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12.08.29 Common infections

Rashes

Condition Pre-disease Distribution
Appearance
Clinical features Dangers Infection control
Varicella
IP 12-14 days
No/mild prodrome
Centripetal
Rarely palms/soles
Macular-papular-vesicular
"Dew-drop on rose petal"
Pleiomorphic rash
Crops of lesions
Rapid evolution
Rarely toxic
Secondary bacterial infections
Pneumonitis/pneumonia
Pregnancy (<20/52, 1/52 pre-delivery)
5/7 after start of rash
Herpes simplex
        Dehydration (painful to drink)
Eczema herpecticum
Genital herpes (HSV2) during birth can cause disseminated infection
None
Roseola infantum
(Exanthem subitum)
(Sixth disease)
 
Macular/maculopapular
Rash is preceded by 3-5 days of high fever
Rash lasts <2 days
Usually <2 years old
Treating fever with antibiotics and then inferring an allergy
 
None
Rubella
IP 17 days
No prodrome in infants
Starts face/centrally
Spreads to extremities
Pink macules
Suboccipital/postauricular lymphadenopathy
Rash lasts 3-5 days
Mild/no fever
Rash is pruritic
Arthralgia in adolescents
Congenital rubella syndrome if pregnant
No danger otherwise
5 days from start of rash
Esp. pregnant women
Mumps
  Face
Bilateral parotitis
Bilateral parotitis Aseptic meningiti
Pancreatitis
Epididymo-orchitis in adolescents
5 days from onset of swelling
Measles
IP 8-14 days
2-6 day prodrome
Characteristic:
    Coryza
    Conjunctivitis
    Cough
Rash starts behind ears/face
Spreads to trunk + extremities over 3-4 days
Brick red maculopapular rash
Discrete spots then coalesce

Koplik's spots are bluish/grey/white on red base, found on buccal mucosa opposite 2nd molar
Always unwell
Irritable
Fever (esp. first 2 days)
May desquamate
Respiratory
Diarrhoea
Encephalitis
5 days from start of rash
Infectious mononucleosis
  Palate
Petechial rash
Pharyngitis
Post-viral fatigue
Treating pharyngitis with antibiotics and then inferring an allergy None
Hand, Foot + Mouth
  Clue's in the name
  Peak in summer/early autumn
  None
Erythema infectiosum
(Fifth disease)
IP 7 days
Mild prodrome
Cheeks
Trunk + limbs
Fiery red on cheeks
Circumoral pallor
Erythematous maculopapular rash on trunk + limbs
Lacy, reticular pattern
Rash develops slowly
Heat-induced rash
Pruritis + arthralgia in adolescents
Red cell aplasia
None


Children with fever





Important diagnoses
  • Meningitis
    • Neck stiffness
    • Bulging fontanelle
    • Decreased level of consciousness
    • Convulsive status epilepticus
  • Meningococcal disease
    • Non-blanching rash, particularly with one or more of the following:
      • an ill-looking child
      • lesions larger than 2 mm in diameter (purpura)
      • CRT ≥ 3 seconds
      • neck stiffness
  • Herpes simplex encephalitis
    • Focal neurological signs
    • Focal seizures
    • Decreased level of consciousness
  • Pneumonia
    • Tachypnoea (depending on age)
    • Crackles
    • Nasal flaring +/- chest indrawing
    • Oxygen saturations < 95%
  • UTI (> 3 months)
    • Vomiting
    • Poor feeding
    • Lethargy
    • Irritability
    • Abdo pain or tenderness
    • Frequency or dysuria
    • Offensive urine or haematuria
  • Septic arthritis / Osteomyelitis
    • Swelling of limb or joint
    • Not using extremity
    • Non weight-bearing




Risk Factors for Neonatal Infection
(in order of risk)

1. PROM >18 hours
2. Preterm delivery <37 weeks
3. Preterm delivery <35 weeks
4. Choramnionitis or Fever>38oC (or 37.5oC on 2 occasions separated by at least 1 hr)
5. Previous infant with invasive GBS disease
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