COMMON CHILDHOOD INFECTIONS AND RASHES

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COMMON CHILDHOOD INFECTIONS AND RASHES

• Sue Lowe
• Oct 2005

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OBJECTIVES

• Bacterial infections
• Viral rashes
• Fungal infections
• Parasitic infestations
• Rashes associated with systemic disease
• Neonatal and congenital rashes
• Quiz!

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MENINGOCOCCAL SEPTICAEMIA

• MORTALITY 5-10 (90 if DIC)
• MORBIDITY 10
• (Deafness, neurological problems, amputations)
• Peak incidence lt 4yrs
• Immunisation programme includes Men C
• 60 of bacterial meningitis in UK due to Men B

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MENINGOCOCCAL SEPTICAEMIA

• CLINICAL FEATURES
• Fever, non-specific malaise, lethargy, vomiting,
  meningism, resp distress, irritability, seizures
• Maculopapular rash common early in disease
• Petechial rash seen in 50-60

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MENINGOCOCCAL SEPTICAEMIA

• MANAGEMENT IN PRIMARY CARE
• IMMEDIATE IV/IM ANTIBIOTICS
• Benzylpenicillin 1.2g gt 10yrs
• Benzylpenicillin 600mg 1-9yrs
• Benzylpenicillin 300mg lt 1yr
• CONTACT PROPHYLAXIS
• Rifampicin 600mg bd 2/7 gt 12yrs
• Rifampicin 10mg/kg bd 2/7 1-12yrs
• Rifampicin 5mg/kg bd 2/7 lt 1yr

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MENINGOCOCCAL SEPTICAEMIA
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IMPETIGO

• Staph Aureus or Gp A Strep Pyogenes
• Classically ruptured vesicles with honey-coloured
  crusting
• May be bullous
• More common in pre-existing skin disease
• Very contagious, rapid spread
• Commonly starts around face/mouth
• Rx. Topical fusidic acid or oral flucloxacillin
• Advice re nursery/school

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IMPETIGO
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STAPHYLOCOCCAL SCALDED SKIN

• Caused by Staphylococcal exfoliative toxin
• Erythematous tender skin, progressing to
  desquamation after 24-48hrs
• Nikolsky sign
• 62 lt 2yrs, 98 lt 5yrs
• BCs usually negative in children
• Usually febrile, may rapidly progress to
  dehydration/shock
• Rx. Systemic antistaphylococcal abx., emollients,
  may need IV fluids

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STAPH SCALDED SKIN
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SCARLET FEVER

• Gp A beta-haemolytic Strep
• 2-4 days post-Streptococcal pharyngitis
• Fever, headache, sore throat, unwell
• Flushed face with circumoral pallor
• Rash may extend to whole body
• Rough sandpaper skin
• Desquamation after 5/7, particularly soles and
  palms
• School age children
• White strawberry tongue
• Dx. Throat swab, ASO titres
• Rx. Penicillin 10/7

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SCARLET FEVER
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SCARLET FEVER
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VARICELLA

• Incubation 14-21 days
• Mild prodromal illness
• Rash Face, scalp, trunk, spreads centrifugally
• Macules papules vesicles pustules crusts
• Complications encephalitis, pneumonia,
  superceded Staphylococcal infection, disseminated
  disease in immunocompromised
• Advice to pregnant mothers

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MEASLES

• Unwell child
• Incubation 7-14 days
• Fever, conjunctival suffusion, coryza
• Maculopapular rash starting on face and
  progressing to whole body
• Kopliks spots are pathognomonic
• Complications Otitis media, pneumonia,
  hepatitis, myocarditis, encephalomyelitis, SSPE

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MEASLES
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MUMPS

• Incubation 14-21 days, infectious for 1 week
  after parotid swelling develops
• Painful salivary gland in 2/3
• Bilat or unilat
• May be parotid (60) or parotid and submandibular
  (10)
• Complications Encephalitis, transient deafness,
  epididymo-orchitis, pancreatitis, myocarditis

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OTHER COMMON VIRAL INFECTIONS

• Slapped cheek Fifth disease Parvovirus B19
  Erythema infectiosum
• Hand, foot and mouth (Coxsackie A and B)
• Roseala infantum (HHV-6)
• HSV
• Molluscum
• Rubella
• EBV
• HPV

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MOLLUSCUM CONTAGIOSUM
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FUNGAL INFECTIONS

• Dermatophyte fungi
• (Trichophyton, Epidermophyton, Microsporum)
• Tinea capitis
• Tinea cruris
• Tinea pedis
• Tinea ungium
• Tinea corporis
• Annular, scaling, erythematous lesions
• Systemic Rx usually required for scalp and nail
  infections (obtain mycological confirmation
  first)

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TINEA CAPITIS
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FUNGAL INFECTIONS

• PITYRIASIS VERSICOLOUR
• Hypopigmented patches on upper chest, neck, arms
• Usually settle spontaneously
• CANDIDA
• Classically causes oral thrush and nappy rash in
  infants
• Vulvovaginitis in adolescent girls
• Intertriginous lesions (neck, groin, axilla)
• Chronic mucocutaneous Candidiasis may occur in
  cell-mediated immune deficiencies
• Disseminated disease may be life-threatening in
  immunocompromised individuals

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PARASITIC INFECTIONS

• HEAD LICE
• Most common aged 4-11 years
• Treatments include wet combing, permethrin or
  malathion (use lotions in preference to shampoos)
• Repeat treatment after 1 week to ensure all
  unhatched ova killed
• Do not need to treat whole family but screen with
  thorough wet combing

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PARASITIC INFECTIONS

• SCABIES
• Highly contagious, spread by skin contact
• Commonly papules, vesicles, pustules, nodules
• Burrows are pathognomonic
• Intractable pruritus, worse at night and in web
  spaces
• Rx. With permethrin, malathion or crotamiton (use
  aqueous preparations in children as alcoholic
  preparations may cause stinging and wheeze)
• Repeat treatment after 1 week
• Treat whole household

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PARASITIC INFECTIONS

• THREADWORMS
• Usually present with pruritus ani
• May see worms in faeces
• Diagnosis on history or sticky tape test
• Rx. Mebendazole 100mg repeat 14 days later
• Treat whole family

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RASHES ASSOCIATED WITH SYSTEMIC DISEASE

• Erythema multiforme
• Stevens Johnson syndrome
• Erythema nodosum
• SLE
• Dermatomyositis
• JIA
• Malignancy
• Drugs
• Kawasakis
• Familial Mediterrean Fever

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ERYTHEMA MULTIFORME
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STEVENS JOHNSON SYNDROME
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NAPPY RASH

• Irritant/ammoniacal
• Candida
• Seborrhoeic dermatitis
• Atopic eczema
• Psoriasis
• Non-accidental injury

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NAPKIN CANDIDIASIS
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COMMON NEONATAL RASHES

• Milia
• Salmon patch (stork mark)
• Mongolian blue spot
• Erythema toxicum neonatorum
• Strawberry naevus (capillary haemangioma)
• Port wine stain (naevus flammeus)
• Sebaceous naevi
• Congenital melanocytic naevus

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MONGOLIAN BLUE SPOT
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PORT WINE STAIN
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CONGENITAL GIANT MELANOCYTIC NAEVUS
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QUIZ

• 1 yr old Amy presents with a history of coryzal
  symptoms, general malaise and high fever (390C).
  After 3 days, her temperature returns to normal.
  12 hours later, she develops a maculopapular rash
  over her trunk. What is the most likely diagnosis?

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QUIZ

• The following are associated with infection with
  Group A beta haemolytic Streptococcus?
• Neonatal meningitis
• Glomerulonephritis
• Scarlet fever
• Toxic shock syndrome
• Pneumonia

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QUIZ

• The following are included in the current UK
  immunisation programme
• Men C at pre-school booster
• BCG at birth
• MMR at 2 months
• DT and polio at 15 years
• Pertussis at pre-school booster

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QUIZ

• The following may cause fever and a widespread
  rash?
• Ulcerative colitis
• Acute lymphoblastic leukaemia
• Familial Mediterrean Fever
• Candidiasis
• Juvenile idiopathic arthritis

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QUIZ

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

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QUIZ

• True or false
• Topical antifungals are effective in tinea
  capitis
• Oral antifungals are always indicated in
  pityriasis versicolour
• Candida is the most likely cause of a vaginal
  discharge in a continent school age child
• Genital warts are common in children

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QUIZ

• Which of the following are notifiable diseases?
• Meningococcal meningitis
• Rubella
• CMV
• Campylobacter
• Parvovirus B19

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QUIZ

• Which of the following are required to make a
  diagnosis of Kawasakis disease?
• Fever of 2 days duration
• Purulent conjunctivitis
• Polymorphous rash
• Mucosal involvement
• Involvement of hands and feet