Roseola + rashes

Question 1

What causes roseola infantum?

Answer 1

HHV6

Question 2

What are clinical features of roseola infantum?

Answer 2

High fever: lasting a few days
Then generalised aculopapular rash
Nagayama spots: papular enanthem (spots on mucous membrane) on uvula and soft palate
Febrile convulsions
Diarrhoea and cough

Question 3

What causes erythema infectiosum? spread?

Answer 3

Parvovirus B19

Respiratory droplet spread

Question 4

CF of erythema infectiosum

Answer 4

Lethargy, fever, headache, N/V
‘Slapped-cheek’ malar rash spreading to proximal arms and extensor surfaces

Supportive management
Virus self-limiting

Question 5

How can Parvovirus B19 infection present?

Answer 5

Asymptomatic
Erythema infectiosum
Pancytopenia in immunosuppressed patients - bleeding, infection anaemia
Aplastic crises:
In sickle-cell disease/thalassaemia PB19 suppresses erythropoiesis
Fetal disease: transmission of maternal parvovirus B19 may lead to fetal hydrops and death

Question 6

What causes hand, foot and mouth disease?

Answer 6

Coxsackie A16

Enterovirus 71

Question 7

What are clinical features of hand, foot and mouth disease?

Answer 7

Mild systemic upset: sore throat, fever
Oral ulcers
Followed later by vesicles on the palms and soles of the feet

Question 8

Management for hand foot and mouth?

Answer 8

Supportive: analgesia and hydration

No need to exclude from school if feeling ok

Question 9

What causes impetigo?

Answer 9

Staphylococcus aureus
Streptococcus pyogenes

Primary infection or complication of existing skin condition

Question 10

CF of impetigo?

Answer 10

Golden, honey coloured crusted skin lesions around mouth

Very contagious

Question 11

What is management for impetigo?

Answer 11

Topical fuscidic acid
Topical retapamulin
MRSA - topica mupirocin

Extensive disease:
Oral flucloxacillin
Oral erythromycin

Exclude from school until lesions are crusted and healed or 48h after commencing antibiotics

Question 12

What causes scarlet fever?

Answer 12

Streptococcus pyogenes (Group A haemolytic strep)

Question 13

What are clinical features of scarlet fever?

Answer 13

Fever fro 24-48h
Malaise, headache, N/V
Sore throat
Strawberry tongue
Rash - fine punctuate erythema on torso and sparing pals and soles
Rough sandpaper texture rash

Question 14

What Mx for scarlet fever?

Answer 14

Phenoxymethylpenicillin PO 10d
Azithromycin in pen allergy

School 24h after commencing abx

Notifiable disease - inform public health

Question 15

What are complications of scarlet fever?

Answer 15

Otitis media
Rheumatic fever
Acute glomerulonephritis
Necrotising fasciitis

Question 16

What is kawasaki disease?

Answer 16

Autoimmune mediated medium vessel vasculitis

Question 17

What are features of kawasaki disease? Complication?

Answer 17

Fever > 5 days
Conjunctivitis
Bright red fissured lips
Strawberry tongue
Erythema of palsma dn soles of feet
Cervical lymphadenopathy

Coronary artery aneurysm

Question 18

What is mx of kawasaki disease?

Answer 18

High dose aspirin
IVIG
Echocardiography to screen for coronary artery aneurysms

Question 19

What is eczema herpeticum?
CF?
Mx?

Answer 19

Severe infection of skin by HSV1 with active atopic eczema

Cluster of itchy and painful blisters on face and neck

IV aciclovir
Systemic antibiotics for secondary bacterial infection