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COMMON CHILDHOOD INFECTIONS AND RASHES

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)

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COMMON CHILDHOOD INFECTIONS AND RASHES

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  1. COMMON CHILDHOOD INFECTIONS AND RASHES Sue Lowe Oct 2005

  2. OBJECTIVES • Bacterial infections • Viral rashes • Fungal infections • Parasitic infestations • Rashes associated with systemic disease • Neonatal and congenital rashes • Quiz!

  3. 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

  4. 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%

  5. 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

  6. MENINGOCOCCAL SEPTICAEMIA

  7. 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

  8. IMPETIGO

  9. 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

  10. STAPH SCALDED SKIN

  11. 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

  12. SCARLET FEVER

  13. SCARLET FEVER

  14. 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

  15. 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

  16. MEASLES

  17. 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

  18. 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

  19. MOLLUSCUM CONTAGIOSUM

  20. 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)

  21. TINEA CAPITIS

  22. 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

  23. 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

  24. 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

  25. 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

  26. RASHES ASSOCIATED WITH SYSTEMIC DISEASE • Erythema multiforme • Stevens Johnson syndrome • Erythema nodosum • SLE • Dermatomyositis • JIA • Malignancy • Drugs • Kawasaki’s • Familial Mediterrean Fever

  27. ERYTHEMA MULTIFORME

  28. STEVENS JOHNSON SYNDROME

  29. NAPPY RASH • Irritant/ammoniacal • Candida • Seborrhoeic dermatitis • Atopic eczema • Psoriasis • Non-accidental injury

  30. NAPKIN CANDIDIASIS

  31. 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

  32. MONGOLIAN BLUE SPOT

  33. PORT WINE STAIN

  34. CONGENITAL GIANT MELANOCYTIC NAEVUS

  35. 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?

  36. QUIZ • The following are associated with infection with Group A beta haemolytic Streptococcus? • Neonatal meningitis • Glomerulonephritis • Scarlet fever • Toxic shock syndrome • Pneumonia

  37. 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

  38. QUIZ • The following may cause fever and a widespread rash? • Ulcerative colitis • Acute lymphoblastic leukaemia • Familial Mediterrean Fever • Candidiasis • Juvenile idiopathic arthritis

  39. 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?

  40. 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

  41. QUIZ • Which of the following are notifiable diseases? • Meningococcal meningitis • Rubella • CMV • Campylobacter • Parvovirus B19

  42. 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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