less prominant than measles rash
3) Forchheimer spots
- 20% of pts
4) Other
- Mild pharyngitis
- Conjunctivitis
- Anorexia
- Low grade fever
- Polyarthritis of hand

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15
Q

What are forchheimer spots?

A
  • Small petechiae of the soft palate
  • Occur in 20% of rubella cases
  • Typically occur before rash
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16
Q

How is rubella managed?

A

Supportive therapy

  • hydration
  • Antipyretics
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17
Q

When are vaccines against rubella given in Ontario?

A
  • 12 months MMR

- between 4-6 MMRV

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18
Q

What is roseola infantum also known as? What causes it?

A
  • 6th disease or Exanthem subitum
  • Caused by human herpes virus type 6
  • Double stranded DNA virus
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19
Q

What are the clinical features of roseola infantum?

A
  • High fever (often >40)
  • Abrupt onset
  • Lasts 3-5 days
  • Macrulopapular rose coloured rash that begins as fever subsides typically (may occur earlier)
  • Rash typically lasting 1-3 days
  • Febrile seizures
  • URTI symptoms
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20
Q

What is the treatment for roseola infantum?

A
  • Supportive care (fluids, antipyretics)

- In immunocompromised hosts ganciclovir or foscarnet can be used

21
Q

What is erythema infectiosum also called? What causes it?

A
  • Fifth disease (slap cheek)
  • Parvovirus B19
  • Single stranded DNA virus
22
Q

What are the clinical manifestations of of erythema infectiosum?

A

1) Begins as mild non-specific illness
- fever
- malaise
- myalgia
- headache
2) Rash in 3 stages (7-10 days after prodrome)
a) slapped cheek rash
b) erythematous symmetric maculopapular rash 1-4 days later
c) lacy, reticulated rash that lasts 2-40 days (mean 11)

23
Q

What can parvovirus B19 do to red blood cells?

A
  • Virus can bind to erythrocyte progenitor cells preventing them from developing
  • Only significant in those with shortened RBC lifespan (hemolytic anemias such as sickle cell, spherocytosis, thalassemia)
  • If this occurs they may develop a transient aplastic crisis lasting 7-10 days
  • Very low retics, low HgB
24
Q

What is the treatment for erythema infectiosum?

A
  • Supportive care (hydrate, antipyretic)

- Transfusions may be needed for aplasic crisis

25
Q

Infection with parvovirus B19 during pregnancy is associated with a risk of what to the fetus?

A
  • Fetal death

- Hydrops fetalis

26
Q

What causes the chicken pox?

A
  • Varicella-zoster virus

- Double stranded DNA virus

27
Q

When is chicken pox contagious?

A
  • 2 days before the onset of rash until the lesions are crusted over (typically 7 days)
28
Q

How is varicella zoster virus transmitted?

A
  • Direct contact
  • Droplet
  • Air
29
Q

What are the clinical features of varicella?

A

1) generally occurs 14-16 days after exposure
2) Prodrome (1 day prior to rash)
- fever
- malaise
- anorexia
3) Rash
- small red paupule that progress to nonumbilicated oval vesicles on erythematous base
- Marked puritis
4) Healing
- Fluid from clear to cloudy
- Vesicles ulcerate, crust and heal

30
Q

Describe the rash seen in varicella

A
  • Small red paupule that progress to nonumbilicated oval vesicles on erythematous base
31
Q

After resolution of varicella, the virus persists in latent form where?

A
  • Dorsal root ganglia cells
32
Q
  • Reactivation of the varicella virus causes what?
A
  • Herpes zoster (shingles)
33
Q

intense localized pain alone a dermatome with an eruption of pupules that quickly vesiculate is most likey caused by what?

A
  • Zoster (Shingles)
34
Q

A zoster infection to which nerve may cause corneal and intraoral lesions?

A

Cranial Nerve V

35
Q

What is ramsay hunt syndrome? What triad is associated with it?

A

1) Zoster affecting cranial nerve VII
- Other cranial nerves may be involved as well

2)
a. Ipsilateral facial paralysis
b. ear pain
c. vesicles in auditory canal and auricle

36
Q

When would you consider treating a patient with varicella with valacyclovir (or similar)? Why?

A

1) Those at risk of severe varicella
- Immunocompromised
- unvaccinated person over age 12
- Chronic cutaneous or pulmonary disease requiring steroids
- Long term salicylate use (^ risk of reye syndrome)

2) Treated to prevent severe complications:
- Pnemonia
- Encephalitis
- Death
* Note dose of antivirals higher with varicella than with zoster

37
Q

Why is varicella screened for in pregnancy?

A
  • A severe form of neonatal varicella may develop in newborns of mothers with varicella (not shingles) occuring 5 days before to 2 days after delivery
  • Fetus is exposed to large amount of the the virus but is born before maternal antibody response develops and can cross placenta
38
Q

What type of vaccine is the varicella vaccine? When is it given in Ontario?

A
  • Live attenuated
  • Given at 15 months as single varicella vaccine
  • Second dose between 4 and 6 years part of combined MMRV
39
Q

What is kowasaki disease?

A
  • A vasculitis of unknown etiology that is characterized by multisystem involvement and inflammation of medium-sized arteries with resulting aneurysm formation
40
Q

For kowasaki disease:

a) Which age group is affected?
b) Which ethnic group is most affected

A

a) Children under 5 years (peaks between 2 and 3)

b) Highest frequency in Japan

41
Q

What are you most worried about in a child with kowasaki disease?

A
  • Coronary artery aneurysm
42
Q

What are the 3 phases of kowasaki disease? explain them

A

1) Acute phase (1-2 weeks)
- sudden onset high fever (>40) w/o source
- conjunctival erythema
- mucosal changes (dry cracked lips, STRAWBERRY TONGUE)
- cervical lymphadenopathy
- Swelling of hands and feet
- Rash in 80% most often inguinal region and chest

2) Subacute phase (weeks 3 and 4)
- Gradual resolution of fever
- Desquamation of skin
- Thrombophilia
- Coronary artery aneurysm

3) Convalescent phase
- Begins with disappearance of clinical signs and continues until ESR normalizes
- Beau lines of fingernails may appear (horizontal grooves in nail)

43
Q

Describe how you would work up a suspected case of kowasaki disease?

A

1) Rule out other causes of fever
- blood and urine culture
- CXR
- consider lumbar puncture
2) Inflammatory markers
- CRP, ESR, WBC
3) Evaluate for coronary artery aneurysm with echo
- In acute phase
- repeat at 2-3 weeks
- repeat again at 6-8 weeks

44
Q

What are the diagnostic criteria for kowasaki disease?

A

1) Presence of fever for more than 5 days without identified source

2) 4+/5 of:
a) bilateral conjunctivitis (no pus)
b) oral mucous membrane changes
- 1+ of:
- pharyngeal injection
- dry fissured lips
- injected lips
- strawberry tongue
c) 1+ changes to extremities
- peripheral erythema
- peripheral edema
- periungual desquamation (fingers or toes)
- general desquamation
d) Cervical lymphadenopathy >1.5cm
e) disease not explained by other known disease process

45
Q

How is kowasaki disease managed?

A

1) Intravenous immunoglobulin (IVIG)
- single dose (2g/kg) over 12hr

2) ASA
- anti-inflammatory dose during acute phase (80-100mg/kg/day) divided q6h
- After acute phase 3-5mg/kg/day until final echocardiogram f/u at 6-8 weeks

3) Echo
- during acute phase
- again at 2-3 wks
- again at 6-8 wks

46
Q

Kowasaki disease is one of the only instances in which ASA is used in children. Why is ASA usually not used? What do you do to lower this risk?

A
  • Risk of reye syndrome

- Give child influenza vaccine in lower the risk

47
Q

When is erythema infectiosum contagious?

A
  • Starting 5-10 days after exposure.

- Contagious period lasts 5 days

48
Q

Kowasaki disease is also called what?

A

Mucocutaneous lymph node syndrome

LMCC Study - Peds (12 decks)

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