Lecture 32: Fever and Rash Flashcards
What are the two main fever+rash concerns in children?
- Measles
- Meningitis
6 m/o child comes in with fever. Hx of being unwell last two days. Rapid pulse and has not had wet nappy for two days. What initial concerns should you recognise?
Signs and symptoms of vaccine preventable disease:
i.e Measles, pertussis, meningococcal and pneumococcal disease
Rash commonly associated with infection
What Hx details do you look for in small children when concerned about immunisatiomn?
- Must know NZ schedule and age child actually received vaccines
- Where they were born, overseas travel etc
- Is there an outbreak of anything atm?
Describe measles infectivity, prodrome, complications and why people are hospitalised:
- Highly infectious
- Prodrome; 2-3 days fever, conjuctivitis, corzya, kopliks spots (buccal mucosa)
- Characteristic rash day 3-7, most unwell at time of rash
- Complications; ~10% have secondary inf. i.e ear, pneumonia, croup
Hospitalisations ~30%
- 0.1% encephalitis
- Rarely subacute sclerosing panencephalitis 7-10 yrs later. fatal. persistent measles infection. (SHES NEVER SEEN BEFORE AND HOPES NEVER TO)
Why was there a measles outbreak?
- 90’s kids had a drop in immunisation
- Covid saw a drop in immunisation again
6 m/o child comes in with fever. Hx of being unwell last two days. Rapid pulse and has not had wet nappy for two days. Fine widepsread rash: Whats of concern.
6 months = no measles vaccine yet (given 12 months)
- Rash + fever -> looking towards measles…
What sorts of infections causes rash + fever in children?
- Measles
- Rubella
- Scarlet fever
- Parvovirus (‘slapped cheek’)
- Roseola (herpes V6)
- CMV, EBV etc
- Enterovirus (common viral meningitis)
But most of these things are historic because of vaccination
Take away: Many causes of rash and fever
Child comes in, fever + irritability last 24hrs. Not sure if all immunisations are up to date. What examinations can you complete?
Examine for:
- General wellbeing
- Rash
- Fortanelle
Febrile infant scenario:
Child comes in;
- Fever
- NO RASH
- Tense fortanelle
What is the next step?
- Fluid resus
- Blood culture
- Lumbar puncture
Whats a possible cause of meningitis in febrile infants?
heamophilus influenzae; Gram negative coccobacilli
- Vaccine preventable
What are some causes of meningitis?
Bacterial
- N meningitidis (Gram -ve, cocci)
- S. pneumoniae (Gram +ive cocci)
- Heamophilus influenzae type B rarely seen.
Viral
- Herpes simplex
- Enterovirus
Tuberculosis
What do the three common bacterial causes of meningitis have in comon?
All are encapsulated bacteria - polysaccharide coating around or part of bacterial cell wall
How do age, polysaccharide and vaccines interlate?
- Young children <2yrs produce very weak antibody responses to polysaccharide antigens
- Poor immunological memory to polysaccharide antigens
How do conjugate vaccines work in relation to polysaccharides?
- Polysaccharide attached to a carrier protein
- Taken up by B cells, digested and presented to helper T cells
- Converts a T cell independent CHO antigen into a t-cell dependent antigen
= Good immunogenicity in those <2yrs of age, good production of memory cells.
The Hib vaccine lasts 30 years and is an example of another conjugate vaccine, write some notes detailing why its been so effective at eliminating heamophilus influenzae b:
- PRP polysac linked to immunogenic protein
- Effective in young infants
- Reduces or eliminates nasopharyngeal colonisation
- If vaccine uptake is >80% invasive disease is virtually eliminated in a population
- Protective efficacy of vaccine >98%
