Paeds Infectious diseases Flashcards
Measles
Organism
RNA Morbillivirus
Paramyxovirus family
Measles
Incubation period
+ Infectivity period
7 - 14 days
From prodrome to 4 days after rash disappears
Measles
Presentation
Prodrome = CCCK for 3-5 days
Rash > 3 days, Fever > 1 day PLUS one of CCC
Measles
Rash
Starts on forehead, neck, behind ears, spreads to limb/trunk
Measles
Ix
IgM and IgG +ve
Salivary swab/serum sample within 6 weeks (measles-specific Ig)
RNA detection in the salivary swab
Measles
Tx
Self-limiting
Notifiable disease!!
Measles
Complications
- otitis media
- croup/tracheitis
- pneumonia
- encephalitis
- subacute panencephalitis
Measles
Complications if in pregnancy?
- Miscarriage
- Prematurity
- Low birth weight
- Vit A deficiency –> deafness
Scarlet fever
Organism
Group A streptococcus (Strep. pyogenes)
Scarlet fever
Incubation period
2 - 4 days
Scarlet fever
Prodrome
Sore throat, tonsillitis, fever, headache, vom
Scarlet fever
Rash
- Scarlatiniform rash
- Chest, axilla, behind ears –> trunk and legs
- Red ‘pinprick’ blanching rash (sandpaper/rough-like)
- Strawberry tongue
Scarlet fever
Ix
- Clinical
- Throat swab + culture
- Antigen detection kits
- Strep antibody test
Scarlet fever
Tx
- Penicillin + Azithromycin for 10 days
- NOTIFIABLE DISEASE
Scarlet fever
Complications
- Sydenhams chorea
- Otitis media
- Rheumatic fever
- Glomerulonephritis
Rubella
Causative organism
RNA virus = Rubivirus Togaviridae
Rubella
Incubation period
14 - 21 days
Rubella
Infectivity
5 days before until 5 days after
Rubella
Prodrome
- lethargy
- low fever
- headache
- mild conjunctivitis
- anorexia
Rubella
Rash
- pink discrete macular rash
- Starts behind ears/face –> body
- Lymphadenopathy - suboccipital
Rubella
Ix
- PCR testing
- FBC - low WCC, high lymphocytes/thrombocytopenia
Rubella
Tx
- Antipyretics
- Vaccine
- NOTIFIABLE DISEASE
Rubella
In-utero complications
- Weeks 1 - 4: eye anomaly (70%)
- Weeks 4 - 8: cardiac abnormality (40%)
- Weeks 8 - 12: deafness (30%)
Slapped cheek syndrome
Causative organism
Parvovirus B19
Slapped cheek syndrome
Incubation period
4 - 20 days
Slapped cheek syndrome
Prodrome
- headche
- rhinitis
- sore throat
- low fever
- malaise
- nausea
- diarrhoea
- abdo pain
- arthralgia
Slapped cheek syndrome
Rash
Prodrome –> 7-10 days symptom free –> Rash
- Cheeks, sparing nose
- 1 - 4 days later: macular rash on limbs, extensor surfaces, not itchy
- Symmetrical arthralgia
Slapped cheek syndrome
Ix
- B19 specific IgM = current infection
- B19 specific IgG = immunity
- PCR
Slapped cheek syndrome
Tx
Advise of risks
Slapped cheek syndrome
Worse prognosis if?
- Sickle cell
- Thalassaemia
- Spherocytosis
- HIV
- Dangerous in pregnancy
Chickenpox
Causative organism
- Varicella-zoster virus
Chickenpox
Incubation period
10 - 21 days
Chickenpox
Symptoms
- Fever 38/39
- Headache
- Malaise
- Abdo pain
Chickenpox
Rash
- 2-4 crops of vesicles over 3-5 days
- Itchy
- Head, neck, trunk
- Macule –> papule –> vesicle (red surround) –> ulcers –> crust
Chickenpox
Ix
Clinical
Fluorescent antibody test (IgG/IgM)
Chickenpox
Tx
- Keep cool
- Calamine lotion
- Antihistamines
- 5 days off school
- IG’s and Acyclovir if severe/immunocompromised/risk of complications
Chickenpox
Complications
- Secondary bacterial infection of lesions
- Pneumonia
- Encephalitis (ataxia)
- Disseminated haemorrhage
- Arthritis
- Nephritis
- Pancreatitis
Chickenpox
RFs for complications
- Immunocompromised
- Older
- Steroid use
- Malignancy
Dangerous for neonates/fetus/immunocomp/severe eczema
Coxsackies
Causative organism
Coxsackievirus A16 (Enterovirus 71)
Coxsackies
Incubation period
5 - 7 days
Coxsackies
Transmission
Faeco-oral
Coxsackies
Presentation/prodrome
- Mildly unwell w/ systemic illness
- Low fever
- Malaise
- Loss of appetite
- Sore mouth/throat
- Cough
- Abdo pain
Coxsackies
Rash
- Mouth lesions: buccal mucosa, tongue + hard palate, yellow ulcers surrounded by red haloes
- Skin lesion: palms, soles, between fingers + toes, erythematous –> grey vesicles. May also be on trunk/buttocks/genitalia
- Heals w/o crusting
Coxsackies
Tx
- Fluids/soft food/analgesia
- Maybe lidocaine gell if v sore
- Only stay off school if unwell
Impetigo
Causative organisms
S. aureus or Strep. pyogenes
Impetigo
Peak age
2 -5 years
Impetigo
incubation period
4 - 10 days
Impetigo
Rash
Honey-coloured crusty lesions on an erythematous base
- Start on nose/face
Impetigo
Tx
- Fusidic acid
- or oral flucloxacillin (if severe)
- Isolate patient
- Keep off school until lesions crust/heal or 48hrs post Abx initiation
Toxic shock syndrome
Organisms
- S.Aureus/Group A Strep
Toxic shock syndrome
Presentation
- Fever > 38
- Hypotension
- Diffuse erythematous macular rash
- Organ dysfunction (3+ organ systems):
o Mucositis
o GI - vom/diarrhoea
o Renal/liver impairment
o Clotting abnormalities + thrombocytopenia
o CNS - altered consciousness/confusion
Toxic shock syndrome
Tx
- Intensive care
- Infection areas surgically debrided
- Abx - CEFTRIAXONE + CLINDAMYCIN
Candida
Vs nappy rash
- Rash extending into skin folds
- Larger red macules
- Well demarcated scaly border
- Circular pattern - similar to ringworm
- Satellite lesions (small similar patches close to the main rash)
- Oral thrush
Candida
Tx
Topical antifungal
Fluconazole, Miconazole, Clotrimazole
Scalded skin syndrome
Causative organism
- S.Aureus toxins
Scalded skin syndrome
Presentation
- Starts with generalised erythema –> thin/wrinkled skin –> fluid-filled blisters (BULLAE) –> burst and leave sore erythematous skin underneath
Lethargy, irritability, dehydration, fever –> sepsis/death
+ve Nikolskys sign (gentle rubbing of skin causes it to peel)
Scalded skin syndrome
Tx
- ADMISSION and IV Abx
- Fluid + electrolyte balance (to prevent dehydration)
Diphtheria
Causative organism
Gram +ve bacterium - Corynebacterium diphtheriae
Necrotic mucosal cells
Diphtheria
Consider in who?
- Recent visit to Eastern Europe/Russia/Asia
- Sore throat with diphtheric membrane = grey, pseudomembrane on posterior pharyngeal wall
- Bulky cervical lymphadenopathy (bull neck)
- Neuritis (cranial nerve)
- Heart block
Diphtheria
Ix
Culture of throat swab -
tellurite agar on Loefflers media
Diphtheria
Tx
- IM Penicillin
- Diphtheria antitoxin
Kawasaki disease
In who?
- 6 months - 5 years
- Predominantly Asian origin
Kawasaki disease
What?
Idiopathic, self-limiting, systemic vasculitis
Kawasaki disease
Presentation
FEVER - non-remitting, > 5 days (Dz = Stills/Leukaemia/RF)
S - Strawberry tongue/sausage fingers
C - Conjunctivitis (non-purulent)
R - Rash - polymorphic/non-vesicular
E - Erythema and oedema of hands
A - Adenopathy (cervical lymph - unilateral)
M - Mucosal involvement
Kawasaki disease
Phases
Acute (1-2 weeks) = febrile
Subacute (4-6 weeks) = remission of fever, development of coronary artery aneurysm, thrombocytosis, desquamation of digits
Convalescent (6-12 weeks) = resolution of clinical signs and inflammatory markers
Kawasaki disease
Ix
- Raised ESR/CRP/AST/A1AT/Platelets/Bilirubin
- ECG
- MUST DO ECHO
Kawasaki disease
Tx
- high dose aspirin
- IV IG’s
- +/- Prednisolone
Kawasaki disease
Major complication?
- Coronary artery aneurysm formation –> PCI
