Ped Exanthems 2 Flashcards
(87 cards)
1
Q
Prior to the vaccine, what was the leading cause of viral meningitis and unilateral hearing loss?
A
- Prior to mumps vaccine, mumps was
A. Leading cause of viral meningitis
B. Unilateral sensorineural hearing loss in children
2
Q
What pathogen causes mumps?
A
- Mumps virus, Paramyxoviridae family
A. RNA virus
3
Q
When were two doses of MMR recommended?
A
Beginning in 1989
4
Q
How is mumps transmitted?
A
- Respiratory secretions and/or saliva
2. Direct contact with fomite
5
Q
What is the incubation period for mumps?
A
Relatively lengthy
14-17 days
6
Q
What is the contagious period for mumps?
A
3 days before sxs until the day you develop parotiditis
7
Q
What are the prodrome sxs of mumps?
A
- Low-grade fever
- Malaise
- HA
- Myalgias
- Anorexia
- Resp sxs
8
Q
What is the classic finding for mumps? When does it happen?
A
- Within 48 hrs prodrome:
A. Parotitis
B. Classic PE finding but not universal - Adults more severely impacted than children
9
Q
What are the sxs of mumps in postpubertal males?
A
- Testicular edema, tenderness
2. Enlarged inguinal lymph nodes
10
Q
What dx studies are used for mumps?
A
1. Parotid gland secretion swab A. Massage 30 sec 2. Serum mumps IgM antibodies by EIA A. 5 days after sx onset 3. Amylase A. Inc can confirm inflammatory process 4. CBC A. Leukopenia w/ lymphocytosis
11
Q
What are the complications of mumps?
A
1. Deafness A. Up to 5/100,000 B. 80% unilateral 2. Orchitis A. Most common complication in adult males B. Testicular atrophy in 30-50% pts C. Sterility- very low 3. CNS A. Aseptic Meningitis B. Encephalitis
12
Q
What is the most common complication of mumps in adult males?
A
Orchitis
13
Q
How is mumps treated?
A
1. Supportive Care A. Rest B. Cold or heat to affected areas C. OTC analgesics / antipyretics D. Bed rest and ice for orchitis E. Avoid acidic foods
14
Q
How is mumps prevented?
A
- MMR vaccine
A. 78% immunity one dose, 88% immunity 2 dose
15
Q
When should the mmr vaccine be given?
A
- 12 through 15 months
2. 4 through 6 years
16
Q
What are the epidemiological facts about lyme disease?
A
- According to CDC, inc 9.7% from 2010-2011
- Incidence and overall geographic distribution in U.S. inc past 20 yrs
- Key is to recognize early and prompt treatment w/o unnecessary diagnostic testing
A. To avoid development into chronic disabling disease when dx and tx are delayed
17
Q
What causes lyme disease?
A
- Borrelia burgdorferi
bacterial spirochete
18
Q
How is lyme disease transmitted?
A
- Infected ticks bite unprotected skin
A. Deer Ticks: Ixodes scapularis and Ixodes pacificus
Most common vector- borne disease in US1
19
Q
What are the 3 stages of lyme dz?
A
1. Early localized disease A. Erythema migrans “Bull’s eye rash” 2. Early disseminated disease A. Systemic sxs 3. Late disseminated disease A. Complications
20
Q
What is the pathophys of lyme dz?
A
- Infected tick innoculates skin
- Spirochete replicates & migrates
- Affinity for skin, CNS and joints
21
Q
How long does the tick need to be attached to transmit the bacteria?
A
Attached tick needs 24-48 hrs to transmit bacterium to new host
22
Q
What is the incubation period for lyme dz for erythema migrans?
A
- Erythema migrans
A. 3-30 days
Most cases present in Summer months
23
Q
What is the incubation period for lyme dz for cardiac sxs?
A
- 35 days
A. Range 21-150 days
24
Q
What is the incubation period for lyme dz for cns sxs?
A
- 38 days
A. Range 14-200 days
25
What is the incubation period for lyme dz for rheumatologic sxs?
1. 67 days
| A. Range 4 days to 2 years
26
Describe hte early localized stage of lyme dz?
1. 3-30 days after tick exposure
2. Typically characterized by EM @ site of tick bite
A. Typically begin as red macule or papule and expand over days to weeks ->large annular, erythematous lesion w/ varying degrees of central clearing
B. Range from 5-70 cm, usually asymptomatic lesions
C. Resolves in 3-4 weeks without treatment
27
What systemic sxs may occur in early localized stage of lyme dz?
Fever
Fatigue
Arthralgias
Myalgias
28
Describe the early disseminated stage of lyme dz?
1. Occurs once bacterium enters bloodstream
A. Days to weeks after initial appearance of EM
2. Skin, CNS & MSK
A. Multiple EM lesions
B. Fever
C. HA
D. Fatigue
E. Myalgias / arthralgias
F. Lyme Carditis (AV node dysfunc, pericarditis, MI, etc)
G. Lyme neuroborreliosis:
Meningitis, Bell’s palsy, HA, meningismus (meningitis-like sxs), peripheral neuropathy
29
Describe the late disseminated stage of lyme dz?
1. Occurs wks to mos later
2. Either rheumatologic or neurologic manifestation
A. Lyme arthritis: 1-3 jts arthritis/ synovitis, knees most commonly
B. Lyme neuroborreliosis: Encephalitis, encephalopathy, polyneuropathy
30
What are the ddx for lyme dz?
1. Insect bites
2. Allergic contact dermatitis
3. Cellulitis
4. Herald patch pityriasis rosea
5. Erythema multiforme
31
What labs will be performed for lyme dz?
```
1. ELISA
A. Screening test
B. If neg. no further testing
2. Western Blot
A. Confirmatory test
3. When western blot positive:
A. IgM and IgG Ab titers
B. Acute
C. Convalescent
```
4. Serology testing is not advised when EM is present- Just TREAT patient!
32
How is lyme dz treated in the early localized stages?
```
1. Doxycycline x 14-21 days
A. Drug of choice
B. 8 yrs or older
C. Not pregnant
2. Alternatives
A. Amoxicillin
B.
```
33
How is lyme dz treated in the later stages?
Ceftriaxone early dissemintated and late disseminated
34
How is lyme dz prevented?
1. Proper clothing
2. DEET repellant
3. Nightly tick checks
A. Back of neck, waist, skin folds
35
How is a tick removed?
1. Tweezers
2. Do not grasp body!
A. Gently and firmly tug until tick releases its hold
3. Do not remove tick by burning it off, solvent bath, or petroleum jelly
36
When should lyme dz be suspected?
1. Consider Lyme Disease in ALL patients presenting w/ derm, neuro, cardiac or rheum symptoms
37
What is the etiology of kawaski's dz? (mucocutaneous lymph node syndrome)
1. Idiopathic
| 2. Usually follows viral syndrome
38
What is the pathophys of kawasaki syndrome?
1. Generalized vasculitis
2. Endoarteritis involves adventia/intima coronary arteries
3. Coronary artery aneurysm (20%), vessel obstruction, distal embolization
39
What is the leading cause of acquired heart dz in children in the us?
1. Kawasaki dz
| 2. 80% pts
40
What are the dx criteria for kawasaki dz?
1. Fever > 5 days without other cause
A. Typically > 101.3 oF
2. Must have at least 4 of the following:
A. Bilateral painless nonexudative conjunctivitis
B. Lip or oral cavity changes (ie lip cracking/fissuring, strawberry tongue, inflammation of oral mucosa)
C. Erythema and edema of hands/feet followed by desquamation
D. Cervical LAD > 1.5 cm in diameter, usually unilateral
E. Polymorphous exanthem
41
What are the asst. sxs for kawasaki dz?
1. vomiting, diarrhea
2. proteinuria
3. cough, hoarseness
4. athralgia
5. irritability
42
What is kawasaki dz commonly mistaken for?
viral gastroenteritis, viral URI or pneumonia
43
What are the sxs of the acute febrile phase of kawasaki dz? How long does it last?
```
1. Day 1-14
A. Abrupt onset fever
B. Photophobia
C. Diarrhea
D. Arthritis
```
E. CV complications may occur in this phase
44
What are the sxs of the subacute phase of kawasaki dz? How long does it last?
```
1. Day 10-25
A. Thrombocytosis
B. Arthritis
C. Carditis
D. Desquamation
E. Highest risk sudden death
```
45
What are the sxs of the convalescent phase of kawasaki dz? How long does it last?
1. Day 21-60
A. Begins when all signs illness disappear
B. Ends when ESR returns to normal
46
What are the ddx for kawasaki dz?
1. JRA: juvenile rheumatoid arthritis
2. Inf Mono
3. Viral exanthems
4. RMSF: rocky mt spotted fv
5. TSS
6. Scalded skin syndrome
7. SLE
47
What are the dx studies for kawasaki dz?
1. Abn LFT’s
2. Leukocytosis
3. Thrombocytosis
4. Pyuria
5. Inc ESR
6. Coronary Aneurysms (20%)
48
What are the complications from kawasaki dz?
1. CA aneurysms
2. Myocarditis
3. Ischemia/infarction
4. Pericarditis
5. Periph Vasc Occ
6. SBO
7. Stroke
49
What is the prognosis for kawasaki dz?
1. Untreated pts have a 15-25% risk of developing coronary aneurysms
A. most coronary artery aneurysms resolve w/in 5 yrs of dx
2. 0.5 – 2.8%
50
How is kawasaki dz treated?
1. Hospitalization
2. IV IgG
3. High dose ASA bc fever not responsive to tylenol or NSAIDs
4. Follow up depends on degree of coronary artery involvement at time of dx
51
Describe tss
Toxin-mediated illness
52
What are the clinical criteria for TSS?
1. Rapid onset fever T > 38.9 C (102 F)
2. Rash- diffuse macular erythroderma
3. Hypotension
4. Desquamation- 1-2 wks after onset of illness (palms and soles)
5. Rapid onset of BP > 90 mmHg can lead to SHOCK*
6. Multisystem involvement 3 or more:
A. GI- vomiting or diarrhea at onset of illness
B. Mucous membranes- vaginal, oropharyngeal, or conjunctival hyperemia
C. MSK- severe myalgias or CPK inc
D. Renal- inc BUN/Cr or pyuria
E. Liver- inc bilirubin, transaminases
F. CNS- altered mental status/ disorientation w/o focal neuro signs in the absence of fever and hypotension
G. Heme- plts
53
What can cause tss? What pts are at risk for tss?
1. S aureus exotoxin termed TSST-1
A. focal infection, usually w/o bacteremia
B. cases found in menstruating young women using tampons
C. can be found in pts with wound infections due to S aureus
54
What is the pathophys of tss?
1. Exotoxins produced
2. Toxins stimulate T-cells
3. Cytokines produced
4. Cause systemic sxs
55
What is the incubation period for tss?
56
What are the sxs of tss?
```
Sudden Fever
1. Hypotension
2. Rash
3. Myalgias
4. Vomiting
5. Diarrhea
6. Confusion
7. Generalized rash
A. “sunburn rash”
8. Bulbar conjunctiva
9. Generalized edema
10 .Desquamation
A. Palms, soles
```
11. Shock potentially leading to multi-organ failure
57
What dx studies are used for tss?
1. Neg. blood, throat, CSF cultures
2. Neg. Serology for Measles, RMSF
3. Isolation of S aureus is not required for dx of Staph TSS
58
How is tss treated?
```
1. Supportive
A. IVF (10-20 L/day), vasopressors
2. Aggressive monitoring- ICU
3. IV Abx- empirically
Clindamycin PLUS Vancomycin
```
59
Describe RMSF?
1. Typically blanching macular rash that begins on wrists and ankles
2. Spreads centripetally arms, thighs, trunk, face
60
What is the etiology of RMSF?
Rickettsia rickettsii
61
What is the incubation period for RMSF?
3-14 days
62
How is RMSF transmitted?
1. Bite of infected wood tick (West) or dog tick (East)
| 2. Late spring – early summer
63
What areas are are endemic for RMSF?
```
Eastern seaboard
Carolinas
Oklahoma
Tenn
Texas
MO
Kansas
Arkansas
```
64
What is the pathophys of RMSF?
1. RR replicates after innoculation into dermis
2. Dissemination via hematologic and lymphatic systems
3. Target tissue: vascular endothelium
4. Resulting in generalized vasculitis
65
What are the sxs of RMSF?
```
Abrupt onset high fever
1. Severe HA: retro orbital
2. Myalgias
3. Photophobia
4. Rigors
5. Nausea, vomiting
6. Characteristic rash usually appears by day 3
7. Faint macules -> papules -> petechiae
A. First on palms/wrists and soles/ankles, then spread to extremities and trunk
8.Conjunctivitis
9.Edema
A. Non dependent
B. Non-pitting
10. Irritability or confusion
```
66
What are the dx studies results for RMSF?
1. Leukocytosis
2. Thrombocytopenia
3. Hyponatremia
4. Hyperkalemia
proteinuria/hematuria
5. LFT’s slight inc
67
What are the complications of RMSF?
1. Myocarditis
2. Severe vasculitis
3. DIC
4. Renal Failure
5. CV collapse
6. Seizures
68
What are the ddx for RMSF?
```
Rubella
Rubeola
TSS
Meningococcemia
Disseminated gonococcal infection
Kawasaki’s Syndrome
```
69
How is the presumptive diagnosis of RMSF treated?
```
1. Doxycycline (regardless of age at least 10 days)
A. Drug of choice
B. Prompt treatment hastens recovery
2. Alternative: Chloramphenicol
3. Supportive
```
70
How can RMSF be prevented?
1. Protective clothing, tick repellant, prompt tick removal
| 2. 5-7% mortality rate
71
Describe meningococcemia
```
1. Early exanthem
A. Diffuse pink macule/papules
2. Later lesions
A. Petechiae
B. Hemorraghic bullae
```
72
What is hte etiology of meningococcemia?
Neisseria meningitidis
73
How is meningococcemia transmitted?
1. Direct contact
2. Indirect contact
A. Airborne droplets
74
Who is most likely to get meningococcemia?
1. Highest 6-12 mos old
| 2. Second peak during adolescence & young adults
75
What are the sxs of meningococcemia?
1. prodrome of URI followed by:
2. High fever
3. HA
4. Nausea
5. Hypotension
6. Lethargy
7. Bright pink, tender macules on extremities & trunk
A. Petechiae
B. Purpura
8. Accompanying meningitis
A. Nuchal rigidity
B. Bulging fontanelle
76
What are the poor prognostic indicators for meningococcemia?
1. Short prodrome
| 2. Fulminant progression (rapid progression and characterized by DIC, massive skin and mucosal hemorrhages and shock)
77
What two sxs when seen together are a medical emergency?
Purpura and fever
78
What labs are indicated for suspected meningococcemia?
1. Gram stain
2. Blood cultures
3. LP- CSF cultures/gram stain
79
How is meningococcemia treated?
1. Aggressive Abx and IVF
2. ICU isolation
A. Vancomycin & Ceftriaxone empirically
B. Once N meningitidis isolated, Penn G IV x 7 days
C. Children with meningitis or meningococcemia should be treated as if shock is imminent
80
what is the case fatality rate for meningococcemia?
20-40%
81
How can meningococcemia be prevented?
1. Meningococcal vaccine: 11-13 years
| 2. High risk infants at 2 months
82
Describe SJS
1. Skin tenderness and erythema
2. Cutaneous epidermal necrosis
3. Sloughing of skin
83
What are the causes of SJS?
```
1. Most common cause in children
A. Severe adverse drug reaction
-Sulfonamides: MC
-Phenobarb
-Carbamazepine
-Lamotrigine
-Valproic acid
-Acetaminophen
-Ibuprofen
2. Herpes simplex Virus
```
84
What is the pathophys of SJS?
1. Cytotoxic immune rxn which results from certain drugs/metabolites
2. Destruction of keratinocytes
3. Cytokines from above cause cell death
85
What are the sxs of SJS?
1. Recent history of medication use
2. Rash, blisters
3. Persistent fevers
4. Blisters in mouth, eyes, ears, nose, genitalia
5. Flu-like sxs
6. Swelling eyelids
7. Conjunctivitis
86
What is the ddx for SJS?
Drug eruptions
Scarlet Fever
Phototoxic eruptions
TSS
87
What is the rx for SJS?
1. D/C suspected drug
2. ICU monitoring
3. IVF
4. Observe for infection; treat if necessary
5. Debridement for necrotic skin
