Paeds - Infectious disease

Question 1

Measles aetiology and presentation

Answer 1

Paramyxovirus

CCCK prodrome!!

Cough
Coryzal
Conjunctivitis
Kopek spots

+ Fever

Rash - MORBILLIFORM

• Begins behind the ears
• Spreads to the rest of the body

Question 2

Measles investigations and management

Answer 2

IgM for measles in the saliva

Paracetamol + NSAIDs

Notify PHE

Infective until 4 days post rash onset

Unvaccinated - MMR
Immunocompromised - Ribavarin

Question 3

Measles complications

Answer 3

Giant cell pneumonia
Myocarditis

Encephalitis
Subacute sclerosing panencephalitis (5-10 years later)

Otitis media
Ketoconjunctivitis
Corneal ulceration

Hemiplegia

Question 4

Mumps aetiology and presentation

Answer 4

Paramyxovirus

Fever
Parotiditis - Pain on eating and drinking
Hearing loss - Transient UL

Question 5

Mumps investigations and management

Answer 5

IgM for mumps in saliva
Amylase ^

Supportive - Paracetamol + NSAIDs

Notify PHE

Infective until 5 days post gland swelling

Question 6

Mumps complications

Answer 6

Deafness
Meningitis

Orchiditis

• Infertility
• Fever
• Back pain
• Testicular pain

Pancreatitis
Mastitis
Arthritis

Question 7

Rubella aetiology and presentation

Answer 7

Togavirus

Low grade fever

Rash - MACULOPAPULAR

• Begins on face
• Spreads to rest of the body

Lymphadenopathy

• Suboccipital
• Post-auricular

Question 8

Rubella investigations and management

Answer 8

Serology - PCR

Management - Supportive

Notify PHE

Infective until 4 days post rash onset

Question 9

Rubella complications

Answer 9

MATE

Myocarditis
Arthritis
Thrombocytopenia
Encephalitis

Maternal rubella

• Cataracts
• Heart defects
• Deafness

Question 10

Scarlet fever aetiology and presentation

Answer 10

Strep pyogenes

Strep throat

• Tonsillitis
• Pharyngitis
• Cervical lymphadenopathy

Fever
N/V

FACIAL FLUSHING
STRAWBERRY TONGUE

Rash - SANDPAPER - Goosebumps

• Torso and flexures
• Armpits
• Groin
• Between fingers and toes

Question 11

Scarlet fever investigations and management

Answer 11

Throat swab
FBC - Polymorphonuclear lymphocytes

Management - Penicillin V - 10 days

Notify PHE

Infective until 24 hours post abx starting

Question 12

Scarlet fever complications

Answer 12

Otitis media
Rheumatic fever
Post-strep glomerulonephritis
Meningitis

Question 13

Slapped cheek syndrome aetiology and presentation

Answer 13

Parvovirus B19

1. Fever and score throat

10 days later…

2. Facial flushing - Erythema infectiosum

Rash - Extremities and extensor surfaces
- Nose is spared

Joint pain and stiffness

Question 14

Slapped cheek syndrome management and complications

Answer 14

Supportive - Paracetamol

Complications

• Aplastic anaemia
• Utero - Hydrops fetalis

Question 15

Coxsackie’s disease aetiology and presentation

Answer 15

Coxsackie A16
FO spread

Hand, foot and mouth

Painful vesicular lesions - Hands and feet
Painful ulcers - Mouth and tongue

Question 16

Reye syndrome aetiology and presentation

Answer 16

ASPIRIN USE

Progressive encephalopathy

• Confusion
• Seizures

Hypoglycaemia

Fatty infiltration

• Liver
• Pancreas
• Kidneys

Question 17

Kawasaki’s disease aetiology

Answer 17

Idiopathic
Autoimmune
Vasculitis of small and medium vessels

Japanese
Chinese
Afro-Caribbean

Question 18

Kawasaki’s presentation

Answer 18

6 months - 4 years

CRASH and BURN and ECHO!

Conjunctivitis 
Rash - Polymorphous 
Adenopathy - Cervical and unilateral 
Strawberry tongue and cracked lips 
Hands/feet erythema 

FEVER!!!! - MASSIVE HIGH GRADE FEVER!!! > 38.5

Coronary artery aneurysms on ECHO

Question 19

Kawasaki’s management

Answer 19

IV IG - First 10 days

High dose aspirin - Reduce thrombosis risk

If severe…

• Steroids
• Anti-TNF
• Ciclosporin