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Child Health > Paediatric Infection and Immunity - Rashes and Infections > Flashcards

Paediatric Infection and Immunity - Rashes and Infections Flashcards

1
Q

What rashes can viruses cause apart from chicken pox and impetigo?

A 
Measles
Rubella
Erythema infectious (slapped cheek disease)
Roseola infants
Hand, foot and mouth disease
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2
Q

What virus causes measles?

A

RNA paramyxovirus - morbillivirus

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3
Q

Describe the rash seen in measles

A

Discrete maculopapular rash that becomes blotchy and confluent

Start behind ears then spread to whole body

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4
Q

What symptoms are indicative of measles?

A

Irritable
Conjunctivitis
Fever
Koplik spots on buccal mucosa

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5
Q

What is a koplik spot?

A

White spots on buccal mucosa

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6
Q

How is measles managed?

A

Must notify public health

School exclusion for 4 days

If not immunised, give MMR

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7
Q

What causes rubella?

A

Togavirus (Rubivirus)

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8
Q

Describe the rash seen in rubella

A

Pink maculopapular rash initially on the face that spreads to the whole body

Usually fade by day 3-5

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9
Q

What symptoms does rubella present with?

A

Low grade fever

Sub-occipital and post-auricular lymphadenopathy

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10
Q

How is rubella managed?

A

School exclusion for 4 days after rash onset

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11
Q

How does measles spread and how long is the incubation period?

A

Droplet spread

10 days

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12
Q

Who is measles particularly dangerous in and why?

A

Immunocompromised children

Risk of giant cell pneumonia and encephalitis

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13
Q

What complications are associated with measles?

A

Acute - febrile convulsions, otitis media, tracheobronchitis and pneumonia

Can get severe encephalitis

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14
Q

How long is the incubation period of rubella?

A

14-21 days

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15
Q

What complications are associated with rubella?

A

Arthritis

Thrombocytopenia

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16
Q

What causes slapped cheek disease?

A

Parvovirus B19

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17
Q

How is slapped cheek disease transmitted?

A

Respiratory secretions between mother and foetus

Contaminated blood products

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18
Q

Describe the rash seen in slapped cheek disease

A

Erythematous rash on cheeks (hence name) which progresses to symmetrical lacy rash on extremities and trunk

Particularly affect proximal arm and extensor surfaces

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19
Q

What other symptoms are associated with slapped cheek disease?

A

Lethargy
Fever
Heachache

All disappear as rash appear

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20
Q

How is slapped cheek disease managed?

A

Manage symptoms

No school exclusion - only infective 3-5 days before rash

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21
Q

What causes Roseola Infantum?

A

Human Herpes Virus 6 or 7

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22
Q

What rash is seen in roseola infantum?

A

Pink maculopapular rash starting on the trunk and spreading to arms and legs

FACIAL SPARING

23
Q

What symptoms are seen with roseola infantum?

A

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

24
Q

How is roseola infantum managed?

A

Supportive management

Antipyretics and Fluid rehydration
No school exclusion

25
Q

What causes scarlet fever?

A

Group A haemolytic strep

26
Q

What rash is seen in scarlet fever?

A

Fine punctate erythema first appear on torso

Spread but spare mouth, palms and soles of feet

Sandpaper texture

27
Q

What features are associated with scarlet fever?

A

Strawberry tongue

Fever, malaise, tonsilitis

28
Q

How is scarlet fever managed?

A

Penicillin
Notifiable disease
School exclusion for 24 hours after abx started

29
Q

What causes hand, foot and mouth disease?

A

Coxsackie A16

30
Q

What rash is seen in hand, foot and mouth disease?

A

Yellow ulcers surrounded by red halo appear in mouth

Erythematous macule then appear on palms of hands and soles of feet

31
Q

What prodrome is hand, foot and mouth disease associated with?

A

Mild systemic upset - sore throat, fever, malaise

32
Q

How is hand foot and mouth disease managed?

A

Supportive management - analgesia, antipyretics etc.

No exclusion or treatment

33
Q

What is preseptal cellulitis?

A

Infection anterior to the orbital septum

Less serious than orbital cellulitis

34
Q

What causes preseptal cellulitis?

A

Staph Aureus
Staph epidermis
Strep

Commonly due to skin lacerations and bites or from URTI and sinusitis

35
Q

What age children does preseptal cellulitis normally affect?

A

<5yo

36
Q

How would preseptal cellulitis present?

A

Red, swollen tender eyelid
Eyelid oedema
Fever, malaise, irritable

37
Q

What is important to consider if you see a patient presenting with potential preseptal cellulitis?

A

Emergency referral needed anyway! Assume orbital cellulitis until proven otherwise!

38
Q

How is preseptal cellulitis managed?

A

IV ceftriaxone until diagnosis

Definitive - Oral co-amoxiclav

39
Q

What complications are associated with preseptal cellulitis?

A

Progress to orbital cellulitis

Lid abscess

40
Q

What is orbital cellulitis?

A

Sight threatening infection of tissues behind orbital septum

41
Q

What causes orbital cellulitis?

A

H Influenzae
S Pneumoniae
Staph Aureus

Can spread from sinuses, lacrimal sac, dental sites or via haematogenous spread from distant site

42
Q

At what age do children typically get orbital cellulitis?

A

7-12 yo

43
Q

How does orbital cellulitis present?

A

Swollen red tender eyelid
Eyelid oedema
Fever, malaise, irritable

Ophthalmoplegia
Proptosis
Blurred vision with decreased acuity and diplopia

44
Q

How is orbital cellulitis treated?

A

IV cefotaxime and fluclox

Optic nerve monitoring 4 hourly

Surgery if no response

45
Q

What complications are associated with orbital cellulitis?

A 
Loss of vision
Raised IOP
Retinal artery/vein occlusion
Exposure keratopathy
Meningitis
Cerebral abscess
46
Q

What differentials would you consider for preseptal/orbital cellulitis?

A

Conjunctivitis
Allergic reaction
Cavernous sinus thrombosis
Tumour

47
Q

What investigations would you carry out if you suspect preseptal/orbital cellulitis?

A

FBC - leukocytosis
Swab discharge
CT sinus and orbit

48
Q

What is Kawasaki disease?

A

Acute systemic vasculitis affecting small and medium vessels including the coronary arteries

49
Q

What happens to the coronary arteries in Kawasaki disease?

A

Aneurysm formation

Scar formation –> vessel narrowing, ischaemia or infarction

Can get sudden death

50
Q

What is the peak age for Kawasaki disease to affect children?

A

6 months to 4 yo

51
Q

What symptoms does Kawasaki disease present with?

A 
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
52
Q

What is the diagnostic criteria for Kawasaki disease?

A

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

53
Q

What investigations are requested for Kawasaki disease?

A 
FBC, ESR
U&amp;E, LFT's
Throat swab and antistreptolysin O titre
Blood cultures and viral titres
Echo
ECG
54
Q

How is Kawasaki disease treated?

A

Single dose IV immunoglobulin (2g/kg)

Aspirin - reduce risk of thrombosis

Child Health (30 decks)

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