Paediatric Infection and Immunity - Rashes and Infections

Question 1

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

Answer 1

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

Question 2

What virus causes measles?

Answer 2

RNA paramyxovirus - morbillivirus

Question 3

Describe the rash seen in measles

Answer 3

Discrete maculopapular rash that becomes blotchy and confluent

Start behind ears then spread to whole body

Question 4

What symptoms are indicative of measles?

Answer 4

Irritable
Conjunctivitis
Fever
Koplik spots on buccal mucosa

Question 5

What is a koplik spot?

Answer 5

White spots on buccal mucosa

Question 6

How is measles managed?

Answer 6

Must notify public health

School exclusion for 4 days

If not immunised, give MMR

Question 7

What causes rubella?

Answer 7

Togavirus (Rubivirus)

Question 8

Describe the rash seen in rubella

Answer 8

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

Usually fade by day 3-5

Question 9

What symptoms does rubella present with?

Answer 9

Low grade fever

Sub-occipital and post-auricular lymphadenopathy

Question 10

How is rubella managed?

Answer 10

School exclusion for 4 days after rash onset

Question 11

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

Answer 11

Droplet spread

10 days

Question 12

Who is measles particularly dangerous in and why?

Answer 12

Immunocompromised children

Risk of giant cell pneumonia and encephalitis

Question 13

What complications are associated with measles?

Answer 13

Acute - febrile convulsions, otitis media, tracheobronchitis and pneumonia

Can get severe encephalitis

Question 14

How long is the incubation period of rubella?

Answer 14

14-21 days

Question 15

What complications are associated with rubella?

Answer 15

Arthritis

Thrombocytopenia

Question 16

What causes slapped cheek disease?

Answer 16

Parvovirus B19

Question 17

How is slapped cheek disease transmitted?

Answer 17

Respiratory secretions between mother and foetus

Contaminated blood products

Question 18

Describe the rash seen in slapped cheek disease

Answer 18

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

Particularly affect proximal arm and extensor surfaces

Question 19

What other symptoms are associated with slapped cheek disease?

Answer 19

Lethargy
Fever
Heachache

All disappear as rash appear

Question 20

How is slapped cheek disease managed?

Answer 20

Manage symptoms

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

Question 21

What causes Roseola Infantum?

Answer 21

Human Herpes Virus 6 or 7

Question 22

What rash is seen in roseola infantum?

Answer 22

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

FACIAL SPARING

Question 23

What symptoms are seen with roseola infantum?

Answer 23

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

Question 24

How is roseola infantum managed?

Answer 24

Supportive management

Antipyretics and Fluid rehydration
No school exclusion

Question 25

What causes scarlet fever?

Answer 25

Group A haemolytic strep

Question 26

What rash is seen in scarlet fever?

Answer 26

Fine punctate erythema first appear on torso Spread but spare mouth, palms and soles of feet Sandpaper texture

Question 27

What features are associated with scarlet fever?

Answer 27

Strawberry tongue | Fever, malaise, tonsilitis

Question 28

How is scarlet fever managed?

Answer 28

Penicillin Notifiable disease School exclusion for 24 hours after abx started

Question 29

What causes hand, foot and mouth disease?

Answer 29

Coxsackie A16

Question 30

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

Answer 30

Yellow ulcers surrounded by red halo appear in mouth Erythematous macule then appear on palms of hands and soles of feet

Question 31

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

Answer 31

Mild systemic upset - sore throat, fever, malaise

Question 32

How is hand foot and mouth disease managed?

Answer 32

Supportive management - analgesia, antipyretics etc. No exclusion or treatment

Question 33

What is preseptal cellulitis?

Answer 33

Infection anterior to the orbital septum Less serious than orbital cellulitis

Question 34

What causes preseptal cellulitis?

Answer 34

Staph Aureus Staph epidermis Strep Commonly due to skin lacerations and bites or from URTI and sinusitis

Question 35

What age children does preseptal cellulitis normally affect?

Answer 35

<5yo

Question 36

How would preseptal cellulitis present?

Answer 36

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

Question 37

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

Answer 37

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

Question 38

How is preseptal cellulitis managed?

Answer 38

IV ceftriaxone until diagnosis Definitive - Oral co-amoxiclav

Question 39

What complications are associated with preseptal cellulitis?

Answer 39

Progress to orbital cellulitis | Lid abscess

Question 40

What is orbital cellulitis?

Answer 40

Sight threatening infection of tissues behind orbital septum

Question 41

What causes orbital cellulitis?

Answer 41

H Influenzae S Pneumoniae Staph Aureus Can spread from sinuses, lacrimal sac, dental sites or via haematogenous spread from distant site

Question 42

At what age do children typically get orbital cellulitis?

Answer 42

7-12 yo

Question 43

How does orbital cellulitis present?

Answer 43

Swollen red tender eyelid Eyelid oedema Fever, malaise, irritable Ophthalmoplegia Proptosis Blurred vision with decreased acuity and diplopia

Question 44

How is orbital cellulitis treated?

Answer 44

IV cefotaxime and fluclox Optic nerve monitoring 4 hourly Surgery if no response

Question 45

What complications are associated with orbital cellulitis?

Answer 45

``` Loss of vision Raised IOP Retinal artery/vein occlusion Exposure keratopathy Meningitis Cerebral abscess ```

Question 46

What differentials would you consider for preseptal/orbital cellulitis?

Answer 46

Conjunctivitis Allergic reaction Cavernous sinus thrombosis Tumour

Question 47

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

Answer 47

FBC - leukocytosis Swab discharge CT sinus and orbit

Question 48

What is Kawasaki disease?

Answer 48

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

Question 49

What happens to the coronary arteries in Kawasaki disease?

Answer 49

Aneurysm formation Scar formation --> vessel narrowing, ischaemia or infarction Can get sudden death

Question 50

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

Answer 50

6 months to 4 yo

Question 51

What symptoms does Kawasaki disease present with?

Answer 51

``` 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 ```

Question 52

What is the diagnostic criteria for Kawasaki disease?

Answer 52

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

Question 53

What investigations are requested for Kawasaki disease?

Answer 53

``` FBC, ESR U&E, LFT's Throat swab and antistreptolysin O titre Blood cultures and viral titres Echo ECG ```

Question 54

How is Kawasaki disease treated?

Answer 54

Single dose IV immunoglobulin (2g/kg) Aspirin - reduce risk of thrombosis