Viral exanthems Flashcards
What are the characteristics of encephalitis following measles?
Encephalitis- occurs in about 1 in 5000, about 8 days after the onset of the illness
initial symptoms are headache, lethargy and irritability, proceeding to convulsions and ultimately coma
mortality is 15%
serious long-term sequelae include seizures, deafness, hemiplegia and severe learning difficulties, affecting up to 40% of survivors
What are the characteristics of subacute sclerosing panencephalitis (SSPE) following measles?
Manifesting, on average, 7 years after measles infection in about 1 in 100 000 cases
Variant of virus that persists in the CNS
Loss of neurological function, progresses over several years to dementia and death
What else can cause severe complications in measles?
Vitamin A deficiency leads to impaired cell-mediated immunity Immunocompromised pateitns (use ribavirin)
What is parvovirus B19?
Causes erythema infectiosum or fifth disease- also called slapped-cheek syndrome
Outbreaks are most common during the spring months
Transmission via respiratory secretions, vertical transmission
What are the clinical syndromes caused by parvovirus?
Asymptomatic
Erythema infectiosum
Aplastic crisis (occurs in chronic haemolytic anaemias)
Foetal disease (foetal hydrops and death due to severe anaemia)
What are the characteristics of erythema infectiosum in parvovirus?
the most common illness, with a viraemic phase of fever, malaise, headache and myalgia followed by a characteristic rash a week later on the face (’slapped-cheek’), progressing to a maculopapular, ‘lace’-like rash on the trunk and limbs complications are rare in children, although arthralgia or arthritis is common in adults
What is Rubella?
Generally mild in childhood
Incubation period is 15-20 days, spread by respiratory route
Prodrome is usually low-grade fever, maculopapular rash on face and then spreading to body, rash isn’t itchy in children
Lymphadenopathy (suboccipital and postauricular)
What are the complications in rubella?
o Arthritis
o Encephalitis
o Thrombocytopenia
o Myocarditis
What is meningococcemia?
Purpura in a febrile child
Herpes encephalitis usually affects temporal lobe (IV acyclovir 3 weeks minimum)
Notifiable disease
IV abx- 3rd class cephasporin like cefotaxime) and supportive therapy
Which organisms cause bacterial meningitis?
0 – 3 months: GBS, E.coli, listeria
1 month – 6 years: N.meningitides, S.pneumoniae, H.influenzae
>6 years: N.meningitides, S.pneumoniae
What is the current immunisation schedule for Neisseria meningitides serotypes?
MenB: at 8 wks of age (2 months) and a booster at 16wks of age (4 months) and 1 year of age
MenC: at 1 year of age
MenACWY: at 14 years of age (Year 9)
What are the red- high risk signs of septicaemia?
Colour: pale/mottled/ashen/blue
Activity: no response/weak high-pitched continuous cry
Respiratory: grunting/RR>60/chest indrawing
Circulation and hydration: reduced skin turgor
Other: Age <3 months/temp >38/non-blanching rash/bulging fontanelle/neck stiffness/status epilepticus/focal neurological signs/focal seizures
What is the management for sepsis?
<17- ceftriaxone
<3 months- cefotaxime (liver failure) and additional abx against listeria (e.g amoxicillin or ampicillin)
Neonates in first 72 hours: IV benpen + gent
Neonates >40 weeks corrected gestational age: IV cefotaxime
What is the paediatric septic 6? (within 1 hour)
High flow O2
• IV access, blood cultures + bloods including lactate
• Abx
• Fluid resuscitation (early and aggressive); 20ml/kg bolus, but can go up to 120ml/kg
as these children often need a lot
• Inotropes early
• Early senior support (consider PICU)
If you need to give a lot of fluid (more than 40ml/kg), think about intubation as pulmonary oedema is a biggie
What is compensated shock? (phase 1)
blood flows to vital organs at the expense of non-essential organs. Child is mildly agitated or confused, tachycardic and has cool, pale skin with decreased capillary refill (>2s)
