Transcript common childhood infections and rashes

COMMON CHILDHOOD
INFECTIONS AND RASHES
Sue Lowe
Oct 2005
OBJECTIVES
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Bacterial infections
Viral rashes
Fungal infections
Parasitic infestations
Rashes associated with systemic disease
Neonatal and congenital rashes
Quiz!
MENINGOCOCCAL SEPTICAEMIA
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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
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CLINICAL FEATURES:
Fever, non-specific malaise, lethargy, vomiting,
meningism, resp distress, irritability, seizures
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Maculopapular rash common early in disease
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Petechial rash seen in 50-60%
MENINGOCOCCAL SEPTICAEMIA
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MANAGEMENT IN PRIMARY CARE
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IMMEDIATE IV/IM ANTIBIOTICS
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Benzylpenicillin 1.2g > 10yrs
Benzylpenicillin 600mg 1-9yrs
Benzylpenicillin 300mg < 1yr
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CONTACT PROPHYLAXIS
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Rifampicin 600mg bd 2/7 > 12yrs
Rifampicin 10mg/kg bd 2/7 1-12yrs
Rifampicin 5mg/kg bd 2/7 < 1yr
MENINGOCOCCAL SEPTICAEMIA
IMPETIGO
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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
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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
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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
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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
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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
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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
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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
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Dermatophyte fungi
(Trichophyton, Epidermophyton, Microsporum)
Tinea
Tinea
Tinea
Tinea
Tinea
capitis
cruris
pedis
ungium
corporis
Annular, scaling, erythematous lesions
Systemic Rx usually required for scalp and nail infections
(obtain mycological confirmation first)
TINEA CAPITIS
FUNGAL INFECTIONS
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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 cellmediated immune deficiencies
Disseminated disease may be life-threatening in
immunocompromised individuals
PARASITIC INFECTIONS
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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
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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
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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
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Erythema multiforme
Stevens Johnson syndrome
Erythema nodosum
SLE
Dermatomyositis
JIA
Malignancy
Drugs
Kawasaki’s
Familial Mediterrean Fever
ERYTHEMA MULTIFORME
STEVENS JOHNSON SYNDROME
NAPPY RASH
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Irritant/ammoniacal
Candida
Seborrhoeic dermatitis
Atopic eczema
Psoriasis
Non-accidental injury
NAPKIN CANDIDIASIS
COMMON NEONATAL RASHES
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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
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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?
QUIZ
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The following are associated with infection with
Group A beta haemolytic Streptococcus?
Neonatal meningitis
Glomerulonephritis
Scarlet fever
Toxic shock syndrome
Pneumonia
QUIZ
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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
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The following may cause fever and a widespread
rash?
Ulcerative colitis
Acute lymphoblastic leukaemia
Familial Mediterrean Fever
Candidiasis
Juvenile idiopathic arthritis
QUIZ
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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
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True or false:
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Topical antifungals are effective in tinea capitis
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Oral antifungals are always indicated in pityriasis
versicolour
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Candida is the most likely cause of a vaginal discharge in
a continent school age child
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Genital warts are common in children
QUIZ
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Which of the following are notifiable diseases?
Meningococcal meningitis
Rubella
CMV
Campylobacter
Parvovirus B19
QUIZ
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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