Paediatric Infections - Measles, Rubella, Chickenpox, Mumps, Slapped-cheek syndrome, Scarlet fever, Hand foot and mouth disease, Kawasaki disease, Threadworm Flashcards
Measles
-causative virus, transmission, infective period
-presentation
-investigations
-management
-management of contacts
-complications
RNA paramyxovirus
Aerosol
10-14day incubation
Infective - prodrome to 4 days after rash appears
Prodrome - fever, irritable, conjunctivitis, Koplik
Rash
-ears => whole body
-maculopapular => blotchy, confluent
IgM AB on rash onset
Supportive
Admit if IC or pregnancy
NOTIFIABLE DISEASE
MMR vaccine of contacts within 72hrs if unimmunized
-AB develops faster with vaccine than with natural infection
Most common - OM
Most common cause of death - pneumonia
Encephalitis, subacute sclerosing panencephalitis
Rubella
-causative virus, transmission, infective period
-presentation
-investigations
-management
-management of contacts
-complications
Togavirus
Droplet, direct contact
2-3wk incubation
7days before rash - 5 days after rash
Prodrome - low grade fever
Rash
-face => body, fades by D3
-maculopapular
LN - suboccipital, postauricular
IgM AB on rash onset
Supportive
Admit if IC or pregnancy
NOTIFIABLE DISEASE
Arthritis
Thrombocytopenia
Encephalitis
Myocarditis
Chickenpox
-causative virus, transmission, infective period
-presentation
-investigation
-management
-management of contacts
-complications
HZV
Resp route
10day - 3wk incubation
4days before rash - 5days after rash
Prodrome - fever
Rash - macular => papular => vesicular
Mild systemic upset
Clinical diagnosis
Keep cool, trim nails
Calamine lotion for itch
School exclusion until lesions have crusted over
IC and newborns with peripartum exposure => VZIG
-IV aciclovir if chickenpox develops
Secondary bacterial infection of lesions
-increased risk with NSAID use
-if GAS infected => nec fasc
Pneumonia, encephalitis, disseminated chickenpox
Mumps
-causative virus, transmission, infective period
-presentation
-investigation
-management
-complications
RNA paramyxovirus - peaking in winter and spring
Droplets
14-21 days incubation
7 days before - 9 days after parotid swelling
Fever
Malaise, myalgia
Parotitis - earache, pain on eating
-unilateral => bilateral
Clinical diagnosis
-confirmed by saliva IgM
Rest
Paracetamol - fever, discomfort
NOTIFIABLE DISEASE
Orchitis - 4-5days after parotitis
Unilateral and transient hearing loss
Meningoencephalitis
Pancreatits
Slapped-cheek syndrome
-causative virus, transmission, infective period
-presentation
-investigation
-management
-complications
Parvovirus B19
Droplets
3-7day incubation
3-5days before rash
Can be asymptomatic
Mild fever
Rose red rash - slapped cheek
-sign that child will recover quickly
Causes arthritis in adults
IC - pancytopenic
Sickle cell - aplastic crisis
-PB19 suppresses erythropoesis
Clinical diagnosis
No specific treatment needed
No school exclusion needed
Must check maternal IgM, IgG if exposed before 20wks in pregnancy
Scarlet fever
-causative bacteria, transmission, infective period
-presentation
-investigation
-management
-complications
GAS
Resp, droplets, direct contact
2-4day incubation
Infective until 24hrs after 1st ABx dose taken
Fever - up to 48hrs
Malaise, headache, N/V
Sore throat - pharyngitis
Strawberry tongue
Fine pinhead sandpaper rash
-torso with palm, sole sparing
Throat swab - give ABx before results return
NOTIFIABLE DISEASE
PO pen V 10days - return to school 24hrs after 1st ABx dose
-alt azithromycin
OM
Rheumatic fever - 20days after infection
Acute glomerulonephritis - 10days after infection
Bacteremia, meningitis, nec fasc
Hand foot and mouth disease
-causative bacteria, transmission, infective period
-presentation
-investigation
-management
Coxsackie A16, enterovirus 71
Droplet, contact
3-6day incubation
1st 5 days since symptom onset
Mild systemic upset - sore throat, fever
Oral ulcers => palm and sole vesicles
Clinical diagnosis
Symptomatic - hydration, alagesia
No school exclusion needed
Kawasaki disease
-cause
-presentation
-investigations
-management
-complications
NOT INFECTIOUS - vasculitis predominantly seen in children
5 day high fever - RESISTANT TO ANTIPYRETICS
Conjunctival injection
Strawberry tongue, bright red cracked lips
Cervical LN
Red peeling soles and palms
CLINICAL DIAGNOSIS
-echo to screen for coronary artery aneurysms
High dose aspirin
IVIG
Pertussis
-causative organism
-presentation
-diagnostic criteria
-diagnosis
-management
-complications
G-ve bordetella pertussis
Catarrhal phase - 1-2 weeks
-similar to URTI
Paroxysmal phase - 2-8wks
-severe coughing spells, ended by vomiting/central cyanosis
-apnoea spells
-inspiratory whoop
Convalescent phase - weeks - months
Diagnosed if
-acute cough lasting 14days+ without another apparent cause with the following features
-paroxysmal cough
-inspiratory whoop
-post-tussive comiting
-undiagnosed apnoea attacks
Nasal swab/PCR and serology
U6months => admit
PO macrolide if cough started within 21days
Household contacts given prophylactic ABx
School exclusion
-48hrs after starting ABx
-21 days from onset if no ABx
NOTIFIABLE DISEASE
Subconjunctival hemorrhage
Pneumonia
Bronchiectasis
Seizures
Viral wheeze
-what is it
-classification
-presentation
-management
Most common diagnosis in paeds, especially nursery
Episodic VW - symptom free between episodes
Multiple trigger VW - wheeze triggered by viral + other causes (exercise, allergens, cigarette smoke)
Smoker parents - advised to stop
Episodic - symptomatic treatment
1st line - spacer with SABA/SAMA
2nd line - montelukast/intermittent ICS or both
Multiple trigger wheeze
ICS/LRTA trial for 4-8wks
Impetigo
-causative organism, transmission, infective period
-presentation
Staph aureus/Strep pyogenes
Direct contact from scab fluid => broken skin
Incubation - 4-10 days
School exclusion - Infectious until lesions crusted/healed or 48hrs after starting ABx
Golden crusted skin lesions, often around
-face
-flexures
-limbs not covered by clothing
Localised disease
1st line - hydrogen peroxide 1% cream
2nd line - TOP fusidic acid
-if fusidic acid resistance suspected => add TOP mupirocin
Extensive disease
-PO fluclox
alt PO erythromycin
Threadworms
-causative organism
-presentation
-investigations
-management
Enteribius vermicularis
-swallowing eggs present in environment
Often asymptomatic
-perianal itching at night
-vulval itching
Apply tape to perianal area and send to microscopy to see eggs
Clinical diagnosis
For all family members
-hygiene measures
-1 dose mebendazole for all above 6 months
Headlice
-spread
-presentation
-investigations
-management
Live on humans, feed on blood
Eggs glued to hair, hatch in 7-10days
Spread by direct head to head contact
Itching and scratching scalp 2-3weeks after infection
Diagnosed by fine toothed combing of wet/dry hair
If live lice found
-malathion/wetcombing/dimeticone/isopropyl myristate/cyclomethicone
Household contacts only need to be treated if affected
School exclusion not needed
