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Paediatrics > Sick Child With A Rash - Macular/ Maculopapular > Flashcards

Sick Child With A Rash - Macular/ Maculopapular Flashcards

1
Q

What is a macule?

A

A flat area of altered colour

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2
Q

What is a papule?

A

A small raised lesion < 0.5cm diameter

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3
Q

What causes roseola infantum?

A

Human herpes virus type 6B

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4
Q

What is roseola infantum characterised by?

A

High fever, mild coryzal symptoms, irritability and tiredness lasting 3-5 days
As fever subsides, macular or maculopapular rash occurs
- rash blanches
- non itchy, painless, do not blister

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5
Q

In roseola infantum, where does the rash start?

A

Starts on chest, back, abdomen and spreads to face, arms and legs

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6
Q

Roseola infantum typically occurs in what age group?

A

6 months to 3 years

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7
Q

How is roseola infantum spread?

A

Person to person via saliva of asymptomatic family members

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8
Q

How long does the rash associated with roseola infantum last?

A

May fade within a few hours or persist for 2 days

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9
Q

How is roseola infantum treated?

A

No specific treatment
Usually mild and self limiting
Rest, maintain fluid and paracetamol for fever

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10
Q

What complication can occur with roseola infantum (although rare)?

A

Febrile seizure due to high temperature

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11
Q

What is another term for erythema infectiosum?

A

Slapped cheek syndrome

Fifth disease

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12
Q

What causes slapped cheek syndrome?

A

Parvovirus B19 or erythrovirus EVB19

Single stranded DNA virus that targets red cells in the bone marrow

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13
Q

How does slapped cheek syndrome spread and what is the incubation period?

A

Spread via respiratory droplets, vertical transmission, transfusion of infected blood products
Incubation: 7 to 10 days

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14
Q

What occurs initially with slapped cheek syndrome?

A

Non specific mild prodrome - mild fever, headache

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15
Q

What are the 3 distinct phases of slapped cheek syndrome (after mild prodrome)?

A

1) bright red erythema over cheeks - 2 to 4 days, cheeks feel hot and firm
2) erythematous macular to morbilliform rash on extensor surfaces 1-4 days
3) rash fades leaving reticulated lacy pattern for days to weeks

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16
Q

Is erythema infectiosum a serious condition?

A

Generally not
Arthritis and arthralgia in adults
Some complications can occur in adults e.g pregnant women small risk of spontaneous abortion or hydrops fetalis due severe anaemia

In those with haemolytic blood disorders it could cause potentially dangerous low blood count (those with sickle cell disease or thalassaemia) -> aplastic crisis
Children that are immunocompromised may not be able to clear infection

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17
Q

How is erythema infectiosum managed?

A

No specific treatment
Affected children may stay at school as the infectious stage occurs before rash evident
Cold flannel to cheeks

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18
Q

When are erythema infectiosum outbreaks most common?

A

Spring

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19
Q

What is rubella also called?

A

German measles

3 day measles

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20
Q

What type of disease is rubella?

A

Viral disease

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21
Q

Rubella is generally a mild disease unless..

A

You are pregnant - results in miscarriage, stillbirth or birth of infant with major abnormalities

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22
Q

What time of year does rubella typically occur?

A

Winter and spring

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23
Q

How does rubella spread?

A

Respiratory route frequently from a known contact

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24
Q

Describe the prodrome symptoms associated with rubella

A 
Eye pain on eye movement 
Conjunctivitis 
Sore throat 
Headache
Body aches 
Low grade fever

Generally lasts 1-5 days before rash
Prodrome phase does not always occur - more common in adults

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25
Describe the rash associated with rubella
``` Maculopapular rash Pink/light red spots Lasts up to 5 days May or may not be itchy Usually not as widespread as measles Begins on face and spreads to trunk and extremities ```
26
What almost always accompanies rubella?
Tender lymphadenopathy- especially posterior auricular and sub occipital
27
What is the Forchheimer sign seen in the prodromal phase of rubella?
Pinpoint or large petechiae on soft palate and uvula
28
How is rubella treated?
No specific treatment Usually mild and self limiting Rest, fluids, paracetamol for fever
29
Are complications of rubella rare in childhood?
``` Yes but they include: Arthritis Arthralgia Encephalitis Thrombocytopenia Myocarditis ```
30
In childhood rubella, what should be done if risk of exposure to non immune pregnant woman?
Confirm diagnosis with serology
31
How can Rubella and congenital rubella syndrome be prevented?
Vaccination - part of routine immunisation programme in UK (MMR vaccine) - 2 dose strategy
32
What type of infection is measles?
Highly contagious viral infection | SS RNA
33
Describe the early symptoms (prodrome) of measles
Conjunctivitis Cough Coryza - swelling of mucus membranes of nose Koplik spots - small white spots in the mouth (pathognomonic) Fever Malaise Appetite loss Prodrome typically lasts 3 days
34
When does a rash appear in measles?
3rd day of illness
35
Describe the rash in measles
Initial red, discrete maculopapular rash On the face initially, behind ears then spreads to trunk and becomes more generalised and confluent May desquamate in second week Non itchy
36
Why has there been a recent increase in the number of measles?
Recent trend of some parents to not immunise their children
37
How is measles spread?
Droplet spread - can survive for up to 2 hours in air or on surfaces An infected person is contagious from 2 days before any symptoms show to at least 5 days after onset of rash Incubation period = 10-14 days
38
What does a the rash in measles usually coincide with?
High fever
39
How is measles diagnosed?
History and exam But because it is rare in developed countries - any suspected case requires laboratory confirmation - viral nasopharyngeal swab and throat swab for PCR - blood and urine samples can also be used
40
What complications can occur with measles?
GI: diarrhoea, mouth ulcers, appendicitis, hepatitis, mesenteric adenitis Ears: otitis media (most common complication) - may lead to deafness Respiratory: pneumonia (most common cause of death) CVS: myocarditis, pericarditis Neurological: febrile seizures, encephalitis, subacute sclerosing panencephalitis (very rare, may occur 5-10 years after illness) Eyes: corneal ulceration Renal: acute glomerulonephritis Haematological: thrombocytopenia Measles can suppress the immune system for up to 6 weeks - bacterial superinfection e.g OM and pneumonia
41
Do children or adults tend to have more severe form of measles?
Adults
42
How is measles treated?
Supportive In immunocompromised- antiviral drug ribavirin can be used Vitamin A (modulates immune response) should be given in low income countries - often malnutrition and vit A deficiency causing protracted course of measles with severe complications If a child not immunised comes into contact with measles, the MMR should be offered as vaccine induced measles antibodies develop more rapidly than following natural infection)
43
What type of infection is scarlet fever?
Bacterial infection | - streptococcal pyrogenic endotoxin strain of streptococcus pyogenes (group A beta haemolytic streptococcus)
44
Who does scarlet fever affect?
Those who have recently had a sore throat (strep pharyngitis) or impetigo caused by certain strains of streptococcus pyogenes
45
What age group does scarlet fever typically affect?
Children aged 4 to 8 | By 10 years up to 80% of children have developed lifelong protective antibodies against streptococcal toxins
46
What are the initial symptoms of scarlet fever?
``` Sore throat High fever > 38.5 Headache Flushed cheeks Bright red swollen tongue ‘strawberry red’ Lymphadenopathy (cervical) Nausea and vomiting Loss of appetite Abdominal pain Malaise ```
47
When does the characteristic rash appear in scarlet fever?
1-2 days after start of fever
48
Describe the rash seen in scarlet fever
Scarlet spots or blotches ‘boiled lobster’ appearance As it progresses, looks like sunburn with goose pimples Skin may have rough sand paper feel In folds, capillaries can rupture - red streaks called Pastia lines
49
Where does the rash generally appear in scarlet fever?
Usually starts on chest, abdomen and spreads to other areas e.g ears and neck
50
How long does the rash last in scarlet fever?
Approximately 1 week | Fades and peels
51
How is scarlet fever diagnosed?
Characteristic history and examination Supported by: Throat swab culture or rapid streptococcal antigen test from posterior pharynx/tonsils
52
How is scarlet fever managed?
Antibiotics - usually oral penicillin V for 10 days (important to take full course) Paracetamol for fever, headache, throat pain Soft foods, plenty of liquids Oral antihistamines to relive rash
53
What complications can occur with scarlet fever?
``` Rheumatic fever - typically 20 days after infection Otitis media (most common complication) Pneumonia Sepsis Meningitis Necrotising fasciitis Glomerulonephritis Osteomyelitis ```
54
What is Kawasaki disease?
An acute febrile illness with inflammation of small and medium sized blood vessels throughout body, in particular the coronary arteries
55
Kawasaki disease typically affects what age group?
Children 6 months to 4 years
56
What ethnicity is Kawasaki disease more common in?
Japanese and black-Caribbean ethnicity
57
What features are associated with Kawasaki disease?
High fever that is difficult to control Strikingly irritable Rash - measles like or maculopapular or red skin, peeling occurs later Oral signs - strawberry tongue, redness in mouth and throat, cracked lips Eyes - conjunctivitis Peripheral limbs - swelling of hands and feet, redness of palms and soles Lymphadenopathy (cervical)
58
Is there a diagnostic test for Kawasaki disease?
No Diagnosis: fever for at least 5 days, 4/5 of cardinal signs and absence of other illness to account for signs Bloods: raised CRP, ESR, WCC, raised platelets
59
How is Kawasaki disease treated?
IV immunoglobulin - lowers the risk of coronary artery aneurysm if given within 10 days Aspirin to reduce thrombosis risk
60
What complications can occur with Kawasaki disease?
Dilatation / narrowing of coronary artery | Can lead to angina, MI or sudden death
61
What is performed as follow up on all children with Kawasaki disease?
ECHO to check the heart at 6-8 weeks
62
Is scarlet fever a notifiable disease?
Yes
63
Is measles a notifiable disease?
Yes

Paediatrics (104 decks)

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