Paediatrics- Infectious Disease Flashcards
1
Q
What is varicella zoster (chicken pox)
A
An acute infection caused by varicella-zoster virus, characterised by an itchy vesicular rash (preceded by fever and malaise)
2
Q
What is age of incidence of varicella zoster
A
• Commonly a childhood illness
◦ Incidence <10 years old
3
Q
What are prodromal symptoms of varicella zoster
A
• Prodromal symptoms:
‣ Fever
‣ Nausea
‣ Malaise
‣ Aching muscles
‣ Headache
‣ Decreased appetite
4
Q
What are the investigations for varicella zoster
A
• Clinical Diagnosis
5
Q
What is the treatment for varicella zoster
A
• Supportive Treatment:
‣ Fluid intake to prevent dehydration
‣ Rest
‣ Analgesia or fever control (paracetamol)
‣ Keep nails short
‣ Avoid contact with at risk groups
‣ Keep home from school until vesicles have crusted over
• Topical calamine: To alleviate itch
• Chlorophenamine: ”
6
Q
What is the treatment for a neonate exposed to varicella zoster
A
• Determine age of exposure
• Determine mother’s immunity status
• If mother is immune, transplacental antibodies viable for 1 week (therefore neonate is covered)
• If mother NOT immune or exposure >1-2 weeks then consider giving human varicella zoster immunoglobulin
7
Q
What is the treatment for a pregnant/breast-feeding woman infected with varicella zoster
A
• Give oral acyclovir
8
Q
What is the treatment for a pregnant woman exposed to varicella zoster
A
• Determine immunity status, if not immune then consider giving human VZV immunoglobulins
9
Q
What are the complications of varicella zoster
A
• Bacterial Superinfection:
• Impetigo, furuncles, cellulitis, necrotising fasciitis and scarring
• Likely due to group A streptococcus
• Sudden high fever
• Encephalitis/Cerebellitis: confusion, ataxic
10
Q
What is hand, foot and mouth disease
A
Self-limiting viral illness characterised by vesicular eruptions in the mouth and papulovesicular lesions of the distal limbs
11
Q
What causes hand, foot and mouth disease
A
• Caused by Coxsackie A16 virus
• Severe disease may be caused by Enterovirus 71
12
Q
What is the presentation of hand, foot and mouth disease
A
• Small vesicles (blister-like)
• Location:
‣ Mouth
‣ Lips
‣ Palate
‣ Hands + Feet
• Oral ulcers
• Mild systemic upset: Sore throat, fever
• Mouth or throat pain (odynophagia): due to mouth ulcers
• Itchy
13
Q
What is the management of hand, foot and mouth disease
A
• Supportive (resolves in 7-10 days):
• Fluids, rest
• Analgesia: Can give anaesthetic throat spray if pain is preventing oral intake
14
Q
Definition of erythema infectiosum (parvovirus B19)
A
AKA ‘fifth disease’ or ‘slapped-cheek syndrome’
15
Q
Mode of transmission and pathophysiology of erythema infectiosum
A
• Transmitted via respiratory secretions
• Infects the RBC precursors in the bone marrow
16
Q
Prodromal symptoms of erythema infectiosum
A
• Prodromal symptoms first:
• Mild fever
• Coryza
• Headache
• Nausea
• Diarrhoea
17
Q
Investigations for erythema infectiosum
A
• Clinical diagnosis
• B19 serology (IgM and IgG)
• PCR
18
Q
Management for erythema infectiosum
A
• Supportive management:
• Self-limiting usually (takes 3 weeks to clear)
• Fluids, rest, analgesia if required
• Cold cloths for cheeks
19
Q
Complications of erythema infectiosum
A
• Aplastic crisis in sickle cell patients
• Chronic infection in immunodeficient patients
• Can affect unborn babies in the first 20 weeks of pregnancy.
◦ Exposure to pregnant woman (<20 weeks) would prompt medical advice
20
Q
Definition of measles
A
A viral illness caused by the RNA Paramyxovirus
21
Q
Mode of transmission of measles
A
• Droplet spread
• Very communicable (15mins in direct contact is enough to spread)
22
Q
Prodromal symptoms of measles
A
• PRODROMAL symptoms:
• 3 C’s:
◦ Cough
◦ Coryza
◦ Conjunctivitis
◦ Irritable ◦ Febrile convulsions
• Kolpik Spots: White spots on the buccal mucosa (‘grain of salt’). Occurs before rash
23
Q
Investigations for measles
A
• Measles serology (IgM and IgG) from Oral Fluid Test
24
Q
Management of measles
A
• Supportive management:
• Rest, fluids, antipyretics
• Hospital admission: For high risk patients (immunosuppressed, pregnant, <1 year old)
• Immunise close contacts with MMR + encourage vaccination following acute episode
25
Complications of measles
Need to safety-net re complications:
• Otitis Media: Most common complication
• Pneumonia: Most common cause of death
• Encephalitis:
• Can occur 1-2 weeks following infection
• Headaches, lethargy
• Irritability-> leads to Seizures
• Subacute Sclerosing Panecephalitis (SSPE): Very rare but may present 5-10 years following illness (measles dormant in CNS)
26
Definition of rubella
AKA ‘German Measles’. Is a viral infection caused by the togavirus
27
Incidence and infectious period of rubella
• Very rare due to MMR vaccines in the UK
• Infectious period: 7 days BEFORE symptoms appear to 4 days AFTER rash onset
28
Prodromal symptoms of rubella
• Prodrome:
• Low grade fever
• Lymphadenopathy: Post-auricular and sub-occipital
29
Investigations for rubella
• Clinical diagnosis
• Rubella serology (IgM and IgG)
30
Management for rubella
• Supportive treatment:
‣ Rest, analgesia, fluids
31
Complications of rubella
• Arthralgia/arthritis
• Thrombocytopenia: Perform FBC
• Congenital Rubella Syndrome: Maternal infection during pregnancy
32
Definition of roseola infantum
AKA ‘sixth disease’ or ‘exanthem subitum’. Is a viral illness caused by Human Herpesvirus 6 (HHV-6) (7 is less common)
33
Age of incidence of roseola infantum
• Common
• Typically affects infants (6 months - 3 years)
34
Prodromal symptoms of roseola infantum
• Prodrome phase:
◦ Sudden onset
◦ High-grade fever: 39-40 degrees
◦ Febrile stage lasts 3-5 days
◦ Irritability
◦ Mild URTI
◦ Cervical lymphadenopathy
◦ Decreased appetite
35
Investigations for roseola infantum
• Clinical diagnosis
• HHV-6 or HHV-7 serology for IgM antibodies
• PCR
36
Management of roseola infantum
• Supportive:
• Rest, analgesia, fluids
• Will clear in around 1 week
• Paracetamol or ibuprofen can be given to manage fever + discomfort
Febrile convulsion:
• Benzodiazepines:
◦ Diazepam, Lorazepam
37
Complications of roseola infantum
• Febrile convulsions
38
Definition of scarlet fever
A reaction to erythrogenic toxins produced by Group A haemolytic streptococci (Streptococcus Pyogenes)
39
Age of incidence of scarlet fever
• Common in children aged 2-6 years old
40
Prodromal symptoms of scarlet fever
• Prodromal symptoms:
‣ Fever (lasts 1-2 days), coryza, malaise, headache, nausea/vomiting, sore throat
41
Investigations for scarlet fever
• Clinical diagnosis
• Throat swab: Should not wait for results when commencing management
42
Management of scarlet fever
• Oral Penicillin V (phenoxymethylpenicillin):
◦ For 10 days
◦ Penicillin allergy-> Azithromycin
• Rash generally self-resolves in 7 days
43
Complications of scarlet fever
• Otitis Media: Most common
• Rheumatic fever: typically occurs 20 days after infection
• Acute glomerulonephritis: can occur 10 days after infection
44
Definition of hepatitis A
Hepatitis A is an RNA virus. Transmits via the faecal-oral route
• Most infections are symptomatic, 70% will develop jaundice
• Unlike Hep B and C, Hep A is NOT associated with chronic liver disease
45
What type of virus is hepatitis A
• RNA virus
46
Pathophysiology of hepatitis A
• Virus would enter hepatocytes, where the hepatitis A virus would replicate
• The virus particles are then secreted into bile and blood from the infected hepatocytes
• Viral particles can then be excreted in stool
• Liver injury can occur when cytotoxic T cells lyse the infected hepatocytes
• Has incubation period of around 3-6 weeks
47
Presentation of hepatitis A (prodrome and hepatitis symptoms)
Abrupt onset and before jaundice symptoms:
‣ Fever
‣ Malaise
‣ Nausea and vomiting
‣ Fatigue
‣ Headache
Hepatitis symptoms (icteric phase):
‣ Jaundice: 70-80% of patients
‣ Hepatomegaly
‣ RUQ pain
‣ Clay coloured stools (pale)
‣ Dark urine
‣ Pruritus
‣ Absence of chronic liver disease stigmata
48
Risk factors for hepatitis A
• Risk factors:
• Living in endemic area
• Close personal contact with infected person
• Contaminated food
• Men who have sex with men
49
Investigations for hepatitis A
• LFTs:
‣ ALT + AST: can be very raised (ALT usually higher), would precede bilirubin increase
‣ ALP: minimally elevated
‣ Bilirubin: Elevated
• IgM anti-hepatitis A virus: Would be positive, but will become undetectable after 6 months of symptom onset
◦ Can order IgG anti-HAV (usually lifelong)
• Prothrombin time: may be mildly prolonged, but more if there is acute liver failure
• U&Es: urea and creatinine may be raised due to risk of AKI
50
Management of hepatitis A
Unvaccinated people with recent exposure to hepatitis A (<2 weeks):
1) Hepatitis A vaccine: active or passive immunisation
Confirmed Hepatitis A:
1) Supportive care: appropriate rest is recommended, no specific antiviral therapy is available
Acute liver failure:
In <1% of cases there will be fulminant liver failure, evaluate for liver transplant in these cases
51
Complications of hepatitis A
• Acalculous cholecystitis
• Pancreatitis
52
Definition of hepatitis B
Is a DNA virus that is transmitted by percutaneous and permucosal routes (blood-bourne). It is also a sexually transmitted infection
• Most common liver infection globally
• Can either be a self-limiting disease, needing no treatment
OR
• Can result in a chronically infected state with cirrhosis, hepatocellular carcinoma or liver failure
53
What are antigens of hepatitis B
• Has an abundant surface antigen which is the S protein (hepatitis B surface antigen- HBsAg)
• Core antigen- HBcAg
• e antigen- HBeAg= marker of active replication and hence high infectivity
54
Pathophysiology of hepatitis B
• The virus does not directly kill hepatocytes
◦ It is the host’s immune response to the viral antigens that causes liver injury
• Primarily a cellular immune response
• There is direct lysis of infected hepatocytes by cytotoxic CD8 T cells
55
Presentation of hepatitis B (acute and chronic)
• Asymptomatic:
• Around 70% of patients are asymptomatic with acute HBV.
• Majority are asymptomatic with chronic HBV until they develop hepatocellular carcinoma, cirrhosis or liver failure
• Serum sickness type illness: fever, malaise, maculopapular or urticarial rash, fatigue, nausea/vomiting, arthralgia/arthritis
ACUTE
• Jaundice
• Hepatomegaly
• RUQ pain
CHRONIC
• Ascites
• Palmar erythema
• Spider nevi
• Splenomegaly
• Asterixis
56
Risk factors for hepatitis B
• Risk factors:
• Multiple sex partners
• Men who have sex with men
• IV drug use
• Family history of Hep B
• Antenatal exposure (from hep B positive mothers)
57
Investigations for hepatitis B
• LFTs: ALT/AST would be very elevated. ALP and bilirubin would also be increased. Low albumin
• Viral serology:
• Serum hepatitis B surface antigen: Positive HBsAg indicates active infection (becomes undetectable after 4-6 months of infection). Persistence indicates chronic HBV
• Antibody to HBsAg: Usually provides life long immunity (suggests resolved infection OR IMMUNISED with hep B vaccine)
• Antibody to hepatitis B core antigen: order both IgM and IgG anti-HBcAg tests. Positive test for IgM anti-HBcAg can indicate acute infection
• Serum hepatitis B e antigen: positive in the early part of an acute infection, would then drop. But it indicates greater infectivity. Chronically high patients may have liver disease
• Antibody to HBeAg: Indicator for clearance of the condition
Coagulation profile: may have prolonged PT. Due to cirrhosis of the liver
58
Treatment of acute hepatitis B
1) Supportive treatment:
‣ 95% of patients will produce anti-HBsAg without treatment
‣ REST
‣ Very few will develop chronic infection
CONSIDER antiviral therapy + assess for liver transplant: if acute liver failure is developed, begin Entecavir and assess for liver transplant due to high mortality risk with liver failure
59
Treatment of chronic hepatitis B
1) Anti-viral therapy: Entecavir until serology for HBsAg is negative
Chlorphenamine can be used to treat itch
Whenever decompensated or liver failure: Assess for liver transplant
60
Treatment for pregnant woman with hepatitis B
• Immediate monovalent hepatitis B vaccine for neonate within 24 hours of birth
• + 6in1 vaccine (8, 12, 16 weeks)
• There is risk of pre-term delivery and/or low birth weight
61
Prevention of hepatitis B
Immunisation against Hep B
• Screen pregnant women
62
Complications of hepatitis B
• Cirrhosis
• HEPATOCELLULAR CARCINOMA: due to increased risk from cirrhosis. Deteriorating chronic Hep B indicates this
• Fulminant hepatic failure:
• Very rare, but risk increases with co-infection with C or D
• Would experience confusion, lethargy, jaundice, asterixis
63
Definition of hepatitis C
Inflammation of the liver caused by the HCV
• Can present as an acute illness (fatigue, arthralgia, jaundice), but the majority of patients are asymptomatic
• Can become chronic and lead to fibrosis and cirrhosis (risk of liver failure and HCC)
64
Mode of transmission and virus type of hepatitis C
• Single stranded RNA virus
◦ Transmitted by percutaneous blood exposure, less frequently spread through sexual activity
65
Pathophysiology of hepatitis C
• Majority of infected patients fail to clear virus
◦ This leads to a chronic infection and progressive liver damage
• Hepatic inflammation and fibrosis over time
• There would be a weak CD4 and CD8 T cell response that cant control the acute infection
• When chronic infection is established, liver damage would be from local immune response, the virus wouldn’t be directly hepatotoxic
• Cirrhosis would be facilitated by factors such as chronic alcohol, NASH and co-infection
66
Presentation of hepatitis C
• Asymptomatic: majority with acute infection would be asymptomatic
• Fatigue: Others can present with non-specific symptoms
• Malaise
• Myalgia
• Arthralgia
• Indications of advanced liver disease:
◦ High rate of patients have chronic infection
◦ Cirrhosis, ascites, confusion (hepatic encephalopathy)
• Extrahepatic manifestation (rare): vasculitis, skin rash, renal complications
67
Risk factors for hepatitis C
• Unsafe injection practices during medical treatments or tattoo
• IV drug use
• Blood transfusion before 1986
68
Investigations for hepatitis C
• Hepatitis C virus antibody enzyme immunoassay (EIA):
◦ If the HCV-antibody EIA is positive, you would have to follow it by a HCV RNA PCR test to confirm presence
◦ A negative result indicates no current infection
◦ Positive indicates current infection (either acute or chronic) or a past resolved infection
• HCV RNA PCR:
◦ Negative result indicates no current HCV infection
◦ A negative PCR, but positive antibody test do not have a current infection but are not protected from re-infection
• LFTs: ALT and AST would be elevated
69
Treatment for hepatitis C
Recent infection or Chronic:
1) Antiviral Therapy:
◦ Direct Acting Anti-virals (DAA’s) are now recommended
◦ Should be initiated without waiting for spontaneous resolution
◦ Take Glecaprevir-Pibrentasivir
70
Complications of hepatitis C
• Cirrhosis
• Rheumatological complications: myalgia, arthralgia, fatigue and arthritis
• Fulminant hepatic failure
• Hepatocellular carcinoma: Hep C biggest cause in Europe
71
Definition of infectious mononucleosis
AKA Glandular Fever. Caused by the Epstein-Barr virus (EBV).
• More severe in adults, common in adolescence and young adults
72
Mode of transmission of infectious mononucleosis
• Commonly transmitted through saliva.
• Can also be transmitted sexually (genital secretions), however less viral load in them
73
Pathophysiology of infectious mononucleosis
• Exposure in the oropharyngeal area
• The virus would infect B cells in the lymphoid tissue
• Circulating B cells would then spread the infection to the liver, spleen and peripheral lymph nodes
• Atypical lymphocytes are a classic feature of IM, CD8 T CELLS RESPOND TO INFECTION
• EBV remains within the host (latent phase), primarily in the B lymphocytes.
74
Presentation of infectious mononucleosis
• Usually asymptomatic in <3 years olds
• Classical TRIAD:
◦ Fever: Lasts 1-2 weeks
◦ Pharyngitis: Sore throat:
◦ Can be exudative or non-exudative
◦ Petechia (round spots as a result of bleeding) may be present on the soft palate
◦ Cervical or generalised lymphadenopathy: Nodes typically are tender, non-erythematous and discrete
• Malaise/Fatigue
• Splenomegaly:
• Enlargement begins in the first week
• Can present with splenic rupture
• May also have hepatomegaly
Uncommon:
• Rash
• Hepatitis: liver is usually always involved, however it is often sub-clinical and self-limited
• Widespread maculopapular rash: in patients who have received ampicillin or amoxicillin
75
Investigations for infectious mononucleosis
1) FBC: Lymphocytosis, atypical lymphocytes (blood film), anaemia (haemolytic anaemia secondary to EBV)
• LFTs: Elevated ALT/AST
• Heterophile antibodies: Positive test
‣ Non specific for EBV infection
‣ Monospot test is a rapid test
‣ Negative heterophile test, but presence of IM symptoms and lymphocytosis indicates an EBV-specific antibody test
• EBV-specific antibodies test:
◦ Very sensitive and specific
◦ VCA-IgM, VCA-IgG, EA, EBV EBNA positive
76
Management of infectious mononucleosis
1) Supportive Care:
◦ Rest
◦ Good hydration
◦ Anti-pyretics and analgesics (e.g paracetamol and NSAIDs)
◦ Avoid strenuous physical activity and contact sports due to potential risk of splenic rupture (for 1 month)
◦ Symptoms can last 2-4 weeks (BUT fatigue can last longer especially in teenagers)
If severe with upper airway obstruction, haemolytic anaemia or thrombocytopenia:
• Corticosteroids
77
Complications of infectious mononucleosis
• Antibiotic-induced rash: Develops 5-10 days after starting ampicillin, amoxicillin or other beta-lactate antibiotics (not a true penicillin allergy). Typically maculopapular and pruritic
• Splenic rupture: Due to massive infiltration with lymphocytes
• Chronic fatigue: for around 6 months
78
What causes mumps
• Caused by the paramyxovirus
79
Risk factors for mumps
• No vaccination
• International travel
• Exposure to known case/outbreak
80
Presentation of mumps
• Parotitis:
‣ Usually bilateral swelling of the parotid glands, can be unilateral
‣ Generally abrupt
‣ Tenderness, pain upon chewing
‣ Earlobe may look elevated by swelling
‣ Lasts around 10 days
• Fever:
‣ Can be between 38-40 degrees
‣ Typically lasts 3-4 days
• Flu like symptoms, headache, myalgia, malaise
• Epididymo-Orchitis: severely painful swelling of one or both of the testicles (usually starts 4-5 days after parotitis)
• Deafness
• Encephalitis
81
Investigations for mumps
• Usually a clinical diagnosis
• Serology: Need lab confirmation using oral fluid sample (salivary IgM)
• May need to differentiate orchitis from torsion (testicular USS)
82
Management of mumps
• Supportive treatment:
‣ Self limiting
‣ Fluids, analgesia, antipyretics
‣ Can take paracetamol or NSAIDs, but avoid aspirin in <16 year olds due to Reye’s syndrome
‣ Topical warm/cold packs for swelling
‣ Resolves in 1-2 weeks
83
Complications of mumps
• Orchitis:
‣ Uncommon in pre-pubertal males, but occurs in 25-35% of post-pubertal males
‣ Occurs 4-5 days following parotitis
• Deafness: Unilateral and transient
• Meningoencephalitis
84
Definition of rheumatic fever
Is a complication of Group A streptococcus (GAS) infection (pharyngitis)
85
What causes rheumatic fever
• Typically caused by recent streptococcus pyogenes infection (2-6 weeks ago)
86
Presentation of rheumatic fever
• Recent streptococcal infection:
◦ 2-6 weeks ago
◦ Fever
◦ Pharyngitis
◦ Headaches
◦ Positive throat swab, positive rapid group A streptococcal antigen test, raised streptococci antibodies
Jone’s Criteria:
Infection PLUS 2 major criteria OR 1 major with 2 minor criteria
• CASES:
‣ Carditis and Valvulitis:
◦ Most significant manifestation due to potential of causing long-term sequelae such as rheumatic heart disease
◦ Can result in pericarditis, myocarditis or endocarditis
◦ Can result in mitral regurgitation (pansystolic murmur)
‣ Arthritis:
◦ Polyarthritis
◦ Involves large joints such as knees, ankles, elbows + wrists
◦ Migratory polyarthritis: Pain + swelling migrates from one joint to another over 21 days
‣ Subcutaneous nodules:
◦ Uncommon
◦ Painless nodules
◦ Firm
◦ Located over boney prominences or extensor surfaces
◦ Typically mobile
‣ Erythema marginatum:
◦ Cutaneous manifestation
◦ Non-pruritic
◦ Erythematous macule or annular lesions with clear centres and well-defined margins (map-like outline)
◦ Found on trunk and proximal extremities
◦ Rash can be worse on heat exposure
‣ Sydenham’s chorea:
• Late feature
• Neurological manifestation
• Involuntary movements, muscular weakness, emotional disturbances
• Can affect the extremities, trunk and facial muscles
87
Management of rheumatic fever
Acutely:
‣ Bed rest
‣ Anti-inflammatory agents:
◦ High dose aspirin
‣ Antibiotics:
‣ IM Benzathine benzylpenicllin
‣ Penicillin allergy= erythromycin or azithromycin
‣ Corticosteroids:
• Prednisolone can be used in patients who are not responding to NSAIDs
• Can be used for severe carditis as well
88
Secondary prevention of rheumatic fever
• Prophylaxis:
• Monthly IM benzathine penicillin: Until 10 years after last episode or until age of 21
89
What is mode of transmission of varicella zoster
• Airborne disease:
◦ Spread by aerosolised droplets- coughing + sneezing + contact with skin lesion
• Incubation period= 1-3 weeks
90
What is the infection period of varicella zoster
• Chicken pox is infectious from 24 hours BEFORE the rash appears until the vesicles are dry or crusted (around 5 days post-rash)
• Virus remains in the sensory nerve root ganglia (reactivation can cause shingles)
91
What are risk factors for severe varicella zoster
RISK FACTORS for severe disease:
◦ Pregnant
◦ Immunocompromised (e.g. corticosteroid use)
◦ Neonate (<28 days)
◦ Chronic skin or respiratory disease
92
What are the rash symptoms of varicella zoster
• RASH:
‣ Begins as erythematous papules
‣ Then becomes CROPS OF VESICLES
‣ Rash can be at different stages at the same time (e.g. mix of crust and vesicles)
• Itchy
• Scalp, trunk. Face, arms+legs
• Oral sores
93
Treatment of severe varicella zoster or for those at high risk of complications
Severe disease or at risk of complications:
1) Oral Acyclovir:
◦ 800mg 5 times a day for 7 days
◦ Not recommended for healthy children with normal chickenpox
94
Age on incidence of hand, foot and mouth disease
• Peak incidence under 10 years old
• Summer and early Autumn rates rise
95
Mode of transmission of hand, foot and mouth disease
• Faecal-oral route of transmission
• Very contagious
96
School isolation for hand, foot and mouth disease?
• No need to remove from school (resolves in 7-10 days)
97
Safety net advice for hand, foot and mouth disease
• Safety net: if it doesn’t get better in 2 weeks, reduced feeding/fluid intake etc, then come back
98
Infectious period of Erythema infectiosum
• Infectious period= 10 days before to 1 day after rash develops
99
Rash symptoms of Erythema infectiosum
Rash AFTER 2-3 days of prodrome: Rose-red rash
• Usually on the cheeks:
‣ Slapped-cheek appearance
‣ Can spread to other parts of body (trunk + limbs). Becomes a lace-like maculopapular rash (with circumoral pallor)
‣ But typically excludes palms and soles
• Child begins to feel better following onset of rash
100
Safety net for erythema infectiosum
• Few months later- warm bath, sunlight, heat or fever may trigger a recurrence of red rash on cheeks
101
School exclusion or notifiable status of erythema infectiosum
No need for school exclusion (child isn’t infectious upon rash appearance)
• Not notifiable
102
Infectious period of measles
Infectious period: From prodrome until 4 days after rash commences
103
Rash symptoms of measles
Rash:
‣ Maculopapular
‣ Starts behind ears
‣ Progresses to head, trunk, extremities (cephalacaudal)
‣ Rash lasts 7 days, then darkens + desquamates
• No lymphadenopathy
104
School exclusion and notifiable status of measles?
NOTIFIABLE DISEASE: Inform Health Protection Unit (HPU)
• EXCLUSION: School exclusion for at least 4 days after development of rash
105
Rash symptoms of rubella
Rash:
‣ Pink
‣ Maculopapular
‣ Small
• Face->neck->trunk->extremities
• Spares palms + soles
• Lasts 3-5 days
• Forchheimer spots: Occurs in 20% of patients- small red spots on soft palate
• Less widespread rash than measles
106
School exclusion and notifiable status of rubella
NOTIFIABLE DISEASE (alert HPU)
• SCHOOL EXCLUSION: Isolate for 4 days after rash onset
107
Infectious period of roseola infantum
Highly infectious, infectious for entire period of disease
108
Rash symptoms of roseola infantum
Rash phase:
• Occurs when fever/symptoms resolve
• Erythematous
• Maculopapular
• Appears on trunk
• Spreads to neck, face and extremities
• Small pink-red macules/papules
• Rash lasts 1-2 days
• Non-pruritic
• Blanching
• No blisters
• Nagayama Spots: Papular exanthem on the uvula and soft palate
• Febrile convulsions: Less common, but can occur due to high-grade fever
• Absence of rash: few children may have no rash
109
School exclusion and notifiable status of roseola infantum
Not notifiable
• No need for school exclusion
110
Mode of transmission of scarlet fever
Spread via respiratory route
• Inhaling or ingesting respiratory droplets or direct contact with nose or throat discharges
111
Rash symptoms of scarlet fever
Rash:
‣ Occurs after 1-2 days of symptoms
‣ Fine punctate erythema (‘pinhead’)
‣ Appears first on torso
‣ Spares palms + soles
‣ ‘Sandpaper’ texture
‣ Desquamation occurs around the fingers + toes
‣ Worse in skin fold (Pastia’s lines)
• Strawberry tongue: Prominent papillae. Tongue becomes white first then strawberry
112
School exclusion and notifiable status of scarlet fever
NOTIFIABLE DISEASE: report to HPU
• Child can return to school 24 hours after commencing antibiotics
113
Mode of transmission of hepatitis A
Transmitted with close contact to infected person or by contact with contaminated food or water
114
Notifiable status of Hepatitis A
• NOTIFIABLE DISEASE: Report to HPU
115
Consequence of pregnant mother with Hepatitis B
• Peri-natal exposure:
‣ Mother infected with HBV
‣ Can transmit to a neonate during childbirth or in-utero via trans-placental transmission
116
Notifiable status of hepatitis B
NOTIFIABLE DISEASE
117
Notifiable status of Hepatitis C
NOTIFIABLE DISEASE
118
What not to give in infectious mononucleosis
DO NOT give ampicillin or amoxicillin if IM is suspected due to risk of maculo-petechial rash
119
Mode of transmission of mumps
Spread via respiratory droplets and direct contact with infected patients
120
Infectious period of mumps
Most infectious 1-2 days before symptom onset
121
School exclusion and notifiable status of mumps
NOTIFIABLE DISEASE
• School/work exclusion for 5 days AFTER parotid swelling onset
122
Age of incidence of rheumatic fever
Can affect children aged 5-15 years old
123
Long term effect of rheumatic fever
Long term damage can lead to mitral stenosis
124
Management of arthritis in rheumatic fever
Arthritis:
• Analgesia: aspirin or NSAID
125
Management of carditis and vavlulitis in rheumatic fever
Carditis and valulitis:
• Surgical valve repair
• Diuretics, ACEi, beta-blockers: if heart failure
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Management of Sydenham chorea in rheumatic fever
Sydenham chorea:
• Treatment not required unless it is severe
• If severe: anti-convulsants (carbamazepine)
