PAEDIATRIC FEVER AND RASH

Measels - NOTIFIABLE
1. RNA Morbillivirus
2. Airborne respiratory - Surface transmissible 2 hrs - Mainly children - Rare due to vaccination(1 yr and pre school) - Beware foreigners/travel/neglect/immunosupressed - highly infectious and contagious (-4rash4+)
3. PRESENATION - Prodrome: Fever, COryza, Conjunctivitis, Diarrhoea. Rash: Forehead and neck - spreads to trunk and legs, flat erythematous macular rash with some coalescing. Recovery quick after rash appearance.
4. Investigations - Salivary swab for IgM or RNA
5. Management - Most cases uncomplicated - symptomatic treatment, fluid, rest, pain relief.
6. Com;plications - Bronchopneumonia (Staph Aureus/Strep Pneumonia), Otitis Media, Encephalitis 1/1000 within 2wks of rash appearing 10-15% mortality and 25% brain damage - Tx supportive unless bacterial cause.
7. CHECK VIT A LEVELS - LOW VIT A = HIGH COMPLICATION RISK
RUBELLA AKA GERMAN MEASELS - NOTIFIABLE
1. RNA RUBIVIRUS TOGAVIRIDAE - AIRBORNE RESPIRATORY
2. RSIK - MATERNAL INFECTION IN EARLY PREGNANCY = CONGENITAL RUBELLA SYNDROME = CARDIAC, OCULAR, CNS & SKELETAL COMPLICATIONS
3. PRESENATION - PRODROME : FEVER, HEADACHE, ANOREXIA, CONJUNCTIVITS. RASH : PINK DISCRETE MACULES START AT HEAD SPREAD TO TRUNK AND LEGS. GENERALISED HEAD LYMPHADENOPATHY IS CHARACTERISTIC. PETICHAE ON SOFT PALATE (FORCHHEIMERS SIGN (NOT DIAGNOSTIC)
4. INVESTIGATIONS - CLINICAL DIAGNOSIS IS UNRELAIBLE - SEROLOGICAL OR SWAB PCR GOLD STANDARD.
5. MANAGEMENT - OFF SCHOOL FOR 7 DAYS AFTER RASH APPEARANCE - SUPPORTIVE TX - REST, FLUIDS, ANTIPYREXIALS - ASK RE CONTACT WITH PREGNANT WOMEN
6. COMPLICATIONS - ENCEPHALOPATHY 6D POST RASH - THROMBOCYTOPENIA - GUILLIANE BARRE (AUTOIMMUNE MSCL WKNS, DMG TO PERIPHERAL N.S.
SCARLET FEVER - NOTIFIABLE
1. EXOTOXIN MEDIATED FROM STREPTOCOCCUS PYOGENES (GROUP A BETA HEAMOLYTIC - AIRBORNE RESPIRATORY DROPLETS - SCHOOL EXCLUSION
2. PREVIOUSLY VERY SERIOUS, COMPLICATIONS REDUCED B/C OF ANTIBIOTICS, MAINLY CHILDREN
3. PRESENTATION = PRODROME : SORE THROAT, FEVER, HEADACHE, VOMIT, PAIN - RASH WITHIN 12-48 HOURS, 1ST - NECK, CHEST AND SCAPULA THEN SPREADS TO TRUNK AND LEGS - COARSE SANDPAPER TEXTURE WITH PINPOINT DARK RED PUNCTUM ON A DIFUSE ERYTHEMATOUS BASE - PALE MOUTH, FLUSHED FACE - EVENTUAL SKIN PEELING - 1ST WHTE STRAWBERRY TOUNGE THEN RED STRAWBERRY TONGUE.
4. INVESTIGATIONS - OFTEN A CLINICAL DIAGNOSIS - OTHERWISE THROAT SWAB AND CULTURE - ENSURE SWAB TAKEN FROM TONSILS OR POSTERIOR PHARYNX.
5. MANAGEMENT - ABX = PENICILLIN (AZITHROMYCIN IF ALLERGIC) - REST - FLUIDS - PAIN REFEIF - SCHOOL EXCLUSION TILL 24HRS POST ABX - INCREASED RISK TO KIDS WITH RECENT CHICKEN POX = WATCH FOR HIGH TEMP, ARTHRITIS OR CELLULITIS. ABX LOWERS RISK OF RHEUMATIC FEVER BUT NOT POST STREP GLOMERULONEPHRITIS
NO ASPIRIN TO UNDER 16 = REYES SYNDROME = LIVER AND BRAIN DAMAGE
MENINGOCOCCAEMIA - NOTIFIABLE
1. NEISSERIA MENINGIDITIS - GRAM -VE DIPLOCOCCUS - NASOPHARANGEAL COMMENSAL - AIRBORNE RESPIRATORY SPREAD - MAY PRESENT WITH SEPTIC ARTHRITIS, OSTEOMYELITIS, CONJUNCTIVITIS, ENDOPTHALMITIS - PATHOGENIC FORM IS ENCAPSULATED PREVENTING PHAGOCYTOSIS
2. VACCINATION OF HIB, MEN C AND PNEUMOCOCCALS = GROUP B MOST COMMON - NEW VACCINE INTRODUCED FOR B IN 2015 MEANS W IS INCREASING - COMMON IN WINTER/SPRING - CHILDREN <5 AND 14-19YRS.
3. PRESENTATION - PRODROME = FEVER, HEADACHE, LEG PAIN, THIRST, DIARRHOEA, COLD HANDS AND FEET - CLASSIC = HAEMORRHAGIC RASH (DONT WAIT TO ADMIT), NECK STIFFNESS, PHOTOPHOBIA, BULGING FONTANELLE - LATE = CONFUSION, SEIZURES, REDUCED CONSCIOUSNESS
4. INVESTIGATIONS = BLOOD CULTURES, FBC, CRP, U&E, RENAL FXN, LFT - PCR FOR N. MENINGIDITS AND SEROGROUP - INCREASE IN APTT AND PTT = DIC - LUMBAR PUNCTURE WHEN STABLE (MC&S PLUS GLUCOSE AND PCR.
5. GROUP B STREP = BEN PEN & GENT, ECOLI = CEFOTAXIME AND GENT, LISTERIA = AMOX AND GENT
CHICKEN POX
1. VARICELLA ZOSTER VIRUS - REACTIVATION = HERPES ZOSTER. ENTERS BY RESPIRATORY TRACT
2. RISK FACTORS - IMMUNOCOMPROMISED - STEROID USE - MALIGNANCY - MILDER FORM WHEN YOUNGER - DANGEROUS IN NEONATES AND TO FETUS IN PREGNANCY - EARLY PREGNANCY = CONGENITAL VARICELLA SYNDROME = GROWTH RESTRICTION, MICROCEPHALY, CATARACTS - LATE PREGNANCY = PREMATURE DELIVERY/NEONATE CHICKEN POX (TX IG AND ACICLOVIR)
3. PRESENTATION - PRODROME = FEVER, HEADACHE, MALAISE. RASH = PAPULE, VESICLE, PUSTULE, CRUST
4. INVESTIGATIONS = USUALLY CLINICAL, SWAB PUSTULE (PCR), IF RESP SYMPTOMS = CXR, IF NEUROLOGICAL = LUMBAR PUNCTURE MC&S.
5. MANAGEMENT - REDUCE SCRATCHING = ANTIHISTAMINES, PAIN RELEIF, FLUIDS. ACICLOVIR <24HRS/SEVERE/COMPLICATIONS. **LINK NSAIDS AND NECROTISING SOFT TISSUE
NON-SPECIFIC VIRAL RASH - WIDESPREAD BLOTCHY - NO OTHER SERIOUS SYMPTOMS
BACTERIAL = NEONATES = GROUP B STREP, ECOLI, LISTERIA. >3MNTHS = NEISSERIA MENINGIDITIS, STREP PNEUMONIA, HAEMOPHILLUS INFUENZA B. VIRAL = ENTEROVIRUSES (COXSACKIE & ECHO), HERPES SIMPLEX 2, VARICELLA ZOSTER, MUMPS.

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PAEDIATRIC FEVER AND RASH

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	Created by Mollie Campbell over 8 years ago