Rashes

Question 1

Features on Hx of Kawasaki

Answer 1

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

Question 2

Ix for kawasaki

Answer 2

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

Question 3

Mx for Kawasaki

Answer 3

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

Question 4

Risks with Kawasaki?

Answer 4

Coronary artery aneurysms

Question 5

Features of VZV

Answer 5

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

Question 6

Mx of VZV

Answer 6

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

Question 7

complications of VZV

Answer 7

1) post herpetic neuralgia
2) Encephalitis
3) Pneumonia
4) Bacterial superinfection

Question 8

features of parvovirus B19

Answer 8

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

Question 9

Dx of parvovirus B19

Answer 9

1) Usually no Ix needed- clinical Dx
2) Can do parvovirus serology (IgM and IgG)
3) Parvovirus PCR= more sensitive and quick

Question 10

Mx of parvovirus B19

Answer 10

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

Question 11

Features of roseola infantum (HHV 6)

Answer 11

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

Question 12

Dx of roseola infantum

Answer 12

Based on Hx and Ex

Question 13

Complications of roseola infantum

Answer 13

1) Seizures
2) Encephalitis
3) TCP

Question 14

Features of hand foot + mouth disease

Answer 14

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

Question 15

Dx of Hand foot + mouth disease

Answer 15

1) Mainly clinical Dx

2) In sick kids- may show raised WCC, CRP and positive serology for virus

Question 16

Rx of Hand foot + mouth disease

Answer 16

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

Question 17

Features of measles

Answer 17

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

Question 18

Dx of measles

Answer 18

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

Question 19

Mx of measles

Answer 19

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

Question 20

Features of mumps

Answer 20

1) Acute fever
2) Swelling and tenderness in salivary glands
3) +/- resp Sx

Question 21

Cx of mumps

Answer 21

1) Mumps meningitis
2) Orchitis
3) Increased chance of spontaneous MC if pregnant woman infected in 1st trimester

Question 22

Dx of mumps

Answer 22

1) Serology to detect mumps IgM

or significant rise in IgG Ab in acute and covalescent sera

Question 23

Rx of mumps

Answer 23

1) No specific Rx
2) Exclude from school- for 9 days or until swelling goes down
3) IVIG not effective