COMMON CHILDHOOD COMMON CHILDHOOD INFECTIONS AND RASHESINFECTIONS AND RASHES

Sue LoweSue Lowe

Oct 2005Oct 2005

OBJECTIVESOBJECTIVES

Bacterial infectionsBacterial infections Viral rashesViral rashes Fungal infectionsFungal infections Parasitic infestationsParasitic infestations Rashes associated with systemic Rashes associated with systemic

diseasedisease Neonatal and congenital rashesNeonatal and congenital rashes Quiz!Quiz!

MENINGOCOCCAL MENINGOCOCCAL SEPTICAEMIASEPTICAEMIA

MORTALITY 5-10% (90% if DIC)MORTALITY 5-10% (90% if DIC)

MORBIDITY 10% MORBIDITY 10% (Deafness, neurological problems, (Deafness, neurological problems, amputations)amputations)

Peak incidence < 4yrsPeak incidence < 4yrs

Immunisation programme includes Men CImmunisation programme includes Men C60% of bacterial meningitis in UK due to Men 60% of bacterial meningitis in UK due to Men BB

MENINGOCOCCAL MENINGOCOCCAL SEPTICAEMIA SEPTICAEMIA

CLINICAL FEATURES:CLINICAL FEATURES:

Fever, non-specific malaise, lethargy, Fever, non-specific malaise, lethargy, vomiting, meningism, resp distress, vomiting, meningism, resp distress, irritability, seizuresirritability, seizures

Maculopapular rash common early in diseaseMaculopapular rash common early in disease

Petechial rash seen in 50-60%Petechial rash seen in 50-60%

MENINGOCOCCAL MENINGOCOCCAL SEPTICAEMIASEPTICAEMIA

MANAGEMENT IN PRIMARY CAREMANAGEMENT IN PRIMARY CARE

IMMEDIATE IV/IM ANTIBIOTICSIMMEDIATE IV/IM ANTIBIOTICS

Benzylpenicillin 1.2g > 10yrsBenzylpenicillin 1.2g > 10yrs Benzylpenicillin 600mg 1-9yrsBenzylpenicillin 600mg 1-9yrs Benzylpenicillin 300mg < 1yrBenzylpenicillin 300mg < 1yr

CONTACT PROPHYLAXISCONTACT PROPHYLAXIS

Rifampicin 600mg bd 2/7 > 12yrsRifampicin 600mg bd 2/7 > 12yrs Rifampicin 10mg/kg bd 2/7 1-12yrsRifampicin 10mg/kg bd 2/7 1-12yrs Rifampicin 5mg/kg bd 2/7 < 1yrRifampicin 5mg/kg bd 2/7 < 1yr

MENINGOCOCCAL MENINGOCOCCAL SEPTICAEMIASEPTICAEMIA

IMPETIGOIMPETIGO

Staph Aureus or Gp A Strep PyogenesStaph Aureus or Gp A Strep Pyogenes Classically ruptured vesicles with honey-Classically ruptured vesicles with honey-

coloured crustingcoloured crusting May be bullousMay be bullous More common in pre-existing skin diseaseMore common in pre-existing skin disease Very contagious, rapid spreadVery contagious, rapid spread Commonly starts around face/mouthCommonly starts around face/mouth Rx. Topical fusidic acid or oral flucloxacillin Rx. Topical fusidic acid or oral flucloxacillin Advice re nursery/schoolAdvice re nursery/school

IMPETIGOIMPETIGO

STAPHYLOCOCCAL SCALDED STAPHYLOCOCCAL SCALDED SKINSKIN

Caused by Staphylococcal exfoliative toxinCaused by Staphylococcal exfoliative toxin Erythematous tender skin, progressing to Erythematous tender skin, progressing to

desquamation after 24-48hrsdesquamation after 24-48hrs Nikolsky signNikolsky sign 62% < 2yrs, 98% < 5yrs62% < 2yrs, 98% < 5yrs BCs usually negative in childrenBCs usually negative in children Usually febrile, may rapidly progress to Usually febrile, may rapidly progress to

dehydration/shockdehydration/shock Rx. Systemic antistaphylococcal abx., Rx. Systemic antistaphylococcal abx.,

emollients, may need IV fluidsemollients, may need IV fluids

STAPH SCALDED SKINSTAPH SCALDED SKIN

SCARLET FEVERSCARLET FEVER

Gp A beta-haemolytic StrepGp A beta-haemolytic Strep 2-4 days post-Streptococcal pharyngitis2-4 days post-Streptococcal pharyngitis Fever, headache, sore throat, unwellFever, headache, sore throat, unwell Flushed face with circumoral pallorFlushed face with circumoral pallor Rash may extend to whole bodyRash may extend to whole body Rough ‘sandpaper’ skinRough ‘sandpaper’ skin Desquamation after 5/7, particularly soles and Desquamation after 5/7, particularly soles and

palmspalms School age childrenSchool age children White strawberry tongueWhite strawberry tongue Dx. Throat swab, ASO titresDx. Throat swab, ASO titres Rx. Penicillin 10/7Rx. Penicillin 10/7

SCARLET FEVERSCARLET FEVER

SCARLET FEVERSCARLET FEVER

VARICELLAVARICELLA

Incubation 14-21 daysIncubation 14-21 days Mild prodromal illnessMild prodromal illness Rash: Face, scalp, trunk, spreads centrifugallyRash: Face, scalp, trunk, spreads centrifugally Macules – papules – vesicles – pustules – crustsMacules – papules – vesicles – pustules – crusts Complications: encephalitis, pneumonia, Complications: encephalitis, pneumonia,

superceded Staphylococcal infection, superceded Staphylococcal infection, disseminated disease in immunocompromiseddisseminated disease in immunocompromised

Advice to pregnant mothersAdvice to pregnant mothers

MEASLESMEASLES

Unwell childUnwell child Incubation 7-14 daysIncubation 7-14 days Fever, conjunctival suffusion, coryzaFever, conjunctival suffusion, coryza Maculopapular rash starting on face and Maculopapular rash starting on face and

progressing to whole bodyprogressing to whole body Koplik’s spots are pathognomonic Koplik’s spots are pathognomonic Complications: Otitis media, pneumonia, Complications: Otitis media, pneumonia,

hepatitis, myocarditis, encephalomyelitis, hepatitis, myocarditis, encephalomyelitis, SSPESSPE

MEASLESMEASLES

MUMPSMUMPS

Incubation 14-21 days, infectious for 1 Incubation 14-21 days, infectious for 1 week after parotid swelling developsweek after parotid swelling develops

Painful salivary gland in 2/3Painful salivary gland in 2/3 Bilat or unilatBilat or unilat May be parotid (60%) or parotid and May be parotid (60%) or parotid and

submandibular (10%)submandibular (10%) Complications: Encephalitis, transient Complications: Encephalitis, transient

deafness, epididymo-orchitis, pancreatitis, deafness, epididymo-orchitis, pancreatitis, myocarditis myocarditis

OTHER COMMON VIRAL OTHER COMMON VIRAL INFECTIONSINFECTIONS

Slapped cheek = Fifth disease = Slapped cheek = Fifth disease = Parvovirus B19 = Erythema infectiosumParvovirus B19 = Erythema infectiosum

Hand, foot and mouth (Coxsackie A and B)Hand, foot and mouth (Coxsackie A and B) Roseala infantum (HHV-6)Roseala infantum (HHV-6) HSVHSV MolluscumMolluscum RubellaRubella EBVEBV HPVHPV

MOLLUSCUM CONTAGIOSUMMOLLUSCUM CONTAGIOSUM

FUNGAL INFECTIONSFUNGAL INFECTIONS

Dermatophyte fungi Dermatophyte fungi (Trichophyton, Epidermophyton, Microsporum) (Trichophyton, Epidermophyton, Microsporum)

Tinea capitisTinea capitis Tinea crurisTinea cruris Tinea pedisTinea pedis Tinea ungiumTinea ungium Tinea corporisTinea corporis

Annular, scaling, erythematous lesionsAnnular, scaling, erythematous lesions Systemic Rx usually required for scalp and nail Systemic Rx usually required for scalp and nail

infections (obtain mycological confirmation first)infections (obtain mycological confirmation first)

TINEA CAPITISTINEA CAPITIS

FUNGAL INFECTIONSFUNGAL INFECTIONS

PITYRIASIS VERSICOLOURPITYRIASIS VERSICOLOUR Hypopigmented patches on upper chest, neck, armsHypopigmented patches on upper chest, neck, arms Usually settle spontaneouslyUsually settle spontaneously

CANDIDACANDIDA Classically causes oral thrush and nappy rash in Classically causes oral thrush and nappy rash in

infantsinfants Vulvovaginitis in adolescent girlsVulvovaginitis in adolescent girls Intertriginous lesions (neck, groin, axilla)Intertriginous lesions (neck, groin, axilla) Chronic mucocutaneous Candidiasis may occur in Chronic mucocutaneous Candidiasis may occur in

cell-mediated immune deficienciescell-mediated immune deficiencies Disseminated disease may be life-threatening in Disseminated disease may be life-threatening in

immunocompromised individualsimmunocompromised individuals

PARASITIC INFECTIONSPARASITIC INFECTIONS

HEAD LICEHEAD LICE

Most common aged 4-11 yearsMost common aged 4-11 years Treatments include wet combing, Treatments include wet combing,

permethrin or malathion (use lotions in permethrin or malathion (use lotions in preference to shampoos)preference to shampoos)

Repeat treatment after 1 week to ensure Repeat treatment after 1 week to ensure all unhatched ova killedall unhatched ova killed

Do not need to treat whole family but Do not need to treat whole family but screen with thorough wet combingscreen with thorough wet combing

PARASITIC INFECTIONSPARASITIC INFECTIONS SCABIESSCABIES

Highly contagious, spread by skin contactHighly contagious, spread by skin contact Commonly papules, vesicles, pustules, nodulesCommonly papules, vesicles, pustules, nodules Burrows are pathognomonicBurrows are pathognomonic Intractable pruritus, worse at night and in web spacesIntractable pruritus, worse at night and in web spaces

Rx. With permethrin, malathion or crotamiton (use Rx. With permethrin, malathion or crotamiton (use aqueous preparations in children as alcoholic aqueous preparations in children as alcoholic preparations may cause stinging and wheeze)preparations may cause stinging and wheeze)

Repeat treatment after 1 weekRepeat treatment after 1 week Treat whole household Treat whole household

PARASITIC INFECTIONSPARASITIC INFECTIONS

THREADWORMSTHREADWORMS

Usually present with pruritus aniUsually present with pruritus ani May see worms in faecesMay see worms in faeces Diagnosis on history or ‘sticky tape’ testDiagnosis on history or ‘sticky tape’ test Rx. Mebendazole 100mg – repeat 14 days Rx. Mebendazole 100mg – repeat 14 days

laterlater Treat whole familyTreat whole family

RASHES ASSOCIATED WITH RASHES ASSOCIATED WITH SYSTEMIC DISEASESYSTEMIC DISEASE

Erythema multiformeErythema multiforme Stevens Johnson syndromeStevens Johnson syndrome Erythema nodosum Erythema nodosum SLESLE DermatomyositisDermatomyositis JIAJIA MalignancyMalignancy DrugsDrugs Kawasaki’sKawasaki’s Familial Mediterrean FeverFamilial Mediterrean Fever

ERYTHEMA MULTIFORMEERYTHEMA MULTIFORME

STEVENS JOHNSON STEVENS JOHNSON SYNDROMESYNDROME

NAPPY RASHNAPPY RASH

Irritant/ammoniacalIrritant/ammoniacal CandidaCandida Seborrhoeic dermatitisSeborrhoeic dermatitis Atopic eczemaAtopic eczema PsoriasisPsoriasis Non-accidental injuryNon-accidental injury

NAPKIN CANDIDIASISNAPKIN CANDIDIASIS

COMMON NEONATAL COMMON NEONATAL RASHESRASHES

MiliaMilia Salmon patch (stork mark)Salmon patch (stork mark) Mongolian blue spotMongolian blue spot Erythema toxicum neonatorumErythema toxicum neonatorum Strawberry naevus (capillary haemangioma)Strawberry naevus (capillary haemangioma) Port wine stain (naevus flammeus)Port wine stain (naevus flammeus) Sebaceous naeviSebaceous naevi Congenital melanocytic naevusCongenital melanocytic naevus

MONGOLIAN BLUE SPOTMONGOLIAN BLUE SPOT

PORT WINE STAINPORT WINE STAIN

CONGENITAL GIANT CONGENITAL GIANT MELANOCYTIC NAEVUSMELANOCYTIC NAEVUS

QUIZQUIZ

1 yr old Amy presents with a history 1 yr old Amy presents with a history of coryzal symptoms, general of coryzal symptoms, general malaise and high fever (39malaise and high fever (3900C). After C). After 3 days, her temperature returns to 3 days, her temperature returns to normal. 12 hours later, she develops normal. 12 hours later, she develops a maculopapular rash over her trunk. a maculopapular rash over her trunk. What is the most likely diagnosis?What is the most likely diagnosis?

QUIZQUIZ

The following are associated with infection The following are associated with infection with Group A beta haemolytic with Group A beta haemolytic Streptococcus?Streptococcus?

Neonatal meningitisNeonatal meningitis GlomerulonephritisGlomerulonephritis Scarlet feverScarlet fever Toxic shock syndromeToxic shock syndrome PneumoniaPneumonia

QUIZQUIZ

The following are included in the current The following are included in the current UK immunisation programme:UK immunisation programme:

Men C at pre-school boosterMen C at pre-school booster BCG at birthBCG at birth MMR at 2 monthsMMR at 2 months DT and polio at 15 yearsDT and polio at 15 years Pertussis at pre-school boosterPertussis at pre-school booster

QUIZQUIZ

The following may cause fever and a The following may cause fever and a widespread rash?widespread rash?

Ulcerative colitisUlcerative colitis Acute lymphoblastic leukaemiaAcute lymphoblastic leukaemia Familial Mediterrean FeverFamilial Mediterrean Fever CandidiasisCandidiasis Juvenile idiopathic arthritisJuvenile idiopathic arthritis

QUIZQUIZ

13 year old Neville is a homozygote 13 year old Neville is a homozygote for sickle cell disease and usually has for sickle cell disease and usually has a Hb of 8.0g/l. Following a mild URTI, a Hb of 8.0g/l. Following a mild URTI, he presents to his GP complaining of he presents to his GP complaining of increased lethargy. A FBC reveals Hb increased lethargy. A FBC reveals Hb 5.0, WCC 4.0, plt 90. What is the 5.0, WCC 4.0, plt 90. What is the most likely cause? most likely cause?

QUIZQUIZ

True or false:True or false:

Topical antifungals are effective in tinea capitisTopical antifungals are effective in tinea capitis

Oral antifungals are always indicated in pityriasis Oral antifungals are always indicated in pityriasis versicolourversicolour

Candida is the most likely cause of a vaginal Candida is the most likely cause of a vaginal discharge in a continent school age childdischarge in a continent school age child

Genital warts are common in childrenGenital warts are common in children

QUIZQUIZ

Which of the following are notifiable Which of the following are notifiable diseases?diseases?

Meningococcal meningitisMeningococcal meningitis RubellaRubella CMVCMV CampylobacterCampylobacter Parvovirus B19Parvovirus B19

QUIZQUIZ

Which of the following are required to Which of the following are required to make a diagnosis of Kawasaki’s disease?make a diagnosis of Kawasaki’s disease?

Fever of 2 days durationFever of 2 days duration Purulent conjunctivitisPurulent conjunctivitis Polymorphous rashPolymorphous rash Mucosal involvementMucosal involvement Involvement of hands and feetInvolvement of hands and feet