Sick Child With A Rash - Purpuric

Question 1

What is Henoch-Schonlein purpura?

Answer 1

An IgA mediated generalised vasculitis of small vessels of skin, GIT, joints and kidneys

Question 2

What age group does Henoch-Schonlein purpura affect?

Answer 2

Usually between 3 and 10 year olds

Question 3

Is Henoch-Scholein purpura the most common vasculitis of childhood?

Answer 3

Yes

Question 4

How does Henoch-Scholein purpura present?

Answer 4

Fever
Rash - symmetrical, over buttocks and extensor surfaces of legs and arms and ankles
Arthralgia - especially knees and ankles, periaeticular oedema
Colicky abdominal pain (GI involvement can cause haematemesis, melaena, intussusception)
Renal involvement - haematuria and mild proteinuria

Question 5

Describe the rash in Henoch-Scholein purpura

Answer 5

Symmetrical
Over buttocks, extensor surfaces of arms and legs and ankles
Palpable
PURPURIC (inflammation of small vessels of skin causes bleeding into skin)

Question 6

What causes Henoch-Scholein purpura?

Answer 6

Cause is unknown
Genetic predisposition and antigen exposure increases circulating IgA and disrupts IgG synthesis. IgA and IgG interact to produce complexes that activate complement and are deposited in affected organs - inflammatory response

Question 7

What does bouts of HSP usually follow?

Answer 7

Infections in throat, tonsils or gastroenteritis

Question 8

How is Henoch-Schönlein diagnosed?

Answer 8

No specific test 
Relies on symptoms and examination 
May be raised IgA in blood (in 1/3)
Biopsy of skin, bowel or kidney - may show IgA in tissue (neg biopsy does not rule HSP out) 
CT for bowel inflammation

Question 9

How is HSP treated?

Answer 9

No specific treatment for most cases in children
Anti inflammatory drugs for joint pain (only if no kidney involvement!)
Steroids can improve bowel symptoms and clear up rash
Long term kidney protection may be required - BP lowering drugs

Question 10

What causes meningococcal sepsis?

Answer 10

The bacteria neisseria meningitidis

Question 11

Meningococcal sepsis is usually accompanied by a purpuric rash. Is the rash present in cases of meningococcal meningitis?

Answer 11

It may or may not be present

Question 12

How is neisseria meningitidis transmitted?

Answer 12

Droplet spread

Requires prolonged contact

Question 13

What is the the peak ages in incidence for meningococcal sepsis?

Answer 13

Under 5 years and second minor peak at 15-19

Question 14

What is the incubation period for neisseria meningitidis?

Answer 14

2-7 days

Question 15

What prodrome symptoms usually precede meningococcal sepsis?

Answer 15

Coryzal flu like illness
High fever 
Poor feeding
Vomiting 
Diarrhoea
Headache 
Irritability 
Drowsiness 
Seizures

Patients especially infants presenting with URTI and high fever w/o identifiable source must be considered for sepsis

Question 16

Describe the rash in meningococcal sepsis

Answer 16

Non blanching, purpuric rash
Irregular in size and outline
May have necrotic centre

Question 17

What is the carriage rate of meningococcus in the nasopharynx?

Answer 17

5-11% of adults
25% adolescence
Rate low in infants and young children

Question 18

What are the most common types of neisseria meningitidis in the UK?

Answer 18

B,C, W and Y

Question 19

What are risk factors for meningococcal sepsis?

Answer 19

Age
Season - peak in winter, low in late summer
Smoking
Preceding influenza infection
Living in closed or semi closed communities e.g university halls, military barracks

Question 20

What is the immediate treatment if child has a fever a non blanching purpuric rash?

Answer 20

IM penicillin or IV third generation cephalosporin

Urgent hospital admission

Question 21

Describe neisseria meningitidis

Answer 21

Gram neg diploccocus
Numerous serogroups based on polysaccharide capsular antigen (evades immune response by preventing phagocytosis)
Outer membrane acts as an endotoxin