Rashes in children - repeat. Flashcards
A child presents with a rash on both cheeks, ferver and and URTI.
What is the most likely diagonsis? [1]
What causes this? [1]
Slapped cheek syndrome:
- Rash on both cheeks, fever (often hardly noticebale), upper respiratory tract infection symptoms.
- Rash rarely involves hand or feet
- Caused by parvovirus B19
Describe the characteristics of the rash in slapped cheek syndrome [3]
The rose-red rash makes the cheeks appear bright red, hence the name ‘slapped cheek syndrome’. The rash may spread to the rest of the body but unlike many other rashes, it only rarely involves the palms and soles.
The child begins to feel better as the rash appears and the rash usually peaks after a week and then fades.
some months afterwards, a warm bath, sunlight, heat or fever will trigger a recurrence of the bright red cheeks and the rash itself.
Hand, foot and mouth disease is a self-limiting condition affecting children. It is caused by the intestinal viruses of the Picornaviridae family (most commonly [] and []).
Hand, foot and mouth disease is a self-limiting condition affecting children. It is caused by the intestinal viruses of the Picornaviridae family (most commonly coxsackie A16 and enterovirus 71).
Describe the clinical features of hand, foot and mouth disease
- mild systemic upset: sore throat, fever
- oral ulcers
- followed later by vesicles on the palms and soles of the feet
How do you treat hand foot and mouth diseasE? [1]
symptomatic treatment only: general advice about hydration and analgesia
reassurance no link to disease in cattle
children do not need to be excluded from school
Scarlet fever is a reaction to erythrogenic toxins produced by []
Scarlet fever is a reaction to erythrogenic toxins produced by Group A haemolytic streptococci (usually Streptococcus pyogenes).
Describe the clinical features of scarlet fever [4]
- Coarse red rash on the cheeks, sore throat, headache, fever, ‘sandpaper’ texture rash
- bright red tongue / strawberry tongue
- fever for 24/48 hours
- rash appears first on torso and spares palms and soles
Describe the management for scarlet fever [2]
When can children return to school? [1]
- oral penicillin V for 10 days
- patients who have a penicillin allergy should be given azithromycin
- children can return to school 24 hours after commencing antibiotics
- scarlet fever is a notifiable disease
What is the most common complication of scarlet fever ? [1]
otitis media
Name 4 complications of scarlet fever [4]
- otitis media: the most common complication
- rheumatic fever: typically occurs 20 days after infection
- acute glomerulonephritis: typically occurs 10 days after infection
- invasive complications (e.g. bacteraemia, meningitis, necrotizing fasciitis) are rare but may present acutely with life-threatening illness
Describe the clinical features of measles [3]
prodrome:
- irritable, conjunctivitis, fever
Koplik spots (before rash):
- white spots (‘grain of salt’) on buccal mucosa
rash:
- starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
Name this feature of measles infection [1[
Koplik spots
How do you investigate for measles? [1]
Measles is generally diagnosed clinically, but PCR testing is helpful to confirm the diagnosis.
IgM antibodies can be detected within a few days of rash onset
Describe the management of measles [1]
Most cases are self-limiting within 1 week with self-care measures such as fluids and symptomatic management
notifiable disease → inform public health
What is the most common complcation [1] and common cause of death [1] due to measles?
otitis media: the most common complication
pneumonia: the most common cause of death
Describe how you differentiate between measles and scarlet fever [1]
Measles has a maculopapular rash that starts on the face and moves down the body; Koplik spots
Scarlet fever has a distinctive rash that appears 1–2 days after the onset of other symptoms, first on the neck and then spreading to the trunk and extremities; strawberry tongue
Describe the rash caused by rubella [1]
Where does lymphadenopathy occur? [2]
What other clinical features are significant? [1]
Rash that starts on the head and spreads to the trunk
lymphadenopathy: suboccipital and postauricular
Often associated with arthritis and arthralgia
Rubella poses a serious risk to unvaccinated pregnant women. Congenital rubella infection (especially in the first 20 weeks of pregnancy) can lead to congenital rubella syndrome, which can cause severe fetal abnormalities such as: [4]
- Cataracts
- Deafness
- Patent ductus arteriosus
- Brain damage
human herpesvirus 6 (HHV-6) causes which pathology in children? [1]
Roseola infantum
Describe the clinical features of Roseola infantum [3]
High Fever
erythematous maculopapular rash appears on the trunk before spreading peripherally to the neck, face, and extremities
- small pink-to-red macules or papules
- non-pruritic and blanch upon pressure
- Nagayama spots, papular enanthem on the uvula and soft palate, may also be seen
Febrile seizures:
- Approximately 10% to 15% of affected children experience febrile seizures during the course of their illness due to rapid temperature elevation.
Diagnosis of Roseola infantum?
Clinical features:
- characteristic sequence of high fever followed by a maculopapular rash is often sufficient for identification.
Serological testing: Detection of HHV-6 or HHV-7-specific immunoglobulin M (IgM) antibodies can support a diagnosis of Roseola infantum.
Management for roseala infantum?
Although generally self-limiting, it is crucial for physicians to be familiar with its management to provide appropriate care and alleviate symptoms in affected patients.
How can measles be prevented in someone who has had close contact with a confirmed case of measles? [2]
Prompt vaccination or a dose of immunoglobulin within a few days of contact.
What is the most likely complication of slapped cheek syndrome? [1]
Anaemia
When are children with scarlet fever no longer infectious? [1]
24 hours after the first dose of antibiotics.
Name two causes of itchy rashes in children.
Two of: eczema, ringworm, chicken pox, heat rash.
What is the usual duration of phenoxymethylpenicillin treatment for scarlet fever? [1]
10 days.
Which feature of a rash in a child would give rise to concern about meningococcal septicaemia? [1]
Non-blanching purpuric rash.
Which complication of measles may not be apparent until years after the infection? [1]
Subacute sclerosing panencephalitis.
Which organism is the most common cause of hand, foot and mouth disease?
Coxsackie virus A16.
When are children with chicken pox no longer infectious? [1]
When all the lesions have crusted over.
How long before the rash appears are children with measles infectious for? [1]
Around 4 days before the rash appears.
Name one possible complication of chicken pox [1]
pneumonia, encephalitis, bacterial skin infections, shingles.
Why should aspirin not be used in a child presenting with fever? [1]
Risk of Reye’s syndrome.
What is characteristic about the rash of chicken pox? [1]
Maculopapular vesicular rash that crusts over and forms blisters on each lesion.
What complication are pregnant woman at risk of after contracting parvovirus B19? [1]
Hydrops fetalis.
What are Pastia’s lines? [1]
Red creases in the skin folds (e.g. armpits) associated with scarlet fever.
When are children with slapped cheek syndrome no longer infectious? [1]
Once the rash appears.
Deficiency of which vitamin is a risk factor for measles? [1]
Vitamin A
Which illness is hand, foot and mouth disease usually associated with? [1]
Common cold.
