Paeds childhood infections

Question 1

Chickenpox

Answer 1

• Fever initially
• Itchy, rash starting on head/trunk before spreading
• Initially macular then papular then vesicular
• Systemic upset is usually mild

Question 2

Measles

Answer 2

• Prodrome: irritable, conjunctivitis, fever
• Koplik spots: white spots (‘grain of salt’) on buccal mucosa
• Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent

Question 3

Mumps

Answer 3

• Fever, malaise, muscular pain

- Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%

Question 4

Rubella

Answer 4

• Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
• Lymphadenopathy: suboccipital and postauricular

Question 5

Erythema infectiosum

Answer 5

• Also known as fifth disease or ‘slapped-cheek syndrome’
• Caused by parvovirus B19
• Lethargy, fever, headache
• ‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces

Question 6

Scarlett fever

Answer 6

• Reaction to erythrogenic toxins produced by Group A haemolytic streptococci
• Fever, malaise, tonsillitis
• ‘Strawberry’ tongue
• Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)

Question 7

Hand, foot and mouth disease

Answer 7

• Caused by the coxsackie A16 virus
• Mild systemic upset: sore throat, fever
• Vesicles in the mouth and on the palms and soles of the feet

Question 8

Roseola infantum

Answer 8

• Also known as exanthem subitum, occasionally sixth disease)
• Caused by thehuman herpes virus 6(HHV6)
• Incubation period of 5-15 days
• Affects children aged 6 months to 2 years

Features:

• high fever: lasting a few days,rapid onset, followed laterby a
• maculopapular rash after resolution of fever, starting on trunk and limns
• Nagayama spots: papular enanthem on the uvula and soft palate
• febrile convulsions occur in around 10-15%
• diarrhoea and cough are also commonly seen
• Rare complication: encephalitis and febrile fits (after cessation of the fever), aseptic meningitis, hepatitis

School exclusion is not needed.

Question 9

Kawasaki

Answer 9

• Type of vasculitis

Features:

• High-grade fever which lasts for > 5 days, characteristically resistant to antipyretics
• Conjunctival injection
• Bright red, cracked lips
• Strawberry tongue
• Cervical lymphadenopathy
• Red palms of the hands and the soles of the feet which later peel

Management

• high-dose aspirin
• intravenous immunoglobulin
• echocardiogram (rather than angiography) is used as the - initial screening test for coronary artery aneurysms

Complications
coronary artery aneurysm