Measles- 3-5 day prodrome
- Spreads downwards from the ears
- Desquamates in 2nd week
- Cough, runny nose, Koplik spots
- Infective from 1-2 days before to 6 days after rash
- Complications
- Subacute sclerosing panencephalitis (SSPE)
- Severe late complication
- History of primary measles
infection usually before the age of 2 years, followed by several
asymptomatic years (6–15 on average)
- Gradual, progressive
psychoneurological deterioration: Personality change, seizures, myoclonus, ataxia, photosensitivity, ocular abnormalities, spasticity, coma
- Otitis media
- Pneumonia
- Encephalopathy
- Treatment is supportive
Meningitis- Organisms:
- Neonates: GBS, E. coli, Listeria
- Children: Neisseria meningitides, Streptococcus pneumoniae, Haemophilus influenzae type B
- Treatment:
- IV ceftriaxone
- BenPen + Gent in neonates
- Ampicillin if Listeria suspected
Chicken pox
- 10-21 day incubation
- 5% get secondary infection
- IV aciclovir
- Older children
- Immunocompromised
- VZIG
Kawasaki
- Peak age 9-11 months
- But may affect from 6 months to 5 years
- Winger/spring peak
- Diagnosis:
- Fever of ≥5 days' duration plus 4 of:
- Bilateral nonsuppurative conjunctivitis
- One or more changes of the mucous membranes of the upper respiratory tract
- Pharyngeal injection, dry fissured lips, injected lips, "strawberry" tongue
- One or more changes of the extremities
- Peripheral erythema, peripheral edema, periungual desquamation, generalized desquamation
- Polymorphous rash
- Cervical lymphadenopathy
- Can cause fatal coronary artery aneurysms
Bronchiolitis
- 90% are <1 year
- RSV most common cause
- Coryza, breathless, reduced feeding, apnoea
- Treatment:
- Oxygen
- NG feeds
- IV fluids
- Check capillary CO2 => ?NIV
- No need for antibiotics, CXR, bronchodilators
GBS
- 15-30% of women are carriers
- Infection may be:
- Early => Pneumonia, septicaemia, meningitis
- Late (3 days - 3 months) => Meningitis
- Risk factors: PROM, Fever in labour
- Admit straight to NICU
- BenPen + Gent
UTI management
- < 3 months
- Refer to paediatric specialist care and send a urine sample for urgent microscopy and culture
- 3 months - 3 years
- Urgent microscopy and culture + antibiotics if specific urinary symptoms
- If non-specific symptoms, send urine for microscopy and culture and start antibiotics if microscopy or culture is positive
- Consider paediatric specialist review
- > 3 years: Do urine dip:
- Both leucocyte esterase and nitrite positive:
- Regard as having UTI and start antibiotic treatment should be started
- Send for culture if high or intermediate risk of serious illness and/or a history of previous UTI
- Leucocyte esterase negative, nitrite positive:
- Start antibiotics if the urine test was carried out on a fresh sample of urine
- Send urine sample for culture to determine further management
- Leucocyte esterase positive, nitrite negative:
- Send urine sample for microscopy and culture
- May be indicative of an infection outside the urinary tract
- Do not start antibiotics without strong clinical suspicion
- Both leucocyte esterase and nitrite negative:
- Regard as not having UTI
- Investigate other causes
Infectious mononucleosis (EBV)
- => Rash with penicillin
- Atypical lymphocytes
- Splenohepatomegaly
- Jaundice
Epiglottitis
- HIB
- Acute emergency
- DON'T EXAMINE
- Urgent senior help + intubation
Croup (laryngotracheobronchitis)
- Triggered by an acute viral infection of the
upper airway; Usually parainfluenza virus
- Classical symptoms: "barking" cough, stridor, and hoarseness
- Often worse at night
- Teated with a single dose of oral steroids; occasionally adrenaline in more severe cases
- Affects about 15% of children at some point, most
commonly between 6 months and 5–6 years of age
Notes
- AVPU
- P or below: Call anaesthetist
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