Paeds - Infectious diseases

Question 1

Rubella presentation

Answer 1

• Generalised Maculopapular rash - STARTS IN FACE; spreads across body
• Low grade FEVER
• Patelal petechiae
• Arthralgia
• Suboccipital/postauricular Lymphadenopathy
• Malaise
• Coryza
• Pharyngitis
• Conjunctivits

Oft asymp

Question 2

Rubella RFx

Answer 2

• INCOMPLETE/Lack of IMMUNISATION
• Infectious contact
• International travel

Less common in UK, typically imported

More common in winter/spring

Question 3

Rubella Dx

Answer 3

Bloods:

• Serology: Rubella-specific IgM serum Ab (ELISA) - Diagnostic but sometimes false +ve
  - 1st 5 days after rash; repeat after 2-3 weeks
• FBC

Viral culture (not routine)
- can get from nasopharynx, throat, urine, blood or CSF

Reverse-transcriptase PCR
- Nasopharyngeal swab

Question 4

Rubella Tx

Answer 4

Generally self limiting

Symptomatic relief:
- NSAIDs for arthritis (?? not sure if tru for kids)

Question 5

Rubella causative organism

Answer 5

Togavirus

Question 6

Complication of rubella infection

Answer 6

Maternal rubella during 1st trimester can cause Congenital / FETAL RUBELLA SYNDROME

• Teratogenicity
• Sensorineural deafness
• Congenital CATARACTS
• Congenital heart defects (Tetralogy of Fallot, ASD, PDA, Transposition of the great Arteries)
• Cerebral palsey
• Microcephaly

Question 7

Management of congenital rubella

Answer 7

Discuss with local HEALTH PROTECTION unit
- NO MMR IF PREG (they are immunocomp)
- Give in postnatal period if non-immune

Consider IM Ig