• 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

• 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
• Pimarily truncal
• Cervical lymphadenopathy
  
• >1.5 cm in diameter
• 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

• => 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