Other Childhood Infections Flashcards
How does scarlet fever present?
Fever >39
Sore throat - tonsillitis - yellow/white exudate
Headaches, lymphadenopathy
Furred tongue + enlarged papillae - strawberry tongue
Blanching punctate rash:
Onset 1-2 days after throat symptoms, lasts c.1wk
Blanching
Feels like sandpaper, possible itchy
Sparing the face (though may be flushed cheeks, white area around mouth), palms and soles
Becomes pronounced in the creases of skin
5’s of Scarlet fever: Strep (A) Sore throat, Strawberry tongue, Sandpaper rash that Spares the face/palms/Soles
What causes scarlet fever, who is most likely affected and how is it diagnosed?
Group A strep producing a specific exotoxin - usually Strep pyogenes
5-15yrs
Throat culture
What are some complications of scarlet fever?
Acute rheumatic fever - 2-6wks post infection with group A strep pharyngitis) - arthritis, carditis (+/- subsequent rheumatic heart disease - mitral stenosis)
Post strep glomeurlonephritis - 1-2wks post infection with any group A strep (or impetigo) - nephritic syndrome (HTN, oedema, proteinuria)
How do you prevent and manage scarlet fever?
No vaccine yet
Amoxicillin - 10days
(Erythromycin as an alternate)
How does erythma infectiosum present?
Also known as ‘slapped cheek syndrome’ or ‘fifth disease’
Low grade fever, headache, lethargy, coryzal symptoms - then disappear and are replaced by…
Slapped cheek rash spreading to proximal arms and extensor surfaces
Red, blanching, may itch
Lasts a few days normally
What causes erythema infectiosum, who is most likely affected and how is it diagnosed and treated?
Parvovirus B19
Most common in 5-15yrs
Clinical picture + bloods + swabs to exclude other diseases
Supportive treatment
What are some complications of erythema infectiosum?
1st trimester pregnancy:
Miscarriage risk
Sickle cell or haemolytic disease:
Aplastic crisis risk
How does hand, foot and mouth disease present?
3-6 days of incubation following infection
Fever
N+V
Malaise, fatigue, irritability
Rash:
Appears 1-2 days later; resolves within 7days
Flat, discoloured vesicles (brown/red) which may blister
Palms of hands, soles of feet, mouth
Rarely itchy in children (can be very itchy for adults)
What causes hand, foot and mouth disease, who gets it and how is it diagnosed and managed?
Caused by Coxackievirus A16 (most common) (or enterovirus 71)
Most commonly occurs in children under 10yrs, still infective after symptoms resolve
Clinical Dx, possible viral swabs or stool culture
Supportive management; proper hygiene and keeping infected individuals isolated
How does measles present?
10-14 days incubation
4D’s + 4C’s:
4x Days of fever - high fever, often as high as 40
Cough
Coryza
Conjunctivitis
+
Rash:
2-4 days after initial symptoms
Starts behind the ears, spreads to whole body within a few hours
Discrete maculopapular rash that becomes blotchy and confluent, chafes from red to dark brown with time
Itchy
Koplik spots - white spots (grain of salt) on buccal mucosa - diagnostic of measles but transient and so are rarely seen
What causes measles, who gets it and how is it diagnosed and managed?
Measles virus
Droplet spread and highly contagious - 90% of nearby non-immune individuals will contract
Anyone not vaccinated - which increasingly is children - is susceptible
Clinical diagnosis +/- bloods/swabs for exclusion +/- measles IgM antibodies on bloods (from about 3 days after rash onset) +/- measles RNA from respiratory specimens
Supportive - possible hospital admission; isolation to prevent spread
Prophylaxis
If a child not immunized against measles comes into contact with measles then MMR should be offered (vaccine-induced measles antibody develops more rapidly than that following natural infection)
this should be given within 72 hours
What are some complications of measles?
Diarrhoea
Pneumonia (most common cause of death), croup, otitis media (most common compilation)
Immunosuppression for weeks/months - leading to co-infection
Acute encephalitis
subacute sclerosing panencephalitis: very rare, may present 5-10 years following the illness febrile convulsions keratoconjunctivitis, corneal ulceration diarrhoea increased incidence of appendicitis myocarditis
Death - 1-2/1000 children infected
How do you prevent measles?
Congenital immunity:
Immune Mother’s will pass antibodies to children but this protection weans over 9 months
Vaccine:
Immunised at 12m + 4-5yrs (with MMR)
95% coverage of population required to ensure heard immunity (and protect the immunocompromised and others who cannot be vaccinated)
Does not cause ASD…
How does mumps present?
Low grade fever
Malaise
Myalgia
Parotitis (parotid gland inflammation):
Facial swelling
Earache, pain on eating or speaking
Starts unilateral but commonly becomes bilateral
Lasting 7-10days, most contagious at day 5
What causes mumps, who gets it and how is it diagnosed and managed?
Mumps virus
Rare now because of vaccination
Dx on recent exposure and clinical picture, possible viral PCR
Supportive - pain relief, fluids etc
Also vaccines
What are some complications of mumps?
Painful testicular inflammation: 15-40% of men Bilateral Occurring 10-6wks days after parotid inflammation Possible infertility
Aseptic meningitis
Ovarian inflammation
Acute pancreatitis
Sensorineural hearing loss
What are the symptoms of rubella?
Low grade fever (rarely above 38) Headaches Corzyal symptoms Conjunctivitis Arthritis
Lymphadenopathy:
Suboccipital and post auricular
Rash:
Pink maculopapular - not as bright as measles
Starts on face, spreads to whole body
Usually fades by day 3-5
What is the cause of rubella, who gets it, how is it diagnosed and managed?
Also called German measles or 3 day measles
Included in the TORCH screen of perinatal infections
Rubella virus
Anyone of any age if unvaccinated
Clinical diagnosis, possible PCR
Supportive treatment
Pregnant women are tested for their immunity and vaccinated after they have given birth (but ideally before they conceive, not whilst they are pregnant)
What are the complications of rubella?
Congenital rubella syndrome (CRS):
If contracted by mother, passed to foetus
Many mothers who contract in 1st trimester I’ll have a miscarriage or stillborn
Foetuses that survive may suffer from - PDA, blindness (congenital cataracts), deafness; born premature with potential anaemia, thrombocytopenia and hepatitis, encephalitis
What are the symptoms of chickenpox?
Low grade fever, nausea, myalgia, headache
Rash:
May start in mouth (enanthum)
Present on face or trunk before spreading (exanthum)
Red, macular then papular then vesicular evolution over 10-12hrs
Itchy as hell
May last up to 1month
Infectious 1-2 days before recognition of disease (in nasal discharge) which persists until all visible lesions have scabbed over
What causes chickenpox, who gets it, how is it diagnosed and treated?
Varicella zoster virus (VZV)
Anyone can get it, mostly children - due to school contact - 4-10yrs, highly communicable, about 10% of adults have not been infected
Clinical picture, can be diagnosed in foetus using amniocentesis
Supportive management, calamine lotion is commonly used to sooth and protect the skin
Is a vaccine, prophylactic immunisation after close contact is effective up to 3 days
What are some complications of chickenpox?
Pregnancy:
Dangers to the foetus if mother contracts in first 6months, in 3rd trimester - mother is more likely to suffer severe symptoms
Varicella syndrome = possible - encephalitis, microcephaly/brain aplasia, cataracts/blindness, motor deficits, horners syndrome, hypoplasia of lower limbs
If exposed - check for varicella antibodies (IgG), if -ve - give varicella zoster immunoglobulins (don’t give vaccine as is live virus - small
transmission risk)
Arterial ischemic stroke
Shingles:
SEE NEURO DECK
What are the symptoms of pertussis?
Also known as whooping cough
2-3d coryza then:
Coughing bouts - worse at night, after feeding and may be ended by vomiting; concomitant central cyanosis; possible sub conjunctival haemorrhage
Inspiratory whoop - forced inspiration against closed glottis, not always present
Infants may be apnoeic at points
Lasts 10-14weeks; more severe in infants
What causes pertussis, who gets it, how is it diagnosed and managed?
Gram -ve bacterium Bordetella pertussis
Contractable at any age, even after infection or immunisation
Clinical picture +/-
Nasal swab culture for Bordetella pertussis - may take several weeks to one back
PCR + serology more common and faster
Management:
Admit infants <6m
Notify PHE
Oral macrolide e.g. clarythromycin, erythromycin etc if cough onset within past 21days
Abx prophylaxis for household/close contacts + school exclusion
Women between 20-32wks are offered the vaccine
