Viral Exanthema Flashcards
What pathogens can cause sepsis in neonates?
Group B Streptococci
Escherichia Coli
Listeria Monocytogenes
What pathogens can cause sepsis in children?
Streptococcus Pneumoniae
Meningococci
Group A Streptococci
Staphylococcus Aureus
What is the most common cause of community aquired sepsis in children?
Neisseria Meningitis
What antibiotics are used in sepsis management for neonates?
Gentamicin and penicillin
What antibiotics are used in sepsis management for children?
Ceftriaxone and amoxicillin
What is scarlet fever
Infection caused by an exotoxin produced by group A streptococci
What is the incubation period of strep A
2-4 days
How does scarlet fever present?
Red/pink blotchy macular rash with rough sandpaper skin that starts on the trunk and spreads out
Strawberry tongue
Tonsilitis/sore throat
Flushed face
Lymphadenopathy
How is scarlet fever managed?
10 days phenoxymethylpenicillin
Notifiable disease
Children should be kept off school until 24 hours after starting antibiotics
What is rheumatic fever?
Untreated scarlet fever
How does rheumatic fever present?
Fever, not always present
Joint pain/swollen joints
New murmur
Raised rash over trunk
Involuntary movements of arm
How is rheumatic fever managed?
Benzylpenicillin
What is Kawasaki disease?
Immune mediated vasculitis leading to coronary aneurysms, common in Japan
How does Kawsaki disease present?
Red eyes, red extremities, red membranes
Fever, for at least 5 days +4/5
Bilateral conjunctival injection
Changes to mucous membranes
- Strawberry tongue
- Cracked lips
- Red pharynx
Cervical lymphadenopathy
Widespread blanching polymorphous rash
Changes to extremities, painful to hold things in hand and stand on feet/desquamation
Inflammation of BCG scar is also associated
How is Kawsaki disease managed?
Immunoglobulins
- Give within 10 days of symptom onset to minimise aneurysm risk
Aspirin
- Prevent coronary artery aneurysm
Other immunosuppressive agents
What organism causes glandular fever/infectious mononucleosis?
Epstein Barr Virus
How does glandular fever present?
Classic triad of fever, sore throat and cervical lymphadenopathy, usually lasting 2 weeks
Erythematous tonsils
Coryzal/URTI symptoms
Splenomegaly
Hepatitis
Platal petichae
Lymphocytosis
Haemolytic anaemia
Rash post amoxicillin
How is glandular fever diagnosed?
Heterophil antibody test (Monospot test) in the 2nd week of the illness
Blood film
- Atypical lymphocytes
When do symptoms of glandular fever usually resolve?
2-4 weeks
How is glandular fever managed?
Supportive
Avoid alcohol and contact sports
Give complications of glandular fever
Splenic rupture, avoid contact sports for 8 weeks
Maculopapular pruritic rash develops in around 99% of patients who take amoxicillin whilst they have infectious mononucleosis
Idiopathic thrombocytpenic purpura
Wha is Henoch–Schönlein Purpura?
Paediatric vasculitis commonly occuring after a viral URTI
Give features of Henoch–Schönlein Purpura
Tetrad of rash, abdominal pain, arthralgia and glomerulonephritis
Large joint arthralgia
Rash
- Urticarial to purpuric
- Purple
- Buttock and thighs
Intusception
Abdominal pain
Renal involvement
- Hypertension
- Nephrotic syndrome
How is Henoch–Schönlein Purpura managed?
NSAIDS
Supportive treatment
What is slapped cheek?
Parovirus infection
What is the incubation period of parovirus?
7-10 days
How does parovirus present?
Viral prodrome
Headache
Erythematous rash
- Occurring on cheeks initially and becoming a lace like network rash on trunk and limbs
- Can take 6 weeks to fully fade
How is parovirus managed?
Supporitve
What organisms cause hand, foot and mouth disease?
Coxsackie virus A16
- Most common
Enterovirus 71
How long do patients take to recover from hand, foot and mouth disease?
5-10 days
How does hand, foot and mouth disease present?
Vesicular rash on hands and feet, followed by mouth ulcers
Viral symptoms
- Fever
- Drooling
- Irritable
How is hand, foot and mouth disease managed?
Self limiting, so supportive treatment
- Antipyretics
- Fluids
Does not require home exclusion
What is the incubation period of varicella zoster virus?
10-21 days
What organism causes chicken pox?
Human herpes virus 3/varicella virus
How long is chicken pox contagious for?
Contagious 1-2 days before rash appears and until lesions have crusted
How does chicken pox present?
Red, itchy papules/small bumps progressing to vesicles/blisters, often starting on the trunk
Mild malaise and fever, children don’t tend to be sick
How is chicken pox managed?
Self limiting
Give complications of chicken pox
Disseminated haemorrhagic chickenpox
Secondary bacterial infection
Encephalitis
Pneumonia
What is the incubation period of mumps?
14-25 days
What is mumps?
Self limiting viral infection, most common in childhood, spread by respiratory droplets
How does mumps present?
Flu like prodrome, occuring for a few days before
Parotid gland swelling with associated pain that can be unilateral or bilateral
Signs of complications
Give complications of mumps
Pancreatitis
Orchitis
Meningitis
Sensorineural hearing loss
How is mumps diagnosed?
PCR testing on saliva swab
Antibodies to mumps virus
Notifiable disease
How is mumps managed?
Supportive
MMR vaccine
What is measles?
Highly contagious infection caused by measles virus spread via respiratory droplets
How does measles present
Symptoms start 10-12 days after infection
Flu like prodrome with fever, coryza
Koplik spots, greyish white spots on the buccal mucosa appearing 2 days after the fever
Erythematous rash that starts behind ear and spreads all over body
Conjunctivitis
Always consider in an incomplete or uncertain vaccination history
How is measles managed?
Supportive/self resolving after 7-10 days of symptoms
Children should be isolated until 4 days after their symptoms resolve
Notifiable disease
MMR vaccine
Give complications of measles
Acute otitis media, most common complication
What is rubella?
Also known as german measles, highly contagious infection caused by rubella virus spread via respiratory droplets
How does rubella present?
Milder erythematous macular rash compared to measles, starting on the face and spreading to the rest of the body, lasting 3 days
Mild fever
Joint pain
Sore throat
Lymphadenopathy
How is rubella managed?
Supportive
Notifiable disease
Children should stay off school for at least 5 days after rash appears
Avoid pregnant women
What is roseola infantum?
Common disease of infancy caused by human herpes virus 6, typically affecting children aged 6 months-2 years
Give features of roseola infantum
High fever lasting a few days followed by maculopapular rash
Nagayama spots around uvula and soft palate
Febrile convulsions
Diarrhoea and cough
School exclusion not required
Differentiate between the main paediatric rashes
Roseola
- Fever before, rash after
Scarlet fever
- Sore throat, sandpaper rash, strawberry tongue (S’s)
Measles
- Cough, conjunctivitis, coryza (C’s)
Kawasaki
- 5 day fever
Rubella
- 3 day fever, 3 day prodrome, 3 days rash
