Paediatric Infection and Immunity - Rashes and Infections Flashcards
What rashes can viruses cause apart from chicken pox and impetigo?
Measles Rubella Erythema infectious (slapped cheek disease) Roseola infants Hand, foot and mouth disease
What virus causes measles?
RNA paramyxovirus - morbillivirus
Describe the rash seen in measles
Discrete maculopapular rash that becomes blotchy and confluent
Start behind ears then spread to whole body
What symptoms are indicative of measles?
Irritable
Conjunctivitis
Fever
Koplik spots on buccal mucosa
What is a koplik spot?
White spots on buccal mucosa
How is measles managed?
Must notify public health
School exclusion for 4 days
If not immunised, give MMR
What causes rubella?
Togavirus (Rubivirus)
Describe the rash seen in rubella
Pink maculopapular rash initially on the face that spreads to the whole body
Usually fade by day 3-5
What symptoms does rubella present with?
Low grade fever
Sub-occipital and post-auricular lymphadenopathy
How is rubella managed?
School exclusion for 4 days after rash onset
How does measles spread and how long is the incubation period?
Droplet spread
10 days
Who is measles particularly dangerous in and why?
Immunocompromised children
Risk of giant cell pneumonia and encephalitis
What complications are associated with measles?
Acute - febrile convulsions, otitis media, tracheobronchitis and pneumonia
Can get severe encephalitis
How long is the incubation period of rubella?
14-21 days
What complications are associated with rubella?
Arthritis
Thrombocytopenia
What causes slapped cheek disease?
Parvovirus B19
How is slapped cheek disease transmitted?
Respiratory secretions between mother and foetus
Contaminated blood products
Describe the rash seen in slapped cheek disease
Erythematous rash on cheeks (hence name) which progresses to symmetrical lacy rash on extremities and trunk
Particularly affect proximal arm and extensor surfaces
What other symptoms are associated with slapped cheek disease?
Lethargy
Fever
Heachache
All disappear as rash appear
How is slapped cheek disease managed?
Manage symptoms
No school exclusion - only infective 3-5 days before rash
What causes Roseola Infantum?
Human Herpes Virus 6 or 7
What rash is seen in roseola infantum?
Pink maculopapular rash starting on the trunk and spreading to arms and legs
FACIAL SPARING
What symptoms are seen with roseola infantum?
Very High fever (upto 40) lasting 3-4 days
Sore throat
Nagayma spots on uvula and soft palate
Possible febrile convulsions
Cervical lymphadenopathy can be seen
How is roseola infantum managed?
Supportive management
Antipyretics and Fluid rehydration
No school exclusion
What causes scarlet fever?
Group A haemolytic strep
What rash is seen in scarlet fever?
Fine punctate erythema first appear on torso
Spread but spare mouth, palms and soles of feet
Sandpaper texture
What features are associated with scarlet fever?
Strawberry tongue
Fever, malaise, tonsilitis
How is scarlet fever managed?
Penicillin
Notifiable disease
School exclusion for 24 hours after abx started
What causes hand, foot and mouth disease?
Coxsackie A16
What rash is seen in hand, foot and mouth disease?
Yellow ulcers surrounded by red halo appear in mouth
Erythematous macule then appear on palms of hands and soles of feet
What prodrome is hand, foot and mouth disease associated with?
Mild systemic upset - sore throat, fever, malaise
How is hand foot and mouth disease managed?
Supportive management - analgesia, antipyretics etc.
No exclusion or treatment
What is preseptal cellulitis?
Infection anterior to the orbital septum
Less serious than orbital cellulitis
What causes preseptal cellulitis?
Staph Aureus
Staph epidermis
Strep
Commonly due to skin lacerations and bites or from URTI and sinusitis
What age children does preseptal cellulitis normally affect?
<5yo
How would preseptal cellulitis present?
Red, swollen tender eyelid
Eyelid oedema
Fever, malaise, irritable
What is important to consider if you see a patient presenting with potential preseptal cellulitis?
Emergency referral needed anyway! Assume orbital cellulitis until proven otherwise!
How is preseptal cellulitis managed?
IV ceftriaxone until diagnosis
Definitive - Oral co-amoxiclav
What complications are associated with preseptal cellulitis?
Progress to orbital cellulitis
Lid abscess
What is orbital cellulitis?
Sight threatening infection of tissues behind orbital septum
What causes orbital cellulitis?
H Influenzae
S Pneumoniae
Staph Aureus
Can spread from sinuses, lacrimal sac, dental sites or via haematogenous spread from distant site
At what age do children typically get orbital cellulitis?
7-12 yo
How does orbital cellulitis present?
Swollen red tender eyelid
Eyelid oedema
Fever, malaise, irritable
Ophthalmoplegia
Proptosis
Blurred vision with decreased acuity and diplopia
How is orbital cellulitis treated?
IV cefotaxime and fluclox
Optic nerve monitoring 4 hourly
Surgery if no response
What complications are associated with orbital cellulitis?
Loss of vision Raised IOP Retinal artery/vein occlusion Exposure keratopathy Meningitis Cerebral abscess
What differentials would you consider for preseptal/orbital cellulitis?
Conjunctivitis
Allergic reaction
Cavernous sinus thrombosis
Tumour
What investigations would you carry out if you suspect preseptal/orbital cellulitis?
FBC - leukocytosis
Swab discharge
CT sinus and orbit
What is Kawasaki disease?
Acute systemic vasculitis affecting small and medium vessels including the coronary arteries
What happens to the coronary arteries in Kawasaki disease?
Aneurysm formation
Scar formation –> vessel narrowing, ischaemia or infarction
Can get sudden death
What is the peak age for Kawasaki disease to affect children?
6 months to 4 yo
What symptoms does Kawasaki disease present with?
Fever Strawberry tongue Red lips Cervical lymphadenopathy Superficial skin layer desquamation Red soles and palms Peripheral oedema Rash over trunk and perineum Intermittent colicky abdominal pain Lethargy, irritable Conjunctival redness
What is the diagnostic criteria for Kawasaki disease?
Fever for 5 days plus 4/5 from:
Bilateral conjunctival injection
Rash - polymorphous exanthema
Lips - red, dry, or cracked and strawberry tongue
Erythema, oedema and peeling of skin on hands and feet
Cervical lymphadenopathy
What investigations are requested for Kawasaki disease?
FBC, ESR U&E, LFT's Throat swab and antistreptolysin O titre Blood cultures and viral titres Echo ECG
How is Kawasaki disease treated?
Single dose IV immunoglobulin (2g/kg)
Aspirin - reduce risk of thrombosis
