The Febrile Child with a Rash Flashcards
What are the subsets of fever in a child?
- Recurrent infection
- Pyrexia of unknown origin
- Fever with swelling in the neck
- Acute fever
- Fever and rash
What are the causes of recurrent infection?
- HIV infection and AIDS
- Hyposlenism and splenectomy
What are some causes of pyrexia of unknown origin?
- Infective endocarditis
- Osteomyelitis
- Collagen vascular disease
- Inflammatory bowel disease
- Neoplastic disease
- Factitious fever
What are some causes of fever with swelling in the neck?
- Cervical adenitis
- Infectious mononucleosis
- Mumps
- Thyroiditis (often no fever)
- Mastoiditis
What are some causes of acute fever?
- Upper respiratory tract infection
- Tonsilitis
- Otitis media
- Nonspecific viral infections
- Pneumonia
- Meningitis
- UTI
- Septic arthritis
- Non-infectious
What are some causes of fever and rash?
- Measles
- Rubella
- Roseola
- Scarlet fever
- Fifth disease
- Hand, foot and mouth disease
- Chicken pox
- Meningococcaemia
What are the three broad causes of fever?
- Infection
- Chronic inflammation
- Immune response
What classifies as a fever?
Oral temperature >37.5 degrees C (>37.8 in adults)
When are investigations for a fever always indicated?
When the child is <8 weeks old
Which investigations are relevant for a fever and what would they show if they highlighted cause of fever?
- FBC - raised WCC with increased neutrophil count = bacterial infection
- Throat swab - bacterial cultures (beta-haemolytic strep treat with penicillin)
- Blood cultures - culture of single organism indicates septicaemia, multiple organisms indicates contamination
- Lumbar puncture
- Chest x-ray - consolidation indicates pneumonia
- Urinalysis and culture - >10^5 cell colonies with >50 WCC, red cells and protein indicates infection
When should a fever be treated?
When it is >38.5 degrees, or below that level if the child is uncomfortable
How can fever be brought down?
- Undress the child
- Antipyretics eg. paracetamol and ibuprofen
- Sponging or tepid baths with lukewarm water to allow vasodilation
Why should aspirin not be given to children?
Because of associations with the development of severe liver disease (Reye’s syndrome)
What are the signs of tonsillitis on throat swab?
Tonsillar redness +- exudate, cervical lymphadenopathy
What are the signs of otitis media on otoscopy?
Bulging and red tympanic membrane
Which causes of fever cause macular and maculopapular rashes?
- Measles
- Rubella
- Roseola
- Scarlet fever
- Fifth disease
- Non-specific viral illnesses
Which causes of fever cause vesicular rashes?
- Chicken pox
- Hand, foot and mouth disease
Which causes of fever cause purpuric rashes?
Meningococcaemia
What are the main complications of measles?
- Otitis media (most common)
- Pneumonia, pneumonitis and tracheobronchitis
- Convulsions, encephalitis and blindness
- Subacute sclerosing panencephalitis (rare)
What are the symptoms of measles?
- Fever
- Cough
- Coryza
- Conjunctivitis
- Maculopapular rash with or without Koplik’s spots
What should be done if measles is suspected?
The local Health Protection Team (HPT) should be notified to confirm the clinical diagnosis, as measles is a notifiable disease
What is the management of measles?
- Rest, adequate fluids, paracetamol/ ibuprofen for symptomatic relief
- Vitamin A for all children <2
- Isolate for 4 days after development of the rash and avoid contact with susceptible people
When is admission of a measles patient necessary?
If they develop a serious complication of measles:
- Pneumonia
- Neurological problems eg. febrile convulsions or encephalitis
What is the incubation period for measles?
10-14 days
What is the transmission of measles?
Respiratory droplets
When is measles infective?
From the prodrome until 4 days after the rash starts
What is the prodromal phase of measles?
- Irritable
- Conjunctivitis
- Fever
Where does the measles rash usually start?
Behind the ears
What should be offered if a non-immunized child comes into contact with measles?
The MMR vaccine within 72 hours
How is diagnosis of measles primarily achieved?
- Measles-specific IgM and IgG serology (most sensitive 3-14 days after onset of rash)
- Measles RNA detection by PCR (most sensitive 1-3 days after rash onset)
What type of vaccine is the MMR?
Live attenuated
In which children is the MMR vaccine contraindicated?
Children with immunosuppression (all live attenuated vaccines are contraindicated)
What is the duration of the rash in measles?
5 days
What causes rubella?
Viral infection caused by the togavirus
What is the risk if rubella is contracted during pregnancy?
Congenital rubella syndrome
When are rubella outbreaks more common?
Around winter and spring
What is the incubation period of rubella?
14-21 days
What is the transmission of rubella?
Respiratory droplets or aerosols
When is the MMR vaccine given?
12 months
What are the symptoms of rubella?
- Fever
- Coryza
- Arthralgia
- Maculopapular rash beginning on the face and moving down the trunk, sparing the limbs
- Lymphadenopathy: suboccipital and postauricular (classic)
How is diagnosis of rubella confirmed?
Detection of rubella-specific IgM or a significant risk in rubella-specific IgG
What is the duration of the rash in rubella?
2-3 days
When are individuals infectious in rubella?
From 7 days before symptoms appear to 4 days after the onset of the rash
Is there an isolation period required with rubella?
Patients should stay away from school/ work at least 5 days after the development of the rash and avoid contact with pregnant women (particularly non-immune in their first trimester)
What are the compliactions of rubella?
- Arthritis and arthralgia (most common in adult women)
- Thrombocytopaenia
- Encephalitis
- Myocarditis
What should be done if there is clinical suspicion of rubella?
Inform the local HPT as rubella is a notifiable disease (within 3 days)
What is the management for rubella?
- Usually self-limiting that resolves within a week
- Rest
- Adequate fluid intake
- Paracetamol/ ibuprofen for symptomatic relief (aspirin avoided in children <16)