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COMMON CHILDHOOD INFECTIONS AND RASHES pharyngitis

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COMMON CHILDHOOD INFECTIONS AND RASHES pharyngitis Powered By Docstoc
					  COMMON CHILDHOOD
INFECTIONS AND RASHES

       Sue Lowe
       Oct 2005
               OBJECTIVES

   Bacterial infections
   Viral rashes
   Fungal infections
   Parasitic infestations
   Rashes associated with systemic disease
   Neonatal and congenital rashes
   Quiz!
    MENINGOCOCCAL SEPTICAEMIA
   MORTALITY 5-10% (90% if DIC)

   MORBIDITY 10%
    (Deafness, neurological problems, amputations)

   Peak incidence < 4yrs

   Immunisation programme includes Men C
    60% of bacterial meningitis in UK due to Men B
    MENINGOCOCCAL SEPTICAEMIA

   CLINICAL FEATURES:

   Fever, non-specific malaise, lethargy, vomiting,
    meningism, resp distress, irritability, seizures

   Maculopapular rash common early in disease

   Petechial rash seen in 50-60%
    MENINGOCOCCAL SEPTICAEMIA
   MANAGEMENT IN PRIMARY CARE

   IMMEDIATE IV/IM ANTIBIOTICS

   Benzylpenicillin 1.2g > 10yrs
   Benzylpenicillin 600mg 1-9yrs
   Benzylpenicillin 300mg < 1yr

   CONTACT PROPHYLAXIS

   Rifampicin 600mg bd 2/7 > 12yrs
   Rifampicin 10mg/kg bd 2/7 1-12yrs
   Rifampicin 5mg/kg bd 2/7 < 1yr
MENINGOCOCCAL SEPTICAEMIA
                   IMPETIGO
   Staph Aureus or Gp A Strep Pyogenes
   Classically ruptured vesicles with honey-coloured
    crusting
   May be bullous
   More common in pre-existing skin disease
   Very contagious, rapid spread
   Commonly starts around face/mouth
   Rx. Topical fusidic acid or oral flucloxacillin
   Advice re nursery/school
IMPETIGO
STAPHYLOCOCCAL SCALDED SKIN

   Caused by Staphylococcal exfoliative toxin
   Erythematous tender skin, progressing to
    desquamation after 24-48hrs
   Nikolsky sign
   62% < 2yrs, 98% < 5yrs
   BCs usually negative in children
   Usually febrile, may rapidly progress to
    dehydration/shock
   Rx. Systemic antistaphylococcal abx., emollients,
    may need IV fluids
STAPH SCALDED SKIN
                SCARLET FEVER
   Gp A beta-haemolytic Strep
   2-4 days post-Streptococcal pharyngitis
   Fever, headache, sore throat, unwell
   Flushed face with circumoral pallor
   Rash may extend to whole body
   Rough ‘sandpaper’ skin
   Desquamation after 5/7, particularly soles and palms
   School age children
   White strawberry tongue
   Dx. Throat swab, ASO titres
   Rx. Penicillin 10/7
SCARLET FEVER
SCARLET FEVER
                  VARICELLA
   Incubation 14-21 days
   Mild prodromal illness
   Rash: Face, scalp, trunk, spreads centrifugally
   Macules – papules – vesicles – pustules – crusts
   Complications: encephalitis, pneumonia,
    superceded Staphylococcal infection,
    disseminated disease in immunocompromised
   Advice to pregnant mothers
                    MEASLES
   Unwell child
   Incubation 7-14 days
   Fever, conjunctival suffusion, coryza
   Maculopapular rash starting on face and
    progressing to whole body
   Koplik’s spots are pathognomonic
   Complications: Otitis media, pneumonia,
    hepatitis, myocarditis, encephalomyelitis, SSPE
MEASLES
                     MUMPS
   Incubation 14-21 days, infectious for 1 week
    after parotid swelling develops
   Painful salivary gland in 2/3
   Bilat or unilat
   May be parotid (60%) or parotid and
    submandibular (10%)
   Complications: Encephalitis, transient deafness,
    epididymo-orchitis, pancreatitis, myocarditis
          OTHER COMMON VIRAL
              INFECTIONS
   Slapped cheek = Fifth disease = Parvovirus B19
    = Erythema infectiosum
   Hand, foot and mouth (Coxsackie A and B)
   Roseala infantum (HHV-6)
   HSV
   Molluscum
   Rubella
   EBV
   HPV
MOLLUSCUM CONTAGIOSUM
             FUNGAL INFECTIONS
   Dermatophyte fungi
   (Trichophyton, Epidermophyton, Microsporum)

   Tinea   capitis
   Tinea   cruris
   Tinea   pedis
   Tinea   ungium
   Tinea   corporis

   Annular, scaling, erythematous lesions
   Systemic Rx usually required for scalp and nail infections
    (obtain mycological confirmation first)
TINEA CAPITIS
           FUNGAL INFECTIONS
   PITYRIASIS VERSICOLOUR
   Hypopigmented patches on upper chest, neck, arms
   Usually settle spontaneously

   CANDIDA
   Classically causes oral thrush and nappy rash in infants
   Vulvovaginitis in adolescent girls
   Intertriginous lesions (neck, groin, axilla)
   Chronic mucocutaneous Candidiasis may occur in cell-
    mediated immune deficiencies
   Disseminated disease may be life-threatening in
    immunocompromised individuals
        PARASITIC INFECTIONS
   HEAD LICE

   Most common aged 4-11 years
   Treatments include wet combing, permethrin or
    malathion (use lotions in preference to
    shampoos)
   Repeat treatment after 1 week to ensure all
    unhatched ova killed
   Do not need to treat whole family but screen
    with thorough wet combing
      PARASITIC INFECTIONS
   SCABIES

   Highly contagious, spread by skin contact
   Commonly papules, vesicles, pustules, nodules
   Burrows are pathognomonic
   Intractable pruritus, worse at night and in web spaces

   Rx. With permethrin, malathion or crotamiton (use
    aqueous preparations in children as alcoholic
    preparations may cause stinging and wheeze)
   Repeat treatment after 1 week
   Treat whole household
       PARASITIC INFECTIONS
   THREADWORMS

   Usually present with pruritus ani
   May see worms in faeces
   Diagnosis on history or ‘sticky tape’ test
   Rx. Mebendazole 100mg – repeat 14 days later
   Treat whole family
       RASHES ASSOCIATED WITH
          SYSTEMIC DISEASE
   Erythema multiforme
   Stevens Johnson syndrome
   Erythema nodosum
   SLE
   Dermatomyositis
   JIA
   Malignancy
   Drugs
   Kawasaki’s
   Familial Mediterrean Fever
ERYTHEMA MULTIFORME
STEVENS JOHNSON SYNDROME
               NAPPY RASH

   Irritant/ammoniacal
   Candida
   Seborrhoeic dermatitis
   Atopic eczema
   Psoriasis
   Non-accidental injury
NAPKIN CANDIDIASIS
    COMMON NEONATAL RASHES
   Milia
   Salmon patch (stork mark)
   Mongolian blue spot
   Erythema toxicum neonatorum
   Strawberry naevus (capillary haemangioma)
   Port wine stain (naevus flammeus)
   Sebaceous naevi
   Congenital melanocytic naevus
MONGOLIAN BLUE SPOT
PORT WINE STAIN
 CONGENITAL GIANT
MELANOCYTIC NAEVUS
                    QUIZ

   1 yr old Amy presents with a history of
    coryzal symptoms, general malaise and
    high fever (390C). After 3 days, her
    temperature returns to normal. 12 hours
    later, she develops a maculopapular rash
    over her trunk. What is the most likely
    diagnosis?
                       QUIZ
   The following are associated with infection with
    Group A beta haemolytic Streptococcus?

   Neonatal meningitis
   Glomerulonephritis
   Scarlet fever
   Toxic shock syndrome
   Pneumonia
                       QUIZ
   The following are included in the current UK
    immunisation programme:

   Men C at pre-school booster
   BCG at birth
   MMR at 2 months
   DT and polio at 15 years
   Pertussis at pre-school booster
                      QUIZ
   The following may cause fever and a widespread
    rash?

   Ulcerative colitis
   Acute lymphoblastic leukaemia
   Familial Mediterrean Fever
   Candidiasis
   Juvenile idiopathic arthritis
                     QUIZ

   13 year old Neville is a homozygote for
    sickle cell disease and usually has a Hb of
    8.0g/l. Following a mild URTI, he presents
    to his GP complaining of increased
    lethargy. A FBC reveals Hb 5.0, WCC 4.0,
    plt 90. What is the most likely cause?
                            QUIZ
   True or false:

   Topical antifungals are effective in tinea capitis

   Oral antifungals are always indicated in pityriasis
    versicolour

   Candida is the most likely cause of a vaginal discharge in
    a continent school age child

   Genital warts are common in children
                       QUIZ
   Which of the following are notifiable diseases?

   Meningococcal meningitis
   Rubella
   CMV
   Campylobacter
   Parvovirus B19
                      QUIZ
   Which of the following are required to make a
    diagnosis of Kawasaki’s disease?

   Fever of 2 days duration
   Purulent conjunctivitis
   Polymorphous rash
   Mucosal involvement
   Involvement of hands and feet

				
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