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