Manolya Flashcards
Rash types, classification, on epidermis
Less than 1 cm:
Macule:Not raised,faded on pressure( vasodilatation)
Papule: Raised, firm, inflammatory cell aggregation
>1 cm:
Nodule: palpable solid/cystic
Plaque: elevated, psoriasis, mantar enfeksiyonu
Vesicle: içi su dolu, <5mm
Bula: vesicle >5mm
Pustule: Vesicle containing infection, purulent
Petechiae: pinpoint red spots, doesnt fade
Purpura
Differential of:
1.Vesicular:
Coxackievirus
Echovirus
Varicella
Herpes
M-pox
2.petechiae:
Meningococcemia!!
3.Maculopapular: many things
Widespread erythema: strep group A, staph aureus
For history and examination think about
Age, season,geolocation,travel history, exposure to insects, animals, ptx, history of vaccines and childhood diseases, immune status of host, medicines
Rash characteristics, distrubiton and progress,, change in morphology, accompanying symptoms, timing w/ fever
1st disease: Measles/Rubella/ kızamık
Single strand RNA virus (paramyxovirus)
Late winter, spring
Transmission by droplet and air, very contagious
Rash during viremia
Resp epithelium: primary viremia
Lymphatic tissue: secondary viremia
Signs:
Rhinorrhea
-conjunctivitis(+photophobia)
Dry cough
Fever(peaks at 3 days, subsides after 4 days)
Koplil spots( pathogonomonic): white spots, molar dişler yanı,yanakta, 48 hours before the rash, disappears 2nd day of rash, lymphatic aggregant)
Rash:3-7. day erythematous maculopaular rash, ear-hairline-nape, forehead to trunk and extremities, fades with brown pigmentation)
Lifelong immunity
Transient immunosupression during infection: 1.otitis media 2.pneumonia(mortality 01-03 !)
Hemorhagic measles: hemorhagic rashes that can be fatal, convulsions coma
Risk factors:
Vit A deficiency
Immune deficiency
Malnutrition
DGX:
Clinical findings+(prodromes,fever, rash koplik)
Positive measles IgM/ IgG serology(4 hafta arayla 4 kat artış) or RT-PCR
Differential: kawasaki, kızamıkçık, 5. 6. Disease,ebv, kızıl, adenovirus, mycoplasma
İlaç erupsiyonları? steven johnson toxic epidermal necrolis !?
Treatment: Vit A tedavisi (özellikle 2 yaş altı)
Korunma: kkk aşısı, 1 yaş, 4 yaş 2 doz
Ama vakaların görüldüğü zamanlar 9. Ayda ilave doz
Anneden geçen antikorlar ilk 6-9ay koruyor, aşının etkisini de engelliyor
Canlı aşı olduğu için 6 aydan önce yapılmaz
Post exposure immunuzation: anyone over 6 months for contact
Aşı durumu bilmiyorsan, kızamık şüpheliyle temas: 72 saat içinde aşı
Post exposure IG: <6 months, pregnant, immunosupressed
Subacute sclerosing panencephalitis(SSPE):
Progressive degenerative disorder of CNS 7-10 years after measles
Rubella( kızamıkcık)
5-9 yaş grubu
Hafif seyreder. Anne hamileyse congenital rubelladan korkarız
Cervical, suboccipital LAP
Maculopapular rash
Ateş prodromal dönemde, bulaşıcılık 2 hafta devam ediyor
Thrombocytopenia
Arthritis, eklem ağrısı
Encephalitis
People are only resource. Droplet, direct contact, late winter early spring, ıncubation 14-21 days, infectious from 2 days before rash to 7 days after, lifelong immunity. Forscheimer spots. Rash spreads from fave to body in 24 hours. 2nd day quickly fades, rarely 3 days.
Congenital rubella: first trimester:%50-80 infected baby
Cataract, cardiac anomaly, deafness,red purple blueberry muffin spots, meningoencephalitis, low birth weight, newborn IgM +, Ig titer increase, virus isolation
5th disease: Erythema Infectiosum
Parvovirus B19
Hafif seyreder
Hemolytic anemia, HIV, kemik iliği nakli durumlarında: aplastic anemia/ krize sebep olur
Pregnancy :hydrops fetalis
Ateş, burun akıntısı, öksürük, YANAKLAR KIPKIRMIZI , okul çağı çocukları, gövdesinde oya şeklinde rash
Döküntü en uzun süren hastalık
Spring,5-15y, respiratory tract and blood, ıncubation 4-14 days, prodrome 2-3 dys, fever, headache, weakness, many are asymptomatic
Rash:macular, plaques, SLAPPED CHEEK, PERORAL PALE, widespread in 1-4 days
Lace like rash on trunk and extremities, for 10-15 days. The rash may recur postinfection with exercise,temperature, stress. Itching, arthritis, arthralgia
Not contagious from onset of rash
yetişkinlerde :Gloves socks appearance: el ayak maculopapular purpuric döküntü, rash
Kızamık döküntüden 4 sonrası 5 gün
Su çiçeği kabuklanana kadar
Parvo döküntü çıktığında bulaştırıcılık kalkar
Infectious mononucleosis
EBV!
+CMV, hiv erken tablo
!Membranous Tonsilit, ağrılı cervical LAP, organomegaly, uzamış ateş, maculopapular rash after amoxicillin/ampicillin!
EBV VCA IgM +
Supportive treatment
Relaps edebilir gelecekte
Older children, adolescents
Fever,chills,sweats,,nausea, anorexia,sore throat, post, cervical lymphadenopathy,splenomegaly, malaise
Rash over trunk, extremities, hands, feet
Scarlet fever- kızıl
Group A streptococci( faranjit)
3 yaştan sonra görülür
Membranous tonsillit( white exudate like infectious mononucleosis)
White/red strawberry tongue
Petechie on soft palate
Suddenly starts with fever
rash: zımpara gibi, pürüzlü, covers entire body except face in 24 hours, face: forehead and cheeks red,flash like rash
Pallor atound mouth
No constitutional symptoms like kızamık(burun akıntısı gibi)
Pastia sign: linear pigmentation at kıvrım bölgeleri
Treatment: penicillin, 10 gün
Transmission respiratory secretion
İncubation 1-7 days
Sudden fever chills
Vomiting, headache, toxic appearance
Cervical lymphadenopathy
Petechia on palate
Exudative tonsillit
Kawasaki
> 5 days fever
+ 4 of these:
Conjunctivit, red tongue-cracked lips, el ayak ödem-erythema of palms, polymorph rash( mostly maculopapular), cervical lenfadenopati
Myocardit peicardit coroner arter genişlemesi, aneurysm
Thrombocytosis at 3 weeks.
A vasculitis
İlk 10 gün ivig, Echo yap
+
Acute period:high fever, conjunctivit,uveit, perianal erythema,strawberry tongue, lip fissure, myocardit, perşcardiy,lymphadenopathy
Subacute(11-30): conjunctivit, fever subsides, thrombocytosis, aneurysm, acral desquamation
6th disease: roseola infantum( gül hastalığı)
/ exanthema subitum
Hsv 6/7
Infants
3-5 gün yüksek ateş 39-40
Ateş düştükten sonra döküntü çıkarsa
Birkaç gün içinde kendi iyleşiyor
+occipital adenopathy
Neurotropic virus: febrile convulsion!
İmmunosupressed ptx: dissemine enfeksiyon
encephalopathyi
hemophagocytic syndrome
Chickenpox/ varicella zoster
Direct contact, droplet, air!
3 hafta incubation
Hafif ateş, baş ağrısı, soğuk algınlığı sonrası
Vesiculer lezyonlar, içi su dolu, kaşıntılı
Vesiculler farklı evrelerde, hepsi kabuklanana kadar bulaştırıcı(7-10 gün)
İtchy papulles
Complications:
pneumonia
Menengitis, cerebellitis
Myocardit
Reye sendromu
Seconder bacterial cilt enfeksiyonu ! (en sık)
Aplastic crisis
Wegener
Hemorrhagic su çiçeği
+fetal anemic hydrops
Congenital chickenpox:
First 20 week: embryopathy
Last 20 weeks: herpes zoster :)
5d before birth, 2 days after birth: en çok bundan korkarlar
Zona zoster
Varicella reaktivasyonu
İmmun sistem zayıflayınca, dermatomal lineda rash( shingles)
Acyclovir/ valacyclovir given to:
immunosupressed patients,
inhale steroid use,
yaşı >13
chronic cilt hastalığı varsa altta yatan,
su çiçeği +aspirin=reyes syndrome( chronic salicylate alan hastalar)
+ unvaccinated adolescents, malignancy, hiv, secondary cases in household contacts, high dose corticosteroid >14 days
Hand foot mouth disease
Conxsackie, enterovirus, echovirus
Çocuklarda yaygın, çok bulaşıcı, bir kere geçirince tekrar geçilir
Vesiculer lezyonlar, kaşınır
Direct temas, fecal oral route
Genital, anal lezyonlar da var
Kendi kendine geçiyor
Very contagious for 2 weeks
Complications:
Myocardit, pericardit, meningoencephalit, sudden death
Atypical HFMD: yetişkinde, ağır
Egzema consackium: daha atipik lezyonlar
Generalized HFMD: disseminated, tüm vücutta
Herpes simplex
Herpes 1/2
Primary infection: herpetic gingivoSTOMATİTİD: ağız içi beyaz +vesicles, fever, LAP
Neonatal herpes:
Scalp/ neck/ eye Vesicles
Dissemine neonatal herpes( adrenals, liver)
Intracranial, CNS
Encephalit
Herpes 1 by contact, herpes 2 vajinal kanal
Mortal
Intrauterine herpes:
yaygın cilt döküntüleri( hypopigmented, scaling, crusted erosions)
Meningococcemia (purpura fulminans)
Fever
Petechiae
En korktukları
Bacterial Meningitis causative organisms
Infants <3 months: Group B streptococcus, E.coli
Older infants children: S.pneumonia( pneumococ), N. Meningitis
Adolescents: N. Meningitis
Mechanism of infection for meningitis
Nasopharynx colonization
Direct entry( komşu enfeksiyon, trauma, medical device)
Invasion of CNS following bacteremia( infective endocarditis)
Predisposimg factors to meningitis
Immunodeficiency( asplenia,complement def. Hypogammaglobulinemia,hiv,steroid use, dm)
Anatomic defects(dermal sinus)
Acquired cranial defects( fracture)
Medical device
Parameningeal infections
Recent infection
Recent exposure
Recent travel
Presentation, clinical of meningitis
Fulminant or grafually progressive
Triad: Fever, neck stifness, abnormal mental status
+ headache, photophobia, nausea/vomiting, Tachycardia, tacyhpnea,hypotension, shock
Petechiae, purpura!
Focal neurologic findings
Seizures
Abnormal mental status
Increased ICP
Systemic findings
INFANTS:
Fever or hypothermia
Bulging fontanelle
Seizures
Jaundice
Respiratory distress
Poor feeding, vomiting, diarhhea
Lethargy, irritability
Meningeal signs:
Nuchal rigidity, headache, photophobia, irritsbility
Nuchal rigidity: limitation of neck flexion, kernig, brudzinski sign
N meningitidis
Only human nasopharynx
Nasal carriage esp adolescents
Gram - diplococcus, aerobic/ facultative anaerobic
Polysacharide capsule inhibits opsonization and phagoctyosis
6 subgroup causes disease
Progession of meningitis - hours
0-8h: nonspecific eatly signs like fever sore theoat nausea
9-15hr: classic meningitis signs
16-24: end stage signs like shock and multiple orgn involvemnet
Myalgia higher in bacterial meningitis
Infants at highest risk, then adolescents
PE of meningitis
Hypotension, tachycardia most common
Petechiae echymosis
Kernig brudzinski
Cold sweats
Partiak clinical response after iv fluids
Shock and multisystem involvement in meningitis
Peripheral vasoconstriction
Acidosis, hypoxia
Hypotension
Purpura fulminans: low protein C, from meningococcal inf, hemorrhage, necrosis, gangrene( DIC, thrombosis)
(DIC in sepsis)
Focal neurologic signs
Convulsions
Cerebral edema
Myocarditis
Acute abdomen
Main toxin in meningitis
LOS
High LOS, low plasma in meningitis
Vice versa in meningococcemia
Treatment of meningitis
4 adet 3rd gen cephalosporins:
1.ceftriaxone
2.cephotaxime
3. Vancomycin
4.penicilline
