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Paeds > Skin Infections & Viruses > Flashcards

Skin Infections & Viruses Flashcards

1
Q

What causes most surface infections in kids? [2]

A 
Strep (mostly Pyogenes)
Or Staph (mostly Aureus)
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2
Q

Streptococci vs Staphylcocci:
Gram positive/negative
Treatment
Resistance

A 
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
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3
Q 
Scarlatina or scarlet fever
Causative organism [1]
Vulnerable age group [1]
Incubation period [1]
3 signs
2 symptoms
Tx [1]
A

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

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4
Q

4 complications of scarlet fever

A

 Erysipelas, Cellulitis, Impetigo
 Streptococcal toxic shock
 Rheumatic fever
 Glomerulonephritis

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5
Q

List 3 infective causes of petechial and purpuric rash

A

Rubella - congenital
Enterovirus
CMV - congenital

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6
Q 
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]
A

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

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7
Q

What non-infective diseases could cause fever and rashes like a strep/staph infection? [2]
And how can you differentiate the two? [1]

A

Kawasaki’s Disease

Henoch-Schonlein Purpura

HSP associated with previous non-specific viral illness

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8
Q

What happens in Kawasaki’s Disease? [1]
Etiology unknown.
Prevalence in which countries [2]

A

Vasculitis of medium sized arteries

Japan and Hawaii

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9
Q

How do you diagnose Kawasaki’s? [8]

A

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

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10
Q

How can you test for Kawasaki’s? [4]

A

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]

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11
Q

How do you treat Kawasaki’s Disease? [3]

A

It’s self limiting so you’re only trying to protect from complications e.g. Coronary Artery Vasculitis:

  • IvIg
  • Aspirin
  • Immunosuppressants
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12
Q

List 8 things that cause an erythematous maculopapular rash?

A 
Measles 
Rubella 
Enterovirus 
Cytomegalovirus 
Human herpesvirus 6 
Human herpesvirus 7 
Parvovirus B19 
Epstein–Barr virus
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13
Q

What is HSP? [1]

Presentation [2]

A

Vasculitis of Skin, kidneys & ~GI tract

Present with persistant fever [1] , purpuric rash that resembles meningococcal rash [1]

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14
Q

What things cause a vesicular rash? [3]

A

Viruses e.g. VZV, HSV or Enteroviruses

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15
Q

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]

A 
	Primary infection 
	Shingles (reactivation)
14 days
papules → vesicles → pustules → crustae → (scarring)
new lesions during 5-7 days
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16
Q

How can you determine the type of vesicular rash? Which one is used most nowadays [3]

A

Clinical findings
Smear of vesicle + Tzanck test
*PCR of fluids, CSF and/or blood
Serology - only tells you about past infections

17
Q

Chickenpox
Complications [4]
Vulnerable groups [2]
Treatment [3]

A

 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

18
Q

What would be the warning signs that a chicken pox kid requires anti-virals? [6]

A 
Underlying immunodeficiency
<1yr old
High fever and inflamed lesions
New lesions >10/day
General Malaise (i.e. unwell)
19
Q

What is Herpes Zoster?

Vulnerable groups [1]

A

Reactivation of latent VZV –> Dermatomal spread of vesicles & exanthema

In paediatrics, only happens in immunodeficient kids

20
Q

What are the main enteroviruses cause vesicular rashes?n[2]

A

Coxsackie A16

Enterovirus 71

21
Q

Enterovirus

  • 3 classical symptoms
  • Age
  • Incubation period
  • Seasonal
  • Treatment
A 
1. Exanthema, enanthema, painful lesions
<10yrs
3-6 days
Summer and early autumn
Supportive, most will recover in 5-10days
22
Q

HSV presentation in children [2]

A

Stomatitis

Recurrent cold sores

23
Q

How is HSV treated?

A

Mostly self-limiting but if needed give aciclovir

24
Q

How could you get neonatal HSV? [2]
Day of presentation [1]
CNS manifestations [2]
External manifestations [3]

A

Usually from the birth canal or contact with mum’s sores
4-21 DOL
sepsis syndrome, meningoencephalitis or hepatitis
Skin, eye and mouth manifestations

25
Q

How do you treat a neonatal HSV case?

A

Aciclovir!

26
Q 
Staphylococcal scalded skin syndrome (SSSS)
Cause [2]
Age group [1]
Clinical features [2]
Skin lesions [3]
A

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]

27
Q

Antibiotic protocols for neonates presenting in:
Hospital [2]
Neonatal unit [2]

A

Hospital - amoxicillin IV and cefotaxime

Neonatal unit - benzylpenicillin and gentamicin

28
Q

Measles
Ax
Transmission
Presentation [3]

A

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

29
Q

What are Kolpick Spots?

A

white spots “grain of salt” on buccal mucosa

30
Q

Measles
Ix
Mx

A

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

31
Q

Measles Complications [5]

A

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

Paeds (33 decks)

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