Scarlet fever, Infectious mononucleosis, Mouth-Hand-Foot disease, Measles

Question 1

Scarlet fever

1. characterized by
2. causative agent
3. source of infection
4. route of infection

Answer 1

1. fever, pharyngotonsillitis, rash
2. group A beta hemolytic streptococcus (GABHS) = S. pyogenes
3. infected people and asymptomatic carriers
4. respiratory droplets

Question 2

Scarlet fever

1. seasonality
2. age
3. incubation period

Answer 2

1. late winter and early spring
2. 4-8 years old
3. 1-5 days, up to 12 days

Question 3

Scarlet fever

-symptoms

Answer 3

-Prodromal period: 1-5 days

• Acute onset, fever, cervical lymphadenopathy, gastrointestinal symptoms (nausea, vomiting, abdominal pain),
• enanthema, pharyngotonsillitis,
• strawberry tongue + white plaque at first –> raspberry tongue (red and enlarged)
• Rash –> erythematous rash first appear in ears, chest and trunk. More commonly in flexural areas, macules can be seen
• Desquamation –> after 7-10 days, palms/ trunk/ feet, without pigmentation, can last up to 6 weeks

Question 4

Scarlet fever

1. complications
2. diagnosis
3. differential diagnosis

Answer 4

1. Purulent: acute otitis media, meningitis, purulent tonsillar abscess, sinusitis, necrotizing fasciitis, sepsis
   Non-purulent: PANDA, glomerulonephritis, rheumatic fever, streptococcal toxic shock syndrome
2. blood count, CRP, throat culture, rapid antigen test (if negative, perform culture), serology (if there are complications)
3. viral pharyngotonsillitis, infectious mononucleosis, Kawasaki disease, allergic dermatitis, pseudotuberculosis, measles, rubella, diphteria…

Question 5

Scarlet fever

1. what is necessary before taking a sample from tonsils?
2. treatment
3. How long is an infected person contagious?

Answer 5

1. should be taken fore antibacterial treatment and at least 2h after a meal
2. gold standard – Penicillin orally – 10d.
   - Recurrent tonsilitis – Amoxicillin + ac. Clavulanicum
   - Patients allergic to Penicillin
   - Macrolides – Azithromycin for 5d.
3. Not treated – 7-21 days, Treated – 24h

Question 6

Infectious mononucleosis

1. etiology
2. source of infection
3. route of infection
4. incubation period

Answer 6

1. Epstein bar virus (most common – HHV-), CMV (rare)
2. sick person or carrier
3. saliva, some utensils, cutlery
4. 30-50 days

Question 7

Infectious mononucleosis

-symptoms

Answer 7

• Prodrome period (2-5d.) –> general weakness, fatigue, subfebrile fever, abdominal pain, throat pain, headache
• Classical symptoms –> lymphadenopathy, fever, hepatosplenomegaly, pharyngotonsillitis
• Extremely severe form –> hemophagocytic lymphohistocytosis (HLH)

Question 8

Infectious mononucleosis

1. diagnosis
2. differential diagnosis
3. complications
4. treatment

Answer 8

1. blood count (leukocytosis – lymphocytosis), increased liver enzymes, serology (specific IgM antibody), PCR - unclear cases
2. streptococcal tonsilitis, adenovirus, toxoplasmosis, diphtheria, HIC, leukemia, lymphoma, allergic rash
3. secondary bacterial tonsilitis, upper airway obstruction
4. anti-viral therapy is NOT effective, symptomatic treatment - anti-pyretic, analgesics as needed, enough fluids, rest

Question 9

Infectious mononucleosis

-recovery period

Answer 9

• Acute period lasts from days to 3-4 weeks
• Possible biphasic course –> symptoms improve and then return
• Hepatosplenomegaly, lymphadenopathy –> up to 1-3 months
• Feeling tired –> up to 6 months
• Rash most commonly occurs when the patient is being treated with Aminopenicillin

Question 10

Mouth-Hand-Foot disease

1. etiology
2. age
3. seasonality
4. route of infection
5. incubation period

Answer 10

1. viruses – Coxsackie A6, A16, A19 or enterovirus A71
2. all ages, most common up to 5-7 years
3. summer and autumn
4. fecal oral, less frequently –> airborne or direct contact with rash
5. 3-5 days, it can be as long as 7-9 days
   - Children can infect others in about 7 days

Question 11

Mouth-Hand-Foot disease

-clinical manifestation

Answer 11

• Begins with –> mouth and throat pain, children refuse to eat, fever
• Typical rash in mouth (blisters, painful sores) and macular, maculopapular or vesicular rash of hands and feet –> gray blisters surrounded by a red ring

Question 12

Mouth-Hand-Foot disease

1. late complication
2. complications
3. diagnosis
4. treatment
5. prophylaxis

Answer 12

1. after 2-8 weeks –> onychomadesis
2. dehydration, romencephalitis, facial paresis, meningitis, myocarditis
3. clinically, PCR
4. self-limiting (within 7 days), no specific treatment
5. hygiene

Question 13

Measles

1. etiology
2. source of infection
3. incubation period
4. route of infection

Answer 13

1. measles virus – extremely volatile, poorly resistant in external environments
2. sick person
3. 7-17 days
4. aerosol, contaminated hands
   - The patient may become infective by the last 1-2 days and 4 days of the incubation period after the onset of the rash

Question 14

Measles

-symptoms

Answer 14

• Catharal period (3-5 days)
• Fever, myalgia, anorexia
• Runny nose, cough, conjunctivitis
• Enantema on the soft and hard palate
• Filatov- Koplick spots in the mucous membranes of the cheeks

Question 15

Measles

1. diagnosis
2. complications
3. treatment
4. prevention

Answer 15

1. PCR and serological tests (specific IgM class antibodies)
2. pneumonia, laryngitis, laryngotracheitis, otitis media, diarrhea, eye damage, subacute sclerosing panencephalitis (PSP) – occurs 7-10 years after Measles
3. no specific treatment, Vit. A is recommended.
4. vaccination