Transcript 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) 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trunk, spreads centrifugally Macules – papules – vesicles – pustules – crusts Complications: encephalitis, pneumonia, superceded Staphylococcal infection, disseminated disease in immunocompromised Advice to pregnant mothers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 (39 diagnosis?
0 C). After 3 days, her temperature returns to normal. 12 hours later, she develops a maculopapular rash over her trunk. What is the most likely
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