2. TREATMENTOF ANY FEBRILE CHILD
NON SPECIFIC TREATMENT
SPECIFIC TREATMENT: antiviral or antibacterial drugs
PREVENTION AND COMPLICATION TREATMENT
as vaccine or Immunoglobin
3. 1- NON SPECIFIC
General measures
Bed rest.
Diet:
Symptomatic treatment:
For fever: Sponging with tap water and antipyretics but avoid over
dosage and prolonged use.
For constipation, headache
Supportive measures:
Fluids for dehydrated patients
4. RASHES
Rashes can be classified as:
Macular, maculopapular eruptions
Papulo-vesicular or bullous eruptions
Petechial or hemorrhagic eruptions.
Ulcerative eruptions
Nodular eruptions.
6. Vesiculo-papular
Urticaria
Post-Allergen as insect
bite
Very itchy
papules→vesicles→exco
-riation and 2ry infection
No scalp
No mm
Over the extensor
surfaces, palms, soles
7. C/P
Describe
distribution: maximum, other areas
Itchy
MM
8. Iry lesions
Macule: Flat lenticular size
circumscribed area (<5 mm- <1cm)
of change in skin color
Papule: small lenticular size (<5mm- 1cm)
Circumscribed elevation of the skin
Nodule: Solid, circumscribed elevation of the
skin whose greater part is beneath skin surface
(felt more than seen)
9. Vesicle: collection of clear fluid
(<5mm in diameter)
Bulla: like vesicle, but > 5 mm
Pustule: Collection of Pus
10. Patches : large lesion due to
gathering of macules
Plaque: flat topped palpable
lesion (gathering of papules)
11. Non blanching
Hgic rash
Petechiae are less
than 2 mm in
diameter
Purpuric lesions
vary from 2 mm to
1 cm
Ecchymoses are
larger than 1 cm.
12. Wheal: Transient,
slightly raised lesion
with pale center and pink
margin. Seen in urticaria.
Telangectasia: Dilated
capillaries visible on skin
surface
17. What is the lesion
A child with rash (red macules, red papules,
vesicles) over the trunk and few over the face
and scalp. History of sneezing and cough one
day before
19. Varicella (Chickenpox)
V-Z Virus
Transmission:
1- skin contact
2- droplets
3- air born transmission
Contagiousness :
1-2 d before rash
till all lesions are crusted
All ages
Most 2-8 ys
20. Clinical Manifestations of Chicken Pox
Incubation period 11-21 days.
Catarrhal stage: mild fever and malaise precede
the typical rash by 24 hours. infective
The rash starts by small red papules that pass
into vesicles on an erythematous base. infective
It starts on the trunk and spreads to the face,
scalp and extremities. Pruritis is usually present.
Vesicles produce a crust that falls with no scar.
NON infective
27. It is a droplet infection and infectivity occurs 24 hours
before, and up to scaling of all rash ( usually 7 days after
the appearance of the characteristic rash) . Dry scales are
non-infective.
33. TT of Varicella (Chickenpox)
1- non specific
2- specific: acyclovir
3- complications treatment: AB, IV acyclovir
REYE SYNDROME
prophylaxis: active ( LA vaccine) > 1y age SC once
passive (VZIG) within 6 days of exposure
34.
35. Herpes zoster
Same virus VZ in
immune persons
Very painful vesicles
Along dermatome of
peripheral nerves
Unilateral
unimorphic
38. WHAT IS THE LESION
4-year-old boy presented with a 5-day history of
mild fever and malaise and a 3-day history of a
vesicular rash involving his hands , feet, tongue ,
and buttocks.
39. . This clinical picture is highly characteristic of
hand, foot, and mouth disease,
Typical skin lesions are elliptical vesicles
surrounded by an erythematous halo.
.
40. Hand – Foot – Mouth Syndrome
Coxsackie virus A16 or
enterovirus 71
contagious childhood
illness starts with a fever,
then painful mouth sores
and a non-itchy rash with
blisters on hands, feet,
and sometimes buttocks
and legs follow
41.
42.
43.
44.
45.
46. TREATMENT OF HFMS
The patient was treated
supportively at home
without medication. At
follow-up 1 week later,
his systemic symptoms
had improved and the
skin lesions were
resolving
47.
48. Impetigo
Staph or streptococcus
No constitutional signs
Starting peri-oral or
nasolabiol folds
No mm
49. Impetigo
red sores or blisters that
can break open, ooze,
and develop a yellow-
brown crust.
Impetigo can be spread
to others through close
contact or by sharing
items like towels and
toys. Scratching can also
spread it to other parts
TT: 1- AB local (ointment)
of the body
2- oral AB ( 10 days for streptococcus)
50.
51. Vesiculo-papular
Urticaria
Post-Allergen as insect
bite
Very itchy
papules→vesicles→exco
-riation and 2ry infection
No scalp
No mm
Over the extensor
surfaces, palms, soles
52. Scabies
Itchy more at night
Mostly covered areas and
interdigital
Pleomorphic + burrows
Positive history of
contacts
53.
54. Maculo-papular DD
Measles
GM
R infantum
E infectiosum
I Mono
Scarlet fever
collagen disease
drug rash
55. MEASLES
Rubeola
What causes the disease?
Measles is caused by a
virus called Morbillivirus, a
paramyxovirus
RNA virus
IP: 10 days
56. Maculopapular Rash
Measles GM R infant E infect Scarlet
AE RNA virus
transm Droplets, contact with
articles
IP 1-2 wk (10d)
Prodrom +ve fever, conj, cough,
cc, LN
enanthm Koplik’s before rash
exanthm With fever
CPT RESP/
CNS/SKIN/ITP/GIT/A
NERGY
TT NON SPECIFIC
isolation
PROPH VACCINE 6MO
Ig G
57. Fever
Catarrhal stage
Fever
Red eyes: (bloody shot eyes)
Conjunctivitis
photophobia
Sneezing , running nose
Sore throat
Cough
General malaise
Body aches
Koplik’s spots
58. Fever
(3-5 days after the onset of catarrhal stage)
Enanthem stage :
1-Small red spots on the
soft palate .
2- Small red spots on the
hard plate .
3- Koplik’s spots on the
buccal mucosa .
59. Fever
(3-5 days after the onset of catarrhal stage)
KOPLIK’S SPOTS
on buccal mucosa .
{tiny white spots inside the
mouth }
60. When is my child infectious?
From 4 days (2 to 5
days) before the rash
appears
until about 4 days
after the rash has started
— which is often when it
starts to disappear
61. RASH
( on the 5th day of the illness )
Exanthem stage :
Fever
Rash :
Type : Maculopapular
rash
Site: general mainly
at the hair line of
face
forehead
back of the neck
behind the ears
62. Rash
appears around the fifth
day of the disease
may last 4 to 7 days
usually starts on the head
and spreads to other
areas,
maculopapular rash
appears as both macules
(flat, discolored areas)
and papules (solid, red,
elevated areas) that later
merge together
(confluent)
63. ( on the 5th day of the illness )
RASH
shape
Blotchy
Irregular
Large red patches
Varying size and shape
Characteristically
coalesces (geographic
pattern}
With mild itching
79. How to manage Measles
PROPHYLAXIS:
During routine immunization:
Measles vaccine alone.
Or combined with German measles and mumps vaccine
(MMR) in the second year.
TREATMENT: SPECIFIC + NON SPECIFIC
No available antiviral drugs are effective against measles.
Symptomatic treatment
Antimicrobials for complications as otitis media and
pneumonia.
84. Maculopapular Rash
Measles GM R infant E infect Scarlet
AE RNA virus
transm Droplet
Intrauterine
IP 2-3 w
Prodrom No/mild cc + LN
enanthm Mild
exanthm Mild
CPT Cong
infection/ITP/arthritis/CNS
TT NON SPECIFIC
PROPH Vaccine/ IgG
85. GERMAN MEASLES
Mild short catarrhal stage
The rash starts around
the hairline and affects
the face and neck first. It
will then spread to the
body and the arms and
legs.
the rash a fine
appearance
IP: 2-3 weeks
87. Congenital Rubella Syndrome:
It represents a type
of congenital viral
infection. The
rubella virus can
cross the placenta
and infect the fetus
resulting in either
death or severe
malformations.
88. CONGENITAL RUBELLA
MR, microcephaly,
hydrocephalus, CP
Cataract,
microphthalmia
SNHL
CCD: PDA, ASD
JODM
CHRONIC
RUBELLA: up to a
year
91. When is my child infectious?
A person with rubella will be infectious from
one week before the rash starts until 4 days after
the rash has started. However, newborn children
who are infected may be infectious for a few
months
92. What to do in a case of Measles & German Measles
Active vaccination either alone or in combination
with measles and mumps (MMR) after the first
year of age, pregnant women should NEVER
receive the vaccine.
Pregnant mothers should avoid exposure to
rubella.
No specific treatment.
Symptomatic treatment and antibiotics for
superadded bacterial infections.
93. Management of Pregnant Women Exposed to
Rubella:
Do an antibody test immediately as an emergency
measure:
If found to be immune, she is reassured and
pregnancy continued.
If found to be susceptible then serial, antibody tests
are done, if it shows subclinical infection abortion is
induced.
If abortion is not accepted, immune serum globulin
(ISO) is indicated.
94.
95. INFECTIOUS MONONUCLEOSIS (glandular
fever)
occurs in
adolescents and
young adult.
Caused by Epstein-
Barr virus (EBV).
The onset is usually
insidious and
occurs after an
incubation period
of 4 to 14 days.
101. What is your Diagnosis?
A 5-year-old boy presents to
clinic with an afebrile rash
involving his extremities and
trunk for three days . Past
history revealed the boy had
mild fever that resolved
without sequelae one week
prior. His rash began three
days prior with flushed
cheeks and then spread
103. Maculopapular Rash
Measles GM R infant E infectiosum Scarlet
AE Parvovirus B 19, DNA
transm DROPLET
IP 1-2 WK
Prodrom RASH WITHOUT FEVER
Recur with hot showers, exercise, sun
enanthm WBC normal
Low reticulocyte
exanthm SLAPPED CHEEKS, general MP rash
of lacy like , itchy
CPT 1- aplastic crises
2- ITP
3- arthralgia, arthritis
TT Asymptomatic
IV IgG in aplasia
PROPH
104. Fifth disease ('slapped cheek')
Erythema Infectiosum
Parvovirus B19 (DNA)*
A contagious and usually
mild illness that passes in
a couple weeks,
Spread by coughing and
sneezing, it's most
contagious the week
before the rash appears
105. starts with flu-like
symptoms,
followed by afebrile ,
asymptomatic rash:
1st stage: a face “
slapped cheeks”
with circum-oral pallor
106.
107. 2nd stage: body rash.,
reticulated lacy
erythematous
eruption on the
proximal extremities,
buttocks and trunk
108. The third phase lasts one
to three weeks and
consists of the reticulated
lacy lesions intermittently
recurring especially when
provoked by warm
temperature, sunlight,
emotion or exercise
109. Treatment
rest, fluids, and pain
relievers (do not use
aspirin if your child has
fever), but watch for
signs of more serious
illness
112. Maculopapular Rash
Measles GM R infant E infect Scarlet
AE Human herpesviruses 6,7
transm droplet
IP 1-2 w (10 days)
Prodrom High fever up to FC
enanthm Wbc increased then decreased
exanthm Generalized MP
No post stain
LN
CPT 1- FC
2- Encephalopathy
TT Asymptomatic
Gancyclovir : immune deficiency,
encephalopathy
PROPH
113. 6 th
Human Herpes Viruses 6*
IP: 10 day
Age
Most cases present within
the first 2 years of life, with
peak occurrence in infants
aged 9-21 months.
114. F Seizures (6-15%)
CP Diarrhea (68%)
Cough (50%)
Fever (often up to 40°C) 3days before
rash
Rash (fades within a few hours to 2 d)
Maculopapular or erythematous
Typically beginning on the trunk and
may spread to involve the neck and
extremities
Nonpruritic
Blanches on pressure
Listlessness , Irritability
115.
116. CPT
Extremely rare manifestations
Encephalitis,
fulminant hepatitis,
hemophagocytic syndrome, and
disseminated infection with HHV-6
117. What is the lesion?
A child with fever, throat pain, halitosis and
generalized erythema. Oral exam showed red
tongue and tonsils
119. Maculopapular Rash
Measles G M E infect R infant Scarlet
AE virus Erythrogenic toxin of : GABHS
transm droplet DROPLET
IP 1 – 2 wk 2-3 wk 1 -2 wk 1-7 days ( 3 days)
Prodrom severe mild Fever; chivering, headache
Tonsillitis : throat pain, fetor oris
Abd pain, V, D
Rash Rainbow
enanthm Koplick,s no
Without After
RED TONSILS WITH MEMBRANE
RED PHARYNX WITH MEMBRANE
fever storm
TONGUE: white then red strawberries
exanthm severe Mild –
moderate
Generaslized erythema fade on p
Goose skin
Pastia line
Circumoral pallor
End with peeling towards fingers
CPT All congenital
infection
---- FC Local IMMEDIATE
Remote DELAYED AGN. RH FEVER
TT AB FOR 10 DAYS
SYMPTOMATIC
PROPH LEUCOCYTOSIS, +ve culture
ASOT, Ag detection
120.
121.
122.
123. G Erythema
Better felt
Sandpaper like
Fade on pressure
144. Treatment
1- specific: AB for 10 days
2- non specific
3- treatment of complications
Complications:
ACUTE LATE
1-Local 1- A Rheumatic F
2-Systemic 2- ADGN
145.
146. Maculo - Papular Rash
Measles GM E infect R infant Scarlet
AE virus Erythrogenic toxin of : GABHS
transm droplet
IP 1 – 2 wk 2-3 wk 1 -2 wk 1-7 days ( 3 days)
Prodrom severe mild Fever
enanthm Koplick,s no
Rash Rainbow
RED TONSILS WITH strawberry tongue
Without After
fever storm
exanthm severe Mild –
moderate
Generaslized erythema fade on p
Better felt than seen
CPT All congenital
infection
---- FC Local IMMEDIATE
Remote DELAYED AGN. RH FEVER
TT Symptomatic AB FOR 10 DAYS
SYMPTOMATIC
147. Sweat rash
The result of blocked
sweat ducts, heat rash
looks like small red or
pink pimples. Appearing
over an infant's head,
neck, and shoulders
154. MUMPS (EPIDEMIC PAROTITIS)
Viral infection
Incubation period 14-
24 days
Moderate rise of
temperature but
hyperpyrexia may be
encountered. One or
both parotids may
enlarge. The swelling
usually subsides in 7-10
days
155. raising the lobule of ear and extending anterior
to it.
The swelling is tender and the pain increases by
sour drinks
161. What to do in a case of Mumps
Treatment
Symptomatic and supportive.
Analgesics to relieve pain.
The mouth should be kept clean and a fluid
diet is needed until swelling subsides. .
VZ virus: 1- Chicken pox in non immune person, 2- H zoster in partiall
2 types of enterovirus A species, coxsackievirus (CV) A16 (CVA16) or enterovirus 71
Less serious in children but serious in adults especially pregnant ladies
Aplastic crisis in ch H Anemia. Papular purpuric “gloves-and-socks” syndrome (PPGSS) is also caused by parvovirus B19 in many cases and commonly presents in teenagers. The illness lasts seven to 14 days and may include fever, arthralgias and rash. Patients with PPGSS are considered infectious at the time of the eruption, which presents as acral painful or pruritic palpable purpura with sharp demarcation at the ankles and wrists. Patients may also have painful swelling of digits. Associated mucosal changes include oral petechiae and erosions, pharyngeal erythema and edematous lips.