Paeds: Infectious diseases Flashcards
A 8-year-old boy presents to the GP as his mother is worried about a fever that is not settling with regular paracetamol and ibuprofen. He has had the fever for 7 days now.
On examination, he has a widespread erythematous rash on his torso and arms. In particular, his palms and soles of his feet are very red. There is conjunctival injection with no discharge. Tender cervical lymphadenopathy is palpated. You measure his temperature at 38ºC.
Most likely diagnosis?
Kawasaki disease
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A vasculitits
Fever > 5 days, not responding to anti pyrexics
When is the routine MenB vaccine given?
The Men B vaccine is given at 2, 4 and 12-13 months.
A mother arrives at the paediatric emergency department with her 4-year-old boy. He has a fever and she has noticed raised nodes on his neck. She has given him paracetamol and ibuprofen but his temperature is not reducing. His lips have become extremely dry and cracked and his tongue red and slightly swollen. She has noticed that his feet are also red and puffy now, and he is developing a widespread fine rash. What is the most likely diagnosis?
Kawasaki disease
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Typical presentation of Kawasaki disease
Strawberry tongue, dry cracked lips and inflamed mucosa
Not responsive to paracetamol and ibuprofen
Not Scarlett fever because it doesn’t explain hand and foot involvement.
Kawasaki disease is a type of vasculitis which is predominately seen in children. Whilst Kawasaki disease is uncommon it is important to recognise as it may cause potentially serious complications, including coronary artery aneurysms.
Management of kawasaki disease?
- High-dose aspirin
- Kawasaki disease is one of the few indications for the use of aspirin in children. Due to the risk of Reye’s syndrome aspirin is normally contraindicated in children
- Intravenous immunoglobulin
- Echocardiogram (rather than angiography) is used as the initial screening test for coronary artery aneurysms
Fever initially. Itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular
Systemic upset is usually mild. What is this condition?
Chicken Pox
Prodrome: irritable, conjunctivitis, fever. Koplik spots: white spots (‘grain of salt’) on buccal mucosa. Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent. What is this condition?
Measles
Fever, malaise, muscular pain. Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%. What is this condition?
Mumps
Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day. Lymphadenopathy: suboccipital and postauricular. Associated with non vaccine. What is this condition?
Rubella
Also known as fifth disease or ‘slapped-cheek syndrome’
Caused by parvovirus B19
Lethargy, fever, headache
‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces
Erythema Infectiosum
Reaction to erythrogenic toxins produced by Group A haemolytic streptococci. Fever, malaise, tonsillitis, ‘Strawberry’ tongue. Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor). What is this condition?
Scarlett fever
Caused by the coxsackie A16 virus. Mild systemic upset: sore throat, fever. Vesicles in the mouth and on the palms and soles of the feet. What is this condition?
Hand, foot and mouth disease
A 2 month old baby is brought in to hospital with a fever. The child is pyrexial, with nil respiratory signs on examination and no diarrhoea. What investigations do you order?
Full blood count
Blood culture
C-reactive protein
Urine testing for urinary tract infection
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Chest radiograph (only if respiratory signs are present)
Stool culture (if diarrhoea is present)
A highly infectious viral gastroenteritis. Typically affects babies and young children. Causes diarrhoea and vomiting, abdo pain and fever. Vaccine given at 2, 3 months (Oral live attenuated). What is this condition?
Rotavirus
