Paediatric Rashes

Question 1

Describe the typical presentation of measles.

Answer 1

1. Prodrome lasting 2-4 days with:
   - high fever + at least 1 of following
   - cough
   - coryza
   - conjunctivitis +/- swelling around eyes +/- photophobia
2. Koplik spots (small red spots with white speck in centre on buccal mucosa)
3. Macular or maculopapular rash starting on forehead + neck, which then spreads over 3-4 days to trunk then limbs

Question 2

How would you investigate and manage a child with suspected measles?

Answer 2

Ix: salivary swab or serum sample for measles-specific IgM

Mx: usually self-limiting condition so treatment is supportive

• encourage fluids + paracetamol/ibuprofen
• notify PHE and identify vulnerable contacts (infants, pregnant women and immunocompromised) for PEP where appropriate
• monitor for signs of complications and consider hospitalisation if these appear

Question 3

Suggest examples of possible complications of measles.

Answer 3

1. Measles causes immune deficiency (lymphopaenia) allowing secondary bacterial and viral infections e.g. pneumonia (accounts for majority of deaths), croup, bacterial or protozoal diarrhoea
2. CNS complications e.g. acute demyelinating encephalitis: presents within 2 weeks of rash appearance with seizures, irritability, headaches and changing LOC, progressing to coma. 25% children have permanent brain damage with 10-15% mortality rate.
3. In pregnancy can cause potentially fatal pneumonitis, also associated with increased risk of miscarriage, prematurity and low birth weight

Question 4

A 2yo girl is brought to be GP. She has a 3 day Hx of coryza + temp 38C. Today she developed a maculopapular rash on her neck + trunk.

What is the diagnosis and cause? How would you manage her?

Answer 4

Roseola infantum

HHV-6

Supportive: antipyretics + encourage hydration

Question 5

A 3yo boy in brought to the GP. He has a 5 day Hx of fever + headache + myalgia, followed by the appearance of bright red cheeks + maculopapular rash on extensor surfaces.

What is the diagnosis and cause? How would you manage him?

Answer 5

Erythema infectiosum (slap-cheek synd.)

Parvovirus B19

Supportive: antipyretics + encourage hydration

Question 6

A 10yo girl is brought to be GP. She has a 4 day Hx of high fever + sore throat. She has now developed flushed cheeks (with circumoral pallor) + strawberry tongue + sandpaper rash starting on her chest.

What is the diagnosis and cause? How would you manage her?

Answer 6

Scarlet fever

Group A streptococci

PO penicillin V for 10/7 and notify PHE

Question 7

A 3yo boy is brought to the GP. He has a 7 day Hx of fever (39.5) and other symptoms. The GP suspects Kawasaki disease.

What are the features of this disease and how would you manage the patient?

Answer 7

1. prolonged high fever >5/7
2. bilateral conjunctivitis
3. maculopapular rash
4. strawberry tongue, red mouth/throat, cracked lips
5. swollen + red hands + feet
6. cervical lymphadenopathy

Mx:

• admit
• high dose aspirin
• IVIG
• echo