Skin Infections & Viruses

Question 1

What causes most surface infections in kids?

Answer 1

Step (mostly Pyogenes)
Or Staph (mostly Aureus)

Question 2

How are strep & staph treated?

Answer 2

Penicillin for strep

Flucloxacillin for Staph

Question 3

What causes Scarlet Fever?

Answer 3

Strep A (Strep Pyogenes) via exotoxins

Question 4

What age group get scarlet fever?

Answer 4

2-10yrs

median 4 yrs

Question 5

How would scarlet fever present?

Answer 5

Malaise, fever & Tonsilitis

Exanthema & Strawberry tongue

Late (1-2wks) squamation of hands/feet

Question 6

How is Scarlet fever treated?

Answer 6

10 days penicillin

Question 7

What non-infective diseases could cause fever and rashes like a strep/staph infection?

Answer 7

Kawasaki’s Disease

Henoch-Schonlein Purpura

Question 8

What happens in Kawasaki’s Disease?

Answer 8

Self-limiting Vasculitis of medium sized arteries

Question 9

How do you diagnose Kawasaki’s?

Answer 9

Fever for 5 days + 4 of:

• Bilateral Conjunctival Injection
• Cervical Lymphadenopathy
• Polymorphous Rash
• Extremities changes
• Mucous membrane changes (e.g. strawberry tongue)

Can also get peripheral oedema & erythema + Periungual Desquamation

Question 10

How can you test for Kawasaki’s?

Answer 10

You can’t its a clinical diagnose specifically but can do other non-specific tests e.g. FBC, ESR/CRP & maybe an Echo to look out for coronary artery vasculitis

Important to rule out Strep Pyogenes

Question 11

How do you treat Kawasaki’s Disease?

Answer 11

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

• Immunoglobulins
• Aspirin
• Immunosuppressants

Question 12

List 4 things that cause an erythematous rash?

Answer 12

Meningitis
Scarlet Fever
Kawasaki’s
Henoch-Scholein Purpura

Question 13

What is HSP?

Answer 13

Vasculitis of Skin, kidneys & ~GI tract

Present with persistant fever, red rash and purpura (may resemble meningococcal rash)

Question 14

What things cause a vesicular rash?

Answer 14

Viruses e.g. VZV, HSV or Enteroviruses

Question 15

Kid presents with malaise & fever but not really unwell

A disseminated exanthema with vesicles at various stages of crusting

Very itchy

Likely diagnosis?

Answer 15

Varicella Zoster Virus aka Chicken Pox

Question 16

How can you determine the type of vesicular rash?

Answer 16

Clinical findings
Smear of vesicle + Tzanck test
PCR of fluids, CSF and/or blood
Serology (For past inf)

Question 17

How would you treat Chicken pox?

Answer 17

Mostly you don’t, except maybe symptomatically

Vaccinate

If it’s dangerous –> acyclovir

Watch out for secondary skin staph/strep inf from the vesicles/pustules

Question 18

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

Answer 18

Underlying immunodeficiency
<1yr old
High fever
Inflamed lesions
New lesions >10/day
General Malaise (i.e. unwell)

Cerebralitis , meningoencephalitis and arthritis

Question 19

What is Herpes Zoster?

Answer 19

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

Pretty much only in immunodeficient kids

Question 20

What are the main enteroviruses cause vesicular rashes?

Answer 20

Coxsackie A16

Enterovirus 71

Question 21

What would Enterovirus look like?

Answer 21

<10yrs
Unusual as it causes vesicles on soles/palms
Exanthema & Enanthema
Painful lesions

Question 22

How do you treat enterovirus?

Answer 22

Supportive, most will recover in 5-10days

Question 23

How do you spot HSV in kids?

Answer 23

Stomatitis

Recurrent cold sores

Question 24

How is HSV treated?

Answer 24

Mostly self-limiting but if needed with aciclovir

Question 25

How could you get neonatal HSV?

Answer 25

Usually from the birth canal or contact with mum’s sores

Question 26

Neonatal HSV is baaaad, what will it cause?

Answer 26

70-80% will get disseminated infection e.g. sepsis syndrome, meningoencephalitis or hepatitis

Other 20-30% will get SEM disease (skin, eye & mouth)

All in the first 1-3wks of life

Question 27

How do you treat a neonatal HSV case?

Answer 27

Aciclovir!