Frsh

DR. FAZAL ASLAM
www.dnbpediatrics.com

Age of child.
Temporal relation of fever with rash.
Site of onset—distribution—direction—
progression
Morphology of rash
Associated symptoms
Is patient in shock ?
PAST HISTORY

Immunisation status.
Contacts
Immunocompromised ?
Drug/food allergy
Travel to endemic areas
Animal/insect bite
Joint pain
Pica

Full exposure in natural light.
MORPHOLOGY-colour, size,
consistency,margins, surface characteristics.
DISTRIBUTION-flexor/extensor,
sym/asymmetrical,centrifugal/centripetel.
If only exposed areas involved?
Involvement of genitals/mucous membrane.
Nikolsky sign

Kopliks spot
Forchheimer spots
Palatal petechiae
Pharyngitis.
Strawberry tongue
Fissuring of lips.
Circumoral pallor.
Coated tongue.

Lymph nodes.
Joints.
CNS involvement.
Hepatosplenomegaly.
Heart.
Eyes

Hb,TLC,DLC,ESR,Platelet count.
Chest xray.
Blood culture.
Tourniquet test.
Viral serology.
TORCH screening.
Urine analysis.
Lumbar puncture.
ECG, 2D echo.

Maintenance of vitals.
Temperature control.
Isolation of patient
Bed rest
Nutritious diet
Stop offending drugs (if any).
Oral hygiene.
Vit A.
Antibiotics.
Antihistaminics
Specific treatment acc to etiologies

MORPHOLOGY SMALL <0.5 CM LARGE >0.5CM
FLAT LESIONS
Normal texture macule patch
Indurated plaque plaque
ELEVATED LESIONS
solid papule nodule
Fluid filled vesicle bulla
Pus filled pustule pustule
LESIONS D/T
EXTRAVASATION OF
BLOOD
petechiae ecchymosis

MACULOPAPULAR PURPURIC /PETECHIAL
Measles (rubeola) Infectious mononucleosis
Rubella Malaria
Roseola infantum (exanthema
subitum/6th disease)
Rickettsial
Erythema infectiosum (5th
disease)
Meningococcal
Kawasaki disease Infective endocarditis
Infectious mononucleosis Viral hemorhagic fever
Early meningococcemia
Typhoid
Dengue
Erythema marginatum
Typhus

VESICOBULLOUS NODULAR SCARLITINIFORM
Varicella Erythema nodosum Scarlet fever
Impetigo. Fungal Kawasaki ds
Enterovirus Pseudomonas Toxic shock syndrome
Meningococcal Atypical mycobacteria Staphylococcal scalded
syndrome

Paramyxovirus.
IP—8 to 12 days.
Period of communicability.
4—Rash—5.
Rash starts from face &
behind ears.
KOPLIKS SPOTS.
Diagnosis mostly clinical

- mild measles in people with partial
protection
◦ Usually children vaccinated prior to age
12 months +/- coadministered
immune serum globulin or
◦ Persons receiving immunoglobulin.
ATYPICAL MEASLES
-Rash begins peripherally and moves
centrally in persons receiving formalin
inactivated measles.

Respiratory infections-otitis media
(mc),croup,tracheitis,bronchiolitis.
Abdominal pain – appendicitis due to swelling of
Peyer patches/hepatitis/gastroentritis
Pneumonia,Hecht’s pneumonia.
Myocarditis,g’nephritis,thrombocytopenic purpura
Encephalitis (most serious)
Late onset: subacute sclerosing pan encephalitis
(autoimmune phenomenon)
Activation of a tubercular focus.
Diarrhoea, malnutrition.
Febrile seizures (<3%).
BLACK MEASLES.

No specific treatment
Hydration, antipyretics
Avoid intense light (for photophobia)
IV ribavirin .
Vitamin A .
single dose of 2 lacs iu oral- >1 yr.
1 lac iu oral -6 m to 1 yr.
if opthalmologic evidence –repeat dose next
day & 4 wks later.

INDICATIONS.
-6 m to 2yrs hospitalised with measles &
complications
- >6 m not received vit A & with risk factors.
immunodeficiency,clinical e/o vit A
def,impaired intestinal absorption,moderate to
severe malnutrition,migration from endemic
areas.

German measles/3 day
measles—RNA Togavirus
IP—2 to 3 weeks.
Most contagious-2 days
prior to 6 days after rash
Winter-spring
Prodrome
Face  neck  trunk.
Lymphadenopathy.
Forchheimers spots(20%)

Thrombocytopenia (1/3000)
Arthritis-clasically small hand joints
Encephalitis(1/5000).
Progressive rubella panencephalitis.
Others – GBS, peripheral neuritis,myocarditis.

Infection in utero: congenital rubella
syndrome (CRS)
◦ If infection in 1st trimester – 90% of fetuses
infected.
◦ After 16 wks of gestation –defects uncommon even
if fetal infection occurs.
Infants with CRS may shed virus in
nasopharyngeal secretions and urine for more
than 1 year – can easily transmit virus

Features of congenital rubella syndrome:
1-Intrauterine growth retardation
small for gestational age and
failure to thrive
2-Nerve deafness
3- Microcephaly and mental
retardation
4- Congenital heart disease (PDA, VSD)
5- Cataract, glaucoma, and cloudy cornea
6- Thrombocytopenic purpura.
7- Hepatosplenomegaly,osteopathy,interstitial
nephritis, pneumonitis.

Exanthema subitum.
HHV-6,7.
IP-5 to 15 days
Children >6 months.
NO PRODROME.
Abrupt high fever.
Fever resolution by CRISIS
& LYSIS.
Febrile seizures.
Rash develops after fever dissipates-rainbow following the
storm
Mainly on trunk-rash fades within 3 days.
NAGAYAMA’S SPOTS
Good prognosis

Begins on trunk & spreads out

Febrile seizure (10% of pts)
HHV-6 can cause meningoencephalitis or
aseptic meningitis
Multiorgan disease can occur in
immunocompromised patients
◦ Pneumonia
◦ Hepatitis
◦ Bone marrow suppression
◦ Encephalitis

Herpes virus varicellae
IP- 10 to 21 days
Papulesvesicles crusting.
Pleomorphic,flexor surface.
Spreads centripetally,symmetrical,mucosa &
axilla involved,spares palm &
soles,diminishes centrifugally.
Scab formation after 4-7 days.
Fever rises with each fresh crop of rash
Period of communicability is 2 days before
and 7 days after lesions crusted over

Secondary infections (staph/strep) most
common; may be life threatening with toxic
shock syndrome/necrotizing fasciitis
Varicella gangrenosa – thrombocytopenia with
hemorrhagic lesions
Pneumonia,Myocarditis/pericarditis.
Hepatitis,Glomerulonephritis,Orchitis
Arthritis
Ulcerative gastritis
Encephalitis (cerebellar ataxia may occur
without encephalitis)
Reyes syndrome

Primary varicella in pregnant woman  fetal
varicella infection
◦ Low birthweight, cortical atrophy, seizures, mental
retardation, chorioretinitis, cataracts, intracranial
calcifications
Children exposed in utero to VZV may
develop zoster without varicella

◦ Occurs in newborns of mothers
with varicella (not shingles) 5 days
before or 2 days after delivery
◦ Child born prior to maternal
antibody response develops
◦ Treat infants ASAP with varicella zoster immunoglobulin

Oral acyclovir- indications
◦ Healthy nonpregnant teenagers and adults
◦ Children > 1 yr with chronic cutaneous or
pulmonary conditions
◦ Patients on chronic salicylate therapy
◦ Patients receiving short or intermittent courses of
aerosolized corticosteroids
Dose: 80 mg/kg/day in four divided doses
for 5 days

VZIG (1 vial/5 kg IM) :
◦ Pts on high dose steroids
◦ Immunocompromised without a history of CP
◦ Pregnant women
◦ Newborns exposed 5 days prior to birth and 2 days
after delivery
◦ Neonates born to nonimmune mothers
◦ Hospitalized premature infants < 28 weeks’
gestation

Human parvovirus B19.
IP-4 to 14 days.
Preschool and young
school age children.
Prodrome minimal or absent
Slapped cheek syndrome with circumoral pallor.
Lacy reticular pattern on fading.
Rash lasts for 1 to 3 weeks. Waxing and waning course.
Spread is respiratory
Initial viremia at 7-10 days; mild flu-like illness
Patients are only contagious up to presence of rash

Complications
◦ Arthritis: F>M, older>younger
◦ Aplastic crisis: usually not noticed in patients
with normal erythrocyte half-life BUT results
in severe anemia in those with any chronic
hemolytic anemia (rash follows hemolysis)
◦ Pregnancy: early miscarriage, late hydrops
fetalis
◦ GLOVES & SOCKS SYNDROME-
Papular/purpuric

Vasculitis of unknown etiology
Multisystem involvement and inflammation of
small and medium sized arteries with
aneurysm formation
More common among children of Asian
decent
Usually children <5 years; peak 2-3 years.
3 CLINICAL PHASES-acute,
subacute,convalescent.

Coronary artery thrombosis and coronary artery aneurysm(25%)
Myocardial infarction
Myocarditis(50%).
Congestive heart failure
Hydrops of gall bladder
Aseptic meningitis
Arthritis
Sterile pyuria (urethritis)
Thrombocytosis
Diarrhea
Pancreatitis
Peripheral gangrene

ACUTE STAGE.
IV Immunoglobulin (mechanism unknown)
◦ Single dose of 2 g/kg over 12 hours
Aspirin 80-100 mg/kg/day divided q 6hrs until
day 14.
 CONVALESCENT STAGE.
Aspirin 3-5 mg/kg od until 6-8 wks after illness
onset.
 CORONARY ABNORMALITIES (long term therapy)
Aspirin 3-5 mg/kg od +/- clopidrogel 1mg/kg
max upto 75 mg/day,
 ACUTE CORONARY THROMBOSIS.
prompt fibrinolytic therapy.

Aedes aegyptii-daytime,urban,collections of
water.
Dengue like disease-chikungunya, o’nyong-
nyong, westnile fever.
IP-1 to 7 days.
Sudden onset of high grade fever.
Frontal/retroorbital pain.
Back break fever.
C/F in first 2 days ,2-6 days,after 1-2 days of
fever.

Multiple types of dengue virus.
Dengue 3 virus- severe clinical syndrome..
Relatively mild 1st phase with rapid clinical
deterioration & collapse after 2-5 days.
Hepatomegaly may be seen.
Positive tourniquet test.
20-30% - Dengue shock syndrome.
10%-gross ecchymosis/gastrointestinal bleed

DENGUE HEMORRHAGIC FEVER.
1. Fever.
2. minor/major hemorrhagic manifestations.
3. thrombocytopenia ( <1lac).
4. objective evidence of increased capillary
permeability (hematocrit increased by >20%).
5.serosal effusion(by CXR/USG).
6.hypoalbuminemia.
 DENGUE SHOCK SYNDROME.
ABOVE + Hypotension/narrow pulse
pressure(<20mm Hg)

GRADE 1- Fever + positive tourniquet test.
GRADE 2- Spontaneous bleeding.
GRADE 3-Circulatory failure.
GRADE 4- Profound shock with undetectable
BP

DF.
Bed rest, supportive treatment, Aspirin C/I.
 DHF.
1. IVF NS>RL.
2. If pulse pressure <10mm Hg/elevn of
hematocrit persists-plasma/colloid.
3. avoid overhydration.
4. serial hematocrit determin & vitals
monitoring

IP-7 to 14 days.
Stepladder rise of fever (rare).
Abdominal pain
Hepatosplenomegaly m
Relative bradycardia.
Coated tongue.
Maculopapular rashes/rose spot in 25%
cases.
Rose spot difficult to appreciate in dark
skinned.

Acute, self limited illness,oral
transmission
Epstein-Barr virus.
IP-30 to 50 days.
Clinical features
Atypical lymphocytosis.

Ampicillin rash.
Gianotti crosti syndrome.

Major jones criteria.
Trunk, upper arms,legs
never on face
Maculopapular, raised edges
central clearing,circular shape
Not itchy/painful.

Erythrogenic toxin producing
group A -hemolytic
streptococci
1 to 2 days after pharyngitis
Rash from neck- trunk- extremities,blanches on
pressure.
Petechiae in linear form.
More intense along elbow,axilla,groin creases.
Fade in 4 to 5 days with desquamation 1st face
progressing downwards.
Warm Sandpaper like skin
White and red strawberry tongue
Treatment –penicillin or erythromycin

Neisseria meningitides.
Usually sudden onset of
fever,chills, myalgia, and arthralgia
Rash is macular, nonpruritic,
erythematous lesions,usually
on extremities,relative sparing of child’s body
surface.
Petechial rash develops in 75% of cases
• Complications: permanent CNS damage, deafness,
seizures, paralysis, cognitive deficits,fever, rash,
hypotension, shock, DIC
Treatment: Pen G/ Cefotaxime/ ceftriaxone.

Superficial infection
of the dermis
Two types:
◦ Impetigo contagiosa
◦ Bullous impetigo
Etiology
◦ Group A ß hemolytic streptococcus
◦ Coagulase positive S. aureus
Treatment : Erythromycin.

Multiple crusted
lesion with
erythematous halo
with polycyclic edges.
Spreads without healing.

< 5 yrs.
Staphylococcal exfoliatin
Bullous lesions.
Easy peeling of skin in
thin sheets.
Positive Nikolsky’s sign
Diagnosis: Tzanck test, bacterial culture
Treatment

Most common rickettsial infection in US
Abrupt fever, headache, and myalgia
Rash from extremities towards trunk
Maculespetechiae
Treatment
◦ Tetracycline
◦ Doxycycline
◦ Chloramphenicol

Enteroviruses
◦ coxsackieviruses A and B
◦ echoviruses
Vesicular lesions, may be petechial
Associated with aseptic meningitis,
myocarditis

Frsh

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (20)

Ähnlich wie Frsh

Ähnlich wie Frsh (20)

Mehr von Ajay Agade

Mehr von Ajay Agade (20)

Frsh

Hinweis der Redaktion