Skin Infections & Viruses Flashcards
What causes most surface infections in kids? [2]
Strep (mostly Pyogenes) Or Staph (mostly Aureus)
Streptococci vs Staphylcocci:
Gram positive/negative
Treatment
Resistance
Both are gram positive Treatment: - Penicillin for strep - Flucloxacillin for Staph Resistance not a big issue in strep but big issue in staphylococci eg MSRA
Scarlatina or scarlet fever Causative organism [1] Vulnerable age group [1] Incubation period [1] 3 signs 2 symptoms Tx [1]
Group A Beta hemolytic Strep (eg Strep Pyogenes) via exotoxins
2-10yrs
Incubation 2-4 days
1. Exanthema - rash confluent and sandpaper-like
2. Strawberry tongue
3. Desquamation of hands/feet (after 1-2w)
Symptoms: malaise, fever
10 days of penicillin V
4 complications of scarlet fever
Erysipelas, Cellulitis, Impetigo
Streptococcal toxic shock
Rheumatic fever
Glomerulonephritis
List 3 infective causes of petechial and purpuric rash
Rubella - congenital
Enterovirus
CMV - congenital
Impetigo Causative organisms [2] Highly contagious but no presence of systemic symptoms. May look similar to NAI but how do you differentiate them? Tx for systemic [3] Appearance of skin lesions [3]
Streptococcus pyogenes or Staphylococcus aureus
Ddx between NAI: variable circumference
10 days flucloxacillin if systemic, topical ab fucidin and oral ab flucloxacillin
Golden crusted skin lesions
What non-infective diseases could cause fever and rashes like a strep/staph infection? [2]
And how can you differentiate the two? [1]
Kawasaki’s Disease
Henoch-Schonlein Purpura
HSP associated with previous non-specific viral illness
What happens in Kawasaki’s Disease? [1]
Etiology unknown.
Prevalence in which countries [2]
Vasculitis of medium sized arteries
Japan and Hawaii
How do you diagnose Kawasaki’s? [8]
Fever for 5 days + 4 of:
- Bilateral Conjunctival Infection
- Cervical Lymphadenopathy
- Polymorphous Rash
- Changes of the extremities
- Mucous membrane changes (e.g. strawberry tongue)
Peripheral oedema
Peripheral erythema + Periungual Desquamation
How can you test for Kawasaki’s? [4]
You can’t its a clinical diagnose [1] specifically but can do other non-specific tests [1] e.g. FBC, ESR/CRP & maybe an Echo to look out for coronary artery vasculitis [1]
Important to rule out Strep Pyogenes [1]
How do you treat Kawasaki’s Disease? [3]
It’s self limiting so you’re only trying to protect from complications e.g. Coronary Artery Vasculitis:
- IvIg
- Aspirin
- Immunosuppressants
List 8 things that cause an erythematous maculopapular rash?
Measles Rubella Enterovirus Cytomegalovirus Human herpesvirus 6 Human herpesvirus 7 Parvovirus B19 Epstein–Barr virus
What is HSP? [1]
Presentation [2]
Vasculitis of Skin, kidneys & ~GI tract
Present with persistant fever [1] , purpuric rash that resembles meningococcal rash [1]
What things cause a vesicular rash? [3]
Viruses e.g. VZV, HSV or Enteroviruses
Chickenpox or varicella zoster virus infection
Entities [2]
Incubation period [1]
1. Mild malaise and fever- child presents quite well
2. Itching
3. Describe the exanthema [5]
Primary infection Shingles (reactivation) 14 days papules → vesicles → pustules → crustae → (scarring) new lesions during 5-7 days
How can you determine the type of vesicular rash? Which one is used most nowadays [3]
Clinical findings
Smear of vesicle + Tzanck test
*PCR of fluids, CSF and/or blood
Serology - only tells you about past infections
Chickenpox
Complications [4]
Vulnerable groups [2]
Treatment [3]
Secondary strep/staph infections skin (10-15%)
Meningoencephalitis, cerebellitis, arthritis
- <1yo
- T cell deficiencies (underlying immunodeficiency)
Vaccinate to prevent
Supportive: trim nails, calamine lotion
School exclusion - 5 days from rash onset
Prophylactic VZIG and IV acyclovir
What would be the warning signs that a chicken pox kid requires anti-virals? [6]
Underlying immunodeficiency <1yr old High fever and inflamed lesions New lesions >10/day General Malaise (i.e. unwell)
What is Herpes Zoster?
Vulnerable groups [1]
Reactivation of latent VZV –> Dermatomal spread of vesicles & exanthema
In paediatrics, only happens in immunodeficient kids
What are the main enteroviruses cause vesicular rashes?n[2]
Coxsackie A16
Enterovirus 71
Enterovirus
- 3 classical symptoms
- Age
- Incubation period
- Seasonal
- Treatment
1. Exanthema, enanthema, painful lesions <10yrs 3-6 days Summer and early autumn Supportive, most will recover in 5-10days
HSV presentation in children [2]
Stomatitis
Recurrent cold sores
How is HSV treated?
Mostly self-limiting but if needed give aciclovir
How could you get neonatal HSV? [2]
Day of presentation [1]
CNS manifestations [2]
External manifestations [3]
Usually from the birth canal or contact with mum’s sores
4-21 DOL
sepsis syndrome, meningoencephalitis or hepatitis
Skin, eye and mouth manifestations
How do you treat a neonatal HSV case?
Aciclovir!
Staphylococcal scalded skin syndrome (SSSS) Cause [2] Age group [1] Clinical features [2] Skin lesions [3]
caused by exotoxins of S. aureus
< 5 yrs (particularly in newborns)
Fever, widespread redness
Fluid-filled blisters [1] that rupture easily [1] especially in the skin folds [1]
Antibiotic protocols for neonates presenting in:
Hospital [2]
Neonatal unit [2]
Hospital - amoxicillin IV and cefotaxime
Neonatal unit - benzylpenicillin and gentamicin
Measles
Ax
Transmission
Presentation [3]
Ax: RNA paramyxovirus
Tr: respiratory droplets
Inc: 10-14d (but infectivity from prodrome until 4d after rash starts )
Presentation:
- Prodrome: fever, conjunctivitis
- Kolpick spots
- Maculopapular rash > blotchy, confluent
What are Kolpick Spots?
white spots “grain of salt” on buccal mucosa
Measles
Ix
Mx
Ix: IgM detectable within a few days of rash onset
Mx: supportive (consider admission if pregnant or immunocompromised)
• Notify public health
• School exclusion: 4d from rash onset
• Contacts: if someone not immunised comes into contact with measles then MMR within 72h
Measles Complications [5]
Acute OM
Encephalitis, (1-2w after onset)
Subacute sclerosing pan encephalitis (RARE, 5-10y post illness)
Febrile convulsions, giant cell pneumonia
Keratoconjunctivitis and corneal ulceration
Diarrhoea, appendicitis, myocarditis
