Paeds Derm + Infectious Diseases Flashcards
Presentation and management of chickenpox
Caused by varicella zoster virus (VZV), highly contagious, generalised vesicular rash
- Fever- first symptom
- Itchy, rash starting on head/trunk before spreading to affect the whole body over 2-5 days
- Initially macular (flat coloured patch of skin) then papular (elevated, solid paplpable lesion) then vesicular (fluid filled- blister)
- Systemic upset is usually mild
Management
-
Conservative management as condition is self-limiting
- Itching symptoms→ calamine lotion and chlorphenamine (antihistamine)
- Keep patients of school, avoid pregnant women and immunocompromised patients until lesions are dry and crusted over- usually around 5 days after the rash appears
- Keep fingernails short, wear long sleeved clothing to prevent scratching
Presentation, complications and management of measles
Preventable infection caused by the measles paramyxovirus
Prodrome: irritable, conjunctivitis, fever, Koplik spots
- Fever >40oC
- Coryzal symptoms
-
Conjunctivitis followed by a rash about 2-5 days after onset of symptoms
- Rash starts behind ears then to whole body (involves limbs unlike rubella)- discrete maculopapular rash becoming blotchy and confluent
- Koplik spots- small grey discolourations of the buccal mucosa. Appear 1-3 days after symptoms begin during the prodrome phase of infection
Complications:
- Otitis media- most common
- Pneumonia
- Encephalitis
Management:
- Mainly supportive
- Notifable disease → inform public health
Presentation and management of rubella
Caused by the rubella togavirus, transmitted via aerosols
Children are routinely vaccinated for Rubella as part of the MMR vaccine starting at 12 months
Non-specific symptoms and signs such as fever, coryza, arthralgia, a rash
- Pink maculopapular rash that starts on head/face before spreading to trunk
- Rash spares limbs as opposed to measles that involves the limbs
- Lymphadenopathy: postauricular
Management:
- Supportive management
- Prognosis is good- symptoms generally mild and resolve in 7-10 days
Presentation and management of hand, foot and mouth disease
Commonly caused by coxsackie A16 and enterovirus 71.
Self-limiting condition, resolves within one week
Very contagious and typically occurs in outbreaks at nursery
Features:
- Mild systemic upset: sore throat, fever
- Oral ulcers → followed by vesicles on hands anf feet, but also face, buttocks, legs, and genitals
Management:
- Symptomatic treatment only- general advice about hydration and analgesia
- Children do not need to be excluded from school
Presentation and management of scarlet fever
Caused by reaction to erythrogenic toxins produced by Group A haemolytic streptococci (usually Streptococcus pyogenes)
Presents with a coarse red rash and other non-specific symptoms such as:
- Sore throat
- Headache
- Fever
- Bright red strawberry tongue
- Rough sandpaper rash
Characteristic rough “sandpaper” texture and tongue appears bright red “strawberry tongue”
Management
- Treated with penicillin V for 10 days, those with penicillin allergy- azithromycin
- Children can return to school 24 hours after starting abx
Presentation and management of rubella
Caused by the rubella togavirus, transmitted via aerosols
Children are routinely vaccinated for Rubella as part of the MMR vaccine starting at 12 months
Non-specific symptoms and signs such as fever, coryza, arthralgia, a rash
-
Pink maculopapular rash that starts on head/face before spreading to trunk
- Rash spares limbs as opposed to measles that involves the limbs
- Lymphadenopathy: postauricular
Management:
- Supportive management
- Prognosis is good- symptoms generally mild and resolve in 7-10 days
Presentation and management of Erythema Infectiousum/Slapped Cheek Syndrome/Fifth Disease
Caused by parovrius B19
Self limiting, usually resolves in 1 week- children usually feel better as the rash appears (at this point they are no longer infectious so don’t need to be excluded from school)
- Presents with rash on both cheeks + mild fever
- Rash may extend to body and usually presents in context of another illness
- Rash rarely involves the palms and soles
Presentation and mangement of urticaria/hives
Caused by the release of histamine and other pro-inflammatory chemicals by mast cells in the skin
May be part of an allegic reaction or autoimmune reaction
- Raised, itchy red rashes
Management:
-
Non-sedating antihistamines are first line
- Antihistmaine cream- can be used but they are self-limiting
- Oral steroids (e.g. prednisolone)- may be considered as short course for severe flares
Presentation and management of Kawasaki Disease
Medium-vessel vasculitis
Features:
- High-grade fever that lasts >5 days- resistant to antipyretics
- Red palms of the hands and the soles of the feet
- Conjunctival infection, red eyes
- Strawberry tongue
CRASH and Burn- need 5 out of the 6 to diagnose:
- Conjunctivitis
- Rash
- Adenopathy (cervical lymphadenopathy)
- Strawberry tongue
- Hands and feet- red, swollen and peeling
- Burn- >5 day high fever that does not respond to antipyretics
Management:
- High-dose aspirin- one of the few indications for use of aspirin in children. Due to risk of Reye’s syndrome, aspirin is normally contraindicated
- IV immunoglobulin (IV Ig)
Presentation and management of atopic dermatitis/eczema in children
Very common condition that starts in childhood (presents <2 years old)
-
Itchy, erythematous rash- repeated scratching may exacerbate affected areas
- Infants- Face and trunk often affected
- Younger children- Extensor surfaces
- Older children- More typical distribution with flexor surfaces affected, and creases of face and neck
Management- maintance and management of flares:
- Maintenance- emollients, avoid activities that break down skin barrier, avoid environmental triggers
- Flares- thicker emollients, topical steroids, “wet wraps”
Presentation and management of tinea/ringworm
Characterised by a red, scaly patch which classically has an area of central clearing and may be itchy
Tinea- dermatophyte fungal infections
- Tinea capitis- scalp
- Tinea corporis- trunk, legs or arms
- Tinea pedis (athlete’s foot)- feet
Management- anti-fungal medications:
- Anti-fungal creams such as clotrimazole and miconazole
- Anti-fungal shampoo such as topical ketoconazole (for tinea capitis)
- Oral anti-fungal medications such as fluconazole and itraconazole (can treat tinea corporis)
Presentation and management of impetigo
Superficial bacterial skin infection caused by Staphylococcus aureus or Streptococcus pyogenes
Lesions tend to occur on the face, flexures and limbs not covered by clothing
Features:
- “Golden”, crusted skin lesions typically found around the mouth
- Very contagious- spread by direct contact with discharges from the scabs of an infected person
Management:
- Localised non-bullous infection- topical hydrogen peroxide 1% for 5 days or topical antibiotic (fusidic acid) if this is not suitable
- Extensive, severe, or bullous infection- oral flucloxacillin for 5 days (or clarithromycin/erythromycin if allergic to penicillin)
Presentation and management of scabies
Caused by the mite Sarcoptes scabiei and spread by prolonged skin contact
Scabies mite burrows into skin, laying its eggs
Intense pruritis associated with scabies is due to delayed type IV hypersensitivity reaction to mites/eggs → occurs about 30 days after initial infection
- Presents with incredibly itchy small red spots, possibly with track marks where mites have burrowed
- Classic location is between the finger webs
Management:
- Permethrin 5% cream- contains insecticide. applied to the whole body, completely covering skin
Presentation and management of molluscum contagiousum
Common skin infection caused by molluscum contagiousum virus (MCV)- type of poxvirus
- Small, flesh-coloured papules (raised individual bumps on the skin) that have a central dimple
- Appear in “crops” of multiple lesions in a local area
- Spread through direct contact or by sharing items like towels or bedsheets
Papules resolve themselves without any treatment, but can take up to 18 months
Presentation and management of glandular fever/infectious mononucleosis (IM)
Caused by Epstein Barr Virus (EBV), transmitted by saliva
Mild infection in small children, more severe infection in teenagers
Diagnosis usually made clinically- triad of:
- Sore throat
- Pyrexia
- Lymphadenopathy- can present in anterior and posterior triangles of the neck
- Causes intensely itchy maculopapular rash in response to amoxicillin or cefalosporins
Acute EBV infection can cause hepatomegaly and splenomegaly
Management:
Supportive- rest during early days, drink fluid
- Avoid alcohol- EBV impairs ability of liver to process alcohol
- Avoid contact sports- due tos risk of splenic rupture
