Rashes Flashcards
Features on Hx of Kawasaki
Fever >5 days + 4/5:
1) Conjunctivitis
2) Rash- polymorphous, not bullous/ vesicles
3) Erythema and oedema of hands and feet
4) Adenopathy- cervical, unilateral, painful, non-purulent
5) Mucous membrane changes- red oropharynx, strawberry tongue
Other features: D + V Arthritis Irritability Coryza + cough
Ix for kawasaki
1) FBE (platelet count)
2) ASOT/ anti-DNAse B
3) Echo- at initial presentation and if -ve, at F/U in 6-8weeks
others: CRP + ESR, LFTs
Mx for Kawasaki
1) Admit
2) IVIG 2g/kg over 10 hours
3) Aspirin 3-5mg/kg OD for 6-8 weeks
4) Arrange for paeds F/U on discharge with echo in 6-8 weeks
Risks with Kawasaki?
Coronary artery aneurysms
Features of VZV
1) Prodrome: fever, malaise, or pharyngitis, loss of appetite
2) ~24h later- develop vesicular rash. Usually starts on trunk, spreads centrally (face, scalp)
3) Features of rash: pruritic, appears in successive crops over several days
a) Macules> papules> pustular> crusted
b) Typically see lesions in different stages of development present simultaneously
Mx of VZV
1) Must exclude from school until fully recovered or at least 5 days after eruption
2) Otherwise Rx usually symptomatic for most patients (trim nails, paracetamol for pain relief, calamine lotion + antihistamines for itch)
3) If rash develops, consider acyclovir if neonate, immunocompromised or older
4) ZIG can be given within 96h of exposure to: pregnant women, neonates whose mum gets VZV between <7d before or 2 days post delivery, immune deficiency
complications of VZV
1) post herpetic neuralgia
2) Encephalitis
3) Pneumonia
4) Bacterial superinfection
features of parvovirus B19
1) School age
2) Prodrome: fever, coryza, headache, N + D
3) 2-5 days later, rash. slapped cheek appearance.
Then diffuse macular erythema of trunk + limbs with central clearing (lacy rash)
palms + soles spared
Dx of parvovirus B19
1) Usually no Ix needed- clinical Dx
2) Can do parvovirus serology (IgM and IgG)
3) Parvovirus PCR= more sensitive and quick
Mx of parvovirus B19
1) Confirm Dx
2) Persons are no longer infectious once rash starts- no specific Rx
3) Sx Mx of itch, fever and pain
4) Contact tracing of any pregnant women prior to rash- can cause fetal anaemia/ MC
Features of roseola infantum (HHV 6)
1) Age: 6m- 3y
2) Prodrome: HIGH fever lasting 3-5 days in otherwise well child- may have viral Sx (coryza, irritable)
3) After fever resolves, you get rash (blanching, maculopapular, mainly trunk- rarely spreads) Non-itchy, painless, no blisters.
Lasts for 1-2 days
Dx of roseola infantum
Based on Hx and Ex
Complications of roseola infantum
1) Seizures
2) Encephalitis
3) TCP
Features of hand foot + mouth disease
Organism= Coxsackie + enteroviruses
1) Age: 95% <5yo
2) Febrile
3) generally unwell: sore throat, anorexia, malaise, D
4) Rash: vesicles/ ulcers on tongue, buccal mucosa, pharynx, lips
Maculopapular/ vesicles on hands, feet and buttocks
Resolves in 2-3 days
5) Highly infectious- so Hx of affected family members, school
Dx of Hand foot + mouth disease
1) Mainly clinical Dx
2) In sick kids- may show raised WCC, CRP and positive serology for virus
Rx of Hand foot + mouth disease
1) Child needs to be exlcuded from school till all blisters have dried
2) Specific Rx not needed
3) Do not rupture blisters
4) Antiseptic mouth washes, simple analgesia
5) ensure good handwashing
Features of measles
See 3 things:
1) 3-4 days of URTI- like Sx Classic triad: coryza, cough, conjunctivitis, Koplik’s AND
2) Fever present when rash is there
3) Followed by generalised maculopapular rash, usually >3 days AND
Rash= red, blotchy rash- starts on 3-7th day. Begins on face–> generalised. Lasts ~1 week
Dx of measles
Dx can be confirmed by anti-measles IgM Ab
PCR
Or A four-fold or greater increase in titre measles antibody between acute and convalescent sera
Mx of measles
1) Must notify DHS
2) Vaccine may be protective is within 72h
3) Resp isolation until 5 days after rash
4) Contact tracing:
- MMR if within 72h, IVIG if >72h-7days from contact (offer MMR 3m later)
5) Don’t give MMR or IVIG if <12m
6) Rx is supportive
Features of mumps
1) Acute fever
2) Swelling and tenderness in salivary glands
3) +/- resp Sx
Cx of mumps
1) Mumps meningitis
2) Orchitis
3) Increased chance of spontaneous MC if pregnant woman infected in 1st trimester
Dx of mumps
1) Serology to detect mumps IgM
or significant rise in IgG Ab in acute and covalescent sera
Rx of mumps
1) No specific Rx
2) Exclude from school- for 9 days or until swelling goes down
3) IVIG not effective
