Red rashes in children

Question 1

What are the 6 red rashes

Answer 1

First disease: Measles

Second disease: Scarlet Fever

Third disease: Rubella (AKA German Measles)

Fourth disease: Dukes’ Disease

Fifth disease: Parvovirus B19

Sixth disease: Roseola Infantum

Question 2

What virus causes measles

Answer 2

Measles virus

Question 3

How is measles spread

Answer 3

Highly contagious via respiratory droplets

Question 4

Presentation of measles

Answer 4

Symptoms start 10 – 12 days after exposure

Fever, coryzal symptoms and conjunctivitis

Koplik spots

Rash starts on the face, commonly behind the ears

Rash is an erythematous, macular rash with flat lesions

Question 5

Koplik spots

Answer 5

Greyish white spots on the buccal mucosa appear 2 days after fever

Question 6

How long does measles take to resolve

Answer 6

Self resolving after 7 – 10 days

Question 7

Management of measles

Answer 7

Children should be isolated until 4 days after their symptoms

Measles is a notifiable disease - report to public health

Question 8

Complications of measles

Answer 8

Pneumonia
Diarrhoea
Dehydration
Encephalitis
Meningitis
Hearing loss
Vision loss
Death

Question 9

What organism causes scarlet fever

Answer 9

Group A streptococcus - strep pyogenes

Question 10

Pathophysiology of scarlet fever

Answer 10

Caused by an exotoxin produced by the streptococcus pyogenes

Question 11

Presentation of scarlet fever

Answer 11

Red-pink, blotchy, macular rash with rough “sandpaper” skin that starts on the trunk and spreads outwards.

Patients can have red, flushed cheeks.

Other features:
Fever
Lethargy
Flushed face
Sore throat
Strawberry tongue
Cervical lymphadenopathy

Question 12

Treatment of scarlet fever

Answer 12

Phenoxymethylpenicillin (penicillin V) for 10 days

Notifiable disease - public health

Children should be kept off school until 24 hours after starting antibiotics

Question 13

Slapped cheek syndrome (erythema infectiosum) presentation

Answer 13

Mild fever, coryza and non-specific viral symptoms such as muscle aches and lethargy.

After 2 – 5 days the rash appears rapidly - diffuse bright red rash on both cheeks

Days later -reticular mildly erythematous rash affecting the trunk and limbs appears that can be raised and itchy

Question 14

What organism causes slapped cheek syndrome

Answer 14

Parvovirus B19

Question 15

Management of erythema infectiosum

Answer 15

Self limiting

Do not need to stay off school

Question 16

How long does the rash last for in erythema infectiosum

Answer 16

1 – 2 weeks

Question 17

Patients at high risk of complications from erythema infectiosum

Answer 17

Immunocompromised patients

Pregnant

Haematological conditions:

• sickle cell anaemia
• thalassaemia
• hereditary spherocytosis and haemolytic anaemia.

Question 18

Investigations for erythema infectiosum in high risk patients

Answer 18

Serology testing for parvovirus to confirm the diagnosis

FBC and reticulocyte count for aplastic anaemia

Question 19

Complications of erythema infectiosum

Answer 19

Aplastic anaemia

Encephalitis or meningitis

Pregnancy complications including fetal death

Rarely hepatitis, myocarditis or nephritis

Question 20

Causative organism for roseola Infantum

Answer 20

Human herpesvirus 6 and 7

Question 21

Presentation of roseola

Answer 21

Presents 1 – 2 weeks after infection

Sudden high fever, lasts for 3 – 5 days and then disappears suddenly.

May be coryzal symptoms, sore throat and swollen lymph nodes

When the fever settles, the rash appears for 1 – 2 days.

Mild erythematous macular rash across the arms, legs, trunk and face and is not itchy

Question 22

Management of roseola

Answer 22

Self limiting

Question 23

How long does roseola last for

Answer 23

1 - 2 weeks

Do not need time off nursery

Question 24

Complication of roseola

Answer 24

Febrile convulsions

If immunocompromised:

• thrombocytopenia
• myocarditis
• Guillian Barre syndrome