The Spotty Child

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					The Spotty Child

        By Julie Dyker
Childhood exanthems
   Exanthem = a skin eruption occurring as a symptom of a general
    disease
   Very common during childhood

   Usually caused by a virus
   Also caused by bacterial infections/drugs

   Diagnosis of exanthems = distinct patterns of rashes and prodromal
    symptoms
   No need to identify causal agent in majority of cases
   Importance of diagnosis
            Pregnancy
            Immunocompromised
            Infection control
            Life-threatening/bacterial infection
CASE STUDIES
Case 1
   4 year old boy
   Coryzal symptoms
   Fever
   Conjunctivitis
   Cough
   Rash started on face before spreading
    downwards
Case 1
Measles
   Paramyxovirus
   Highly contagious
   Spread by airborne/droplet transmission
   Infective period 2 days before
    prodrome till 4 days after onset of rash
   Incubation period 8-14 days
Measles
   Koplik’s spots
                        blue-white spots on
                         buccal mucosa
                         opposite molars
                        1-2 days before rash
                        Duration of 2-3 days
Measles
   Skin lesions develop 14 days after
    exposure
   Reddish purple macules
   Start on face around hairline and
    behind ears and neck, spread
    downwards
   Change to brown/coppery lesions with
    fine scales
Measles
   Supportive management
   Complications
       Otitis media
       Pneumonia
       Myocarditis
       Pericarditis
       SSPE
Case 2
   5 year old boy
   Fever
   Sore throat
   Runny nose
   Malaise
   Cervical and post-auricular
    lymphadenopathy
Case 2
Rubella
   Togavirus
   Droplet transmission
   Mild or no prodrome
   Infectious 5-7 days before rash till 4
    days after
   Incubation period 14-21 days
Rubella
   Assoc polyarthralgia/arhritis
   Forschheimer’s spots=petechial spots
    on hard palate
   Pink spots last up to 5 days
   Begin on face then cover neck, trunk
    and extremities
   Not as widespread as measles
Rubella
   Supportive treatment
   Complications
         Peripheral neuritis
         Encephalitis
         Thrombocytopenic purpura
         Congenital rubella syndrome
Case 3
   10 year old girl
   Sore throat
   Fever
   headache
   Painful red tongue
   rash
Case 3
Scarlet fever
   Group A beta-haemolytic streptococcus
   Contagious via direct contact/droplet spread
   Spread by asymptomatic carriers (15-20%
    school age children)
   Susceptible to toxin
   Age 4-8 years
   Incubation period 1-4 days
   Infective during acute attack and gradually
    diminishes
Scarlet fever
   Red face with circumoral pallor
   Strawberry tongue
   Rash appears 12-48 hours after fever
   Ears, neck, chest, axillae, groin
   Scarlet spots ‘boiled lobster’ appearance
   Rough sandpaper-like feel
   Pastia’s sign=fragile capillaries can rupture, classic
    red streaks
   Erythroderma fades after 6 days
   generalised desquamation then occurs starting with
    hands and feet and can last up to 6 weeks
Scarlet fever
   Throat swab
   10 days of penicillin
   Complications
          Otitis media
          Rheumatic fever
          Pneumonia
          Acute glomerulonephritis
          septicaemia
Case 4
   3 year old girl
   Mild fever
   Headache
   Red hot cheeks
   Rash
   Sore throat
Case 4
Erythema infectiosum                     (fifth
disease)
   Parvovirus B19
   50% infected people are asymptomatic
   Young children or close family members
   Incubation period 4-14 days
   Infectivity up until onset of rash

   Generalised maculopapular rash 1-4 days after
    prodrome
   Lace/network pattern on limbs and trunk
   Slapped cheek appearance can last intermittently for
    up to 6 weeks
Erythema infectiosum
   Supportive treatment

   Complications
         Arthritis in adults
         Aplastic crisis in patients with haem problems
         IUD/hydrops fetalis
Case 5
   3 year old boy
   1 week history of fever
   Cervical lymphadenopathy
   Irritability
   Conjunctivitis
   Dry, cracked lips and strawberry tongue
   Swollen hands and feet
   rash
Case 5
Kawasaki disease
   Unknown cause
   Vasculitis (small and medium-sized blood
    vessels)
   Usually self-limiting, resolves spontaneously
    without Rx within 4-8 weeks
   15-20% cases damage to coronary arteries
   2% die from a MI
Kawasaki disease
   Clinical diagnosis
   Antibiotics given until bacterial infection
    excluded
   antipyretics
   IV immunoglobulin and aspirin
   Reduce cardiac complications
Summary
   Majority of childhood exanthems are non-
    specific viral infections for which no Rx is
    needed
   Important to recognise patterns of viral
    infections by symptoms and type of rash,
    particularly if child is immunocompromised or
    if there is a pregnant contact
   DD: Kawasaki disease, systemic juvenile
    chronic arthritis, erythema multiforme, TSS,
    allergy and drug reaction
   DON’T FORGET MENINGOCOCCAL DISEASE

				
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