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DR HUSSEIN ABDELDAYEMDR HUSSEIN ABDELDAYEM
PROF OF PEDIATRIC NEUROLOGY. PROF OF PEDIATRIC NEUROLOGY.
Alex UniversityAlex University
EgyptEgypt
TREATMENTOF ANY FEBRILE TREATMENTOF ANY FEBRILE CHILDCHILD
NON SPECIFIC TREATMENTNON SPECIFIC TREATMENT
SPECIFIC TREATMENT: antiviral or SPECIFIC TREATMENT: antiviral or antibacterial drugs antibacterial drugs
PREVENTION AND COMPLICATION PREVENTION AND COMPLICATION TREATMENTTREATMENT
as vaccine or Immunoglobinas vaccine or Immunoglobin
1- NON SPECIFIC1- NON SPECIFIC General measuresGeneral measures
Bed rest.Bed rest. Diet: Diet:
Symptomatic treatment:Symptomatic treatment: For fever: Sponging with tap water and antipyretics For fever: Sponging with tap water and antipyretics
but avoid over dosage and prolonged use.but avoid over dosage and prolonged use. For constipation, headacheFor constipation, headache
Supportive measures:Supportive measures: Fluids for dehydrated patientsFluids for dehydrated patients
RASHESRASHES
Rashes can be classified as:Rashes can be classified as: Macular, maculopapular eruptionsMacular, maculopapular eruptions Papulo-vesicular or bullous Papulo-vesicular or bullous
eruptionseruptions Petechial or hemorrhagic Petechial or hemorrhagic
eruptions.eruptions. Ulcerative eruptionsUlcerative eruptions Nodular eruptions.Nodular eruptions.
INFECTIOUSE DISEASES INFECTIOUSE DISEASES CAUSING MACULOPAPULAR CAUSING MACULOPAPULAR
RASHRASH MEASLES MEASLES GERMAN MEASLESGERMAN MEASLES SCARLET FEVERSCARLET FEVER ROSEOLA INFANTUMROSEOLA INFANTUM ERYTHEMA ERYTHEMA
INFECTIOSUMINFECTIOSUM EBV(INFECTIOUSE EBV(INFECTIOUSE
MONONUCLEOSIS)MONONUCLEOSIS) OTHERS ENTEROVIRUS OTHERS ENTEROVIRUS
or COXASACKIE VIRUD or COXASACKIE VIRUD INFECTIONS WITH RASHINFECTIONS WITH RASH
Vesiculo-papular Vesiculo-papular UrticariaUrticaria
Post-Allergen as Post-Allergen as insect biteinsect bite
Very itchyVery itchy papules→vesicles→expapules→vesicles→ex
co-riation and 2ry co-riation and 2ry infectioninfection
No scalpNo scalp No mmNo mm Over the extensor Over the extensor
surfaces, palms, soles surfaces, palms, soles
C/PC/P
DescribeDescribe distribution: maximum, other areasdistribution: maximum, other areas Itchy Itchy MMMM
Iry lesionsIry 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)
Vesicle: collection of clear fluid (<5mm in diameter)
Bulla: like vesicle, but > 5 mm
Pustule: Collection of Pus
Patches : large lesion due to gathering of macules
Plaque: flat topped palpable lesion (gathering of papules)
NonNon blanchingblanchingHgic rashHgic rash Petechiae are Petechiae are
less than 2 mm less than 2 mm in diameter in diameter
Purpuric lesions Purpuric lesions vary from 2 mm vary from 2 mm to 1 cmto 1 cm
Ecchymoses are Ecchymoses are larger than 1 larger than 1 cm.cm.
Wheal: Transient, slightly raised lesion with pale center and pink margin. Seen in urticaria.
Telangectasia: Dilated capillaries visible on skin surface
Maculo-papular DDMaculo-papular DD
What is the lesionWhat is the lesion
A child with rash (red macules, red A child with rash (red macules, red papules, vesicles) over the trunk and papules, vesicles) over the trunk and few over the face and scalp. History few over the face and scalp. History of sneezing and cough one day beforeof sneezing and cough one day before
Vesiculopapular RashVesiculopapular Rash
Chicken pox (varicella)Chicken pox (varicella) Herpes zosterHerpes zoster Herpes simplexHerpes simplex Hand-foot-mouth syndromeHand-foot-mouth syndrome ImpetigoImpetigo ScabiesScabies urticariaurticaria
Varicella (Chickenpox) Varicella (Chickenpox)
V-Z VirusV-Z Virus Transmission: Transmission:
1- skin contact1- skin contact
2- droplets2- droplets
3- air born 3- air born transmissiontransmission
Contagiousness :Contagiousness :
1-2 d before rash1-2 d before rash
till all lesions are till all lesions are crustedcrusted
All agesMost 2-8 ys
Clinical Manifestations of Chicken PoxClinical Manifestations of Chicken Pox
Incubation period 11-21 days.Incubation period 11-21 days. Catarrhal stage: mild fever and Catarrhal stage: mild fever and
malaise precede the typical rash by 24 malaise precede the typical rash by 24 hours. hours.
The rash starts by small red papules The rash starts by small red papules that pass into vesicles on an that pass into vesicles on an erythematous base. erythematous base.
It starts on the trunk and spreads to It starts on the trunk and spreads to the face, scalp and extremities. the face, scalp and extremities. Pruritis is usually present. Vesicles Pruritis is usually present. Vesicles produce a crust that falls with no scar. produce a crust that falls with no scar.
infective
infective
NON infective
Varicella CP Varicella CP
1- Prodroma: mild1- Prodroma: mild 2- rash:2- rash:
skin: pleomorphic, skin: pleomorphic, centripetalcentripetal
itchyitchy
tear droptear drop
vesicles, scabsvesicles, scabs
mm: conj, oral, vaginamm: conj, oral, vagina
ChickenChicken PoxPox Pleomorphic:Pleomorphic:
macules macules
papulespapules
tear drop vesiclestear drop vesicles
scabs (crusts)scabs (crusts)
pleomorphic
ChickenChicken PoxPoxpleomorphic
centripetal
Start at trunkThen face and scalp
Start at trunkThen face and scalp
centripetal
Mucus MembraneMucus Membrane
It is a droplet infection and infectivity occurs 24 It is a droplet infection and infectivity occurs 24 hours before, and up to scaling of all rash hours before, and up to scaling of all rash ( usually 7 days after the appearance of the ( usually 7 days after the appearance of the characteristic rash) . Dry scales are non-infective.characteristic rash) . Dry scales are non-infective.
VARICELLA /ZOSTER VARICELLA /ZOSTER INFECTIONSINFECTIONS
NEONATAL VARICELLANEONATAL VARICELLA
Complications Complications Skin: 2ry bacterial infectionSkin: 2ry bacterial infection Blood complications: ITP, internal hge, purpura Blood complications: ITP, internal hge, purpura
fulminansfulminans CNS: encephalitis, cerebellitis, transverse CNS: encephalitis, cerebellitis, transverse
myelitis, GBS, cranial ns palsy as optic neuritis myelitis, GBS, cranial ns palsy as optic neuritis or bell’sor bell’s
Respiratory: laryngitis, virus pnRespiratory: laryngitis, virus pn Liver: Reye, hepatitisLiver: Reye, hepatitis Heart: all 3Heart: all 3 Renal: GNRenal: GN Extremities: arthritis , myositisExtremities: arthritis , myositis Eyes : keratitisEyes : keratitis
Hgic varicella
TT of Varicella TT of Varicella (Chickenpox) (Chickenpox)
1- non specific1- non specific 2- specific: acyclovir2- specific: acyclovir 3- complications treatment: AB, IV 3- complications treatment: AB, IV
acycloviracyclovir
prophylaxis: active ( LA vaccine) prophylaxis: active ( LA vaccine) > >
1y age SC once1y age SC once
passive (VZIG) passive (VZIG) within 6 within 6 days of exposuredays of exposure
REYE SYNDROME
Herpes zosterHerpes zoster
Same virus VZ in Same virus VZ in immune personsimmune persons
Very painful Very painful vesiclesvesicles
Along dermatome Along dermatome of peripheral of peripheral nervesnerves
Unilateral Unilateral unimorphicunimorphic
Herpes simplex infectionsHerpes simplex infections
See stomatitis DD
4-year-old boy presented with a 5-day 4-year-old boy presented with a 5-day history of mild fever and malaise and a 3-history of mild fever and malaise and a 3-day history of a vesicular rash involving day history of a vesicular rash involving his hands , feet, tongue , and buttocks.his hands , feet, tongue , and buttocks.
WHAT IS THE LESION
. This clinical picture is highly . This clinical picture is highly characteristic of hand, foot, and characteristic of hand, foot, and mouth disease, mouth disease,
Typical skin lesions are elliptical Typical skin lesions are elliptical vesicles surrounded by an vesicles surrounded by an erythematous halo. erythematous halo.
..
Hand – Foot – Mouth Hand – Foot – Mouth SyndromeSyndrome
Coxsackie virus A16 Coxsackie virus A16 or enterovirus 71or enterovirus 71
contagious childhood contagious childhood illness starts with a illness starts with a fever, then painful fever, then painful mouth sores and a mouth sores and a non-itchy rash with non-itchy rash with blisters on hands, blisters on hands, feet, and sometimes feet, and sometimes buttocks and legs buttocks and legs followfollow
TREATMENT OF HFMSTREATMENT OF HFMS
The patient was The patient was treated treated supportively at supportively at home without home without medication. At medication. At follow-up 1 week follow-up 1 week later, his systemic later, his systemic symptoms had symptoms had improved and the improved and the skin lesions were skin lesions were resolvingresolving
Impetigo Impetigo
Staph or Staph or streptococcusstreptococcus
No constitutional No constitutional signssigns
Starting peri-oral Starting peri-oral or nasolabiol folds or nasolabiol folds
No mmNo mm
Impetigo Impetigo red sores or blisters red sores or blisters
that can break open, that can break open, ooze, and develop a ooze, and develop a yellow-brown crust. yellow-brown crust.
Impetigo can be Impetigo can be spread to others spread to others through close contact through close contact or by sharing items or by sharing items like towels and toys. like towels and toys. Scratching can also Scratching can also spread it to other spread it to other parts of the body parts of the body
TT: 1- AB local (ointment) TT: 1- AB local (ointment) 2- oral AB ( 10 days for streptococcus)2- oral AB ( 10 days for streptococcus)
Vesiculo-papular Vesiculo-papular UrticariaUrticaria
Post-Allergen as Post-Allergen as insect biteinsect bite
Very itchyVery itchy papules→vesicles→expapules→vesicles→ex
co-riation and 2ry co-riation and 2ry infectioninfection
No scalpNo scalp No mmNo mm Over the extensor Over the extensor
surfaces, palms, soles surfaces, palms, soles
Scabies Scabies
Itchy more at nightItchy more at night Mostly covered Mostly covered
areas and areas and interdigitalinterdigital
Pleomorphic + Pleomorphic + burrowsburrows
Positive history of Positive history of contactscontacts
Maculo-papular DDMaculo-papular DD
MeaslesMeasles GMGM R infantumR infantum E infectiosumE infectiosum I MonoI Mono Scarlet feverScarlet fever collagen disease collagen disease drug rashdrug rash
MEASLESMEASLESRubeolaRubeola
What causes the What causes the disease?disease?
Measles is caused Measles is caused by a virus called by a virus called MorbillivirusMorbillivirus, a , a paramyxovirusparamyxovirus
IP: 10 daysIP: 10 days
RNA virus
MaculopapularMaculopapular RashRashMeasles G M 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/ANERGY
TT NON SPECIFICisolation
PROPH VACCINE 6MOIg G
FeverFever CatarrhalCatarrhal stagestage
Fever Fever Red eyes: (bloody shot Red eyes: (bloody shot
eyes) Conjunctivitiseyes) Conjunctivitis photophobiaphotophobia Sneezing , running noseSneezing , running nose Sore throatSore throat Cough Cough General malaiseGeneral malaise Body aches Body aches Koplik’s spotsKoplik’s spots
FeverFever (3-5 days after the onset of (3-5 days after the onset of
catarrhal stage)catarrhal stage) Enanthem stage : Enanthem stage :
1-Small red spots on 1-Small red spots on the soft palate .the soft palate .
2- Small red spots 2- Small red spots on the hard on the hard plate .plate .
3- Koplik’s spots on 3- Koplik’s spots on the buccal the buccal mucosa .mucosa .
FeverFever (3-5 days after the onset of (3-5 days after the onset of
catarrhal stage)catarrhal stage) KOPLIK’S KOPLIK’S
SPOTS on SPOTS on buccal mucosa .buccal mucosa .
{tiny white spots {tiny white spots inside the inside the mouth } mouth }
When is my child When is my child infectious?infectious?
From From 4 days 4 days (2 (2 to 5 days) before to 5 days) before the rash appearsthe rash appears
until about until about 4 4 days days after the after the rash has started — rash has started — which is often when which is often when it starts to it starts to disappeardisappear
RASHRASH( on the 5th day of the illness )( on the 5th day of the illness )
Exanthem stage :Exanthem stage : Fever Fever Rash :Rash :
Type : Type :
Maculopapular Maculopapular rashrash
Site: general Site: general mainly at the mainly at the hair line of face hair line of face
foreheadforehead back of the neckback of the neck behind the earsbehind the ears
RashRash appears around the appears around the
fifth day of the disease fifth day of the disease may last 4 to 7 days may last 4 to 7 days usually starts on the usually starts on the
head and spreads to head and spreads to other areas,other areas,
maculopapular rash maculopapular rash appears as both appears as both macules (flat, (flat, discolored areas) and discolored areas) and papules (solid, red, papules (solid, red, elevated areas) that elevated areas) that later merge together later merge together (confluent) (confluent)
( on the 5th day of ( on the 5th day of the illness )the illness )
RASHRASH
shapeshape BlotchyBlotchy IrregularIrregular Large red patchesLarge red patches Varying size and Varying size and
shape shape Characteristically Characteristically
coalesces coalesces (geographic (geographic pattern}pattern}
With mild itchingWith mild itching
End byEnd by
Desquamation : (Branny)Desquamation : (Branny)
MeaslesI Day Before the Rash
Measles Rash : Face
Measles Rash On Dark Skin
MEASLESMEASLES
End byEnd by
Desquamation : (Branny)Desquamation : (Branny)
How to manage MeaslesHow to manage Measles
PROPHYLAXIS:PROPHYLAXIS:
During routine immunization: During routine immunization: Measles vaccine alone.Measles vaccine alone. Or combined with German measles and mumps Or combined with German measles and mumps
vaccine (MMR) in the second year.vaccine (MMR) in the second year.TREATMENT: SPECIFIC + NON TREATMENT: SPECIFIC + NON SPECIFICSPECIFIC
No available antiviral drugs are effective against No available antiviral drugs are effective against measles.measles.
Symptomatic treatment Symptomatic treatment Antimicrobials for complications as otitis media Antimicrobials for complications as otitis media
and pneumonia.and pneumonia.
ComplicationsComplications
1- Respiratory 1- Respiratory complications :complications :
Otitis mediaOtitis media Measles Measles
pneumoniapneumonia Secondary Secondary
bacterial bacterial broncho broncho pneumoniapneumonia
2- Activation of 2- Activation of latent pulmonary latent pulmonary T.BT.B
3- Neurological 3- Neurological complications :complications : EncephalomyelitisEncephalomyelitis Aseptic meningitisAseptic meningitis Subacute sclerosing Subacute sclerosing
panencephalitispanencephalitis
4- skin and MM4- skin and MM
- Hemorrhagic rash - Hemorrhagic rash
- Bleeding from - Bleeding from mucus membranesmucus membranes
5- Digestive tract :5- Digestive tract : DiarrheaDiarrhea VomitingVomiting DehyrationDehyration AcidosisAcidosis Cancrum orisCancrum oris Ulcerative stomatitisUlcerative stomatitis
6- Impaired 6- Impaired immunity .immunity .
the rubella virus which is a togavirus. IP: 2-3 weeks
GERMAN MEASLESGERMAN MEASLES
Maculopapular RashMaculopapular RashMeasles G M R infant E infect Scarlet
AE RNA virus
transm DropletIntrauterine
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
IP: 2-3 weeks
GERMAN MEASLESGERMAN MEASLES Mild short catarrhal Mild short catarrhal
stagestage The rash starts The rash starts
around the hairline around the hairline and affects the face and affects the face and neck first. It will and neck first. It will then spread to the then spread to the body and the arms body and the arms and legs. and legs.
the rash a fine the rash a fine appearance appearance
Rash + Enlarged lymph Rash + Enlarged lymph nodesnodes
Congenital Rubella Syndrome:Congenital Rubella Syndrome: It represents a It represents a
type of type of congenital viral congenital viral infection. The infection. The rubella virus can rubella virus can cross the cross the placenta and placenta and infect the fetus infect the fetus resulting in resulting in either death or either death or severe severe malformations.malformations.
CONGENITAL RUBELLACONGENITAL RUBELLA MR, MR,
microcephaly, microcephaly, hydrocephalus, hydrocephalus, CPCP
Cataract, Cataract, microphthalmiamicrophthalmia
SNHLSNHL CCD: PDA, ASDCCD: PDA, ASD JODMJODM CHRONIC CHRONIC
RUBELLA: up to RUBELLA: up to a yeara year
Congenital rubella Congenital rubella syndromesyndrome
When is my child infectious?When is my child infectious?
A person with rubella will be A person with rubella will be infectious from one week before the infectious from one week before the rash starts until 4 days after the rash starts until 4 days after the rash has started. However, newborn rash has started. However, newborn children who are infected may be children who are infected may be infectious for a few monthsinfectious for a few months
What to do in a case of Measles & German What to do in a case of Measles & German MeaslesMeasles
Active vaccination either alone or in Active vaccination either alone or in combination with measles and mumps combination with measles and mumps (MMR) after the first year of age, (MMR) after the first year of age, pregnant women should NEVER receive pregnant women should NEVER receive the vaccine.the vaccine.Pregnant mothers should avoid Pregnant mothers should avoid exposure to rubella.exposure to rubella.No specific treatment.No specific treatment.Symptomatic treatment and antibiotics Symptomatic treatment and antibiotics for superadded bacterial infections.for superadded bacterial infections.
Management of Pregnant Women Management of Pregnant Women Exposed to Rubella:Exposed to Rubella:Do an antibody test immediately as an Do an antibody test immediately as an emergency measure:emergency measure:
If found to be immune, she is reassured If found to be immune, she is reassured and pregnancy continued.and pregnancy continued.
If found to be susceptible then serial, If found to be susceptible then serial, antibody tests are done, if it shows antibody tests are done, if it shows subclinical infection abortion is induced.subclinical infection abortion is induced.
If abortion is not accepted, immune If abortion is not accepted, immune serum globulin (ISO) is indicated.serum globulin (ISO) is indicated.
INFECTIOUS MONONUCLEOSIS INFECTIOUS MONONUCLEOSIS (glandular fever)(glandular fever)
occurs in occurs in adolescents and adolescents and young adult. young adult. Caused by Caused by Epstein-Barr Epstein-Barr virus (EBV). virus (EBV). The onset is The onset is usually usually insidious and insidious and occurs after an occurs after an incubation incubation period of 4 to period of 4 to 14 days.14 days.
Diagnosis of Infectious Diagnosis of Infectious MononucleosisMononucleosis
Diagnosis of Infectious Mononucleosis Diagnosis of Infectious Mononucleosis (cont.)(cont.)
4- SCARLET FEVER4- SCARLET FEVER
bacterial toxin of GABHSbacterial toxin of GABHS
See later
55th diseaseth disease
What is your Diagnosis?What is your Diagnosis? A 5-year-old boy presents A 5-year-old boy presents
to clinic with an afebrile to clinic with an afebrile rash involving his rash involving his extremities and trunk for extremities and trunk for three days . Past history three days . Past history revealed the boy had mild revealed the boy had mild fever that resolved fever that resolved without sequelae one without sequelae one week prior. His rash week prior. His rash began three days prior began three days prior with flushed cheeks and with flushed cheeks and then spread then spread
ERYTHEMA INFECTIOSUMERYTHEMA INFECTIOSUM (('slapped'slapped cheekcheek')')
RASH WITHOUT FEVERRASH WITHOUT FEVER
Maculopapular RashMaculopapular RashMeasles G M 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
FifthFifth diseasedisease ( ('slapped'slapped cheekcheek')')ErythemaErythema InfectiosumInfectiosum
Parvovirus B19 (DNA)*Parvovirus B19 (DNA)*
A contagious and A contagious and usually mild illness usually mild illness that passes in a couple that passes in a couple weeks,weeks,
Spread by coughing Spread by coughing and sneezing, it's most and sneezing, it's most contagious the week contagious the week before the rash before the rash appearsappears
starts with flu-like starts with flu-like symptoms,symptoms,
followed by afebrile followed by afebrile , asymptomatic , asymptomatic rash:rash:
11stst stage: a face stage: a face
“ “ slapped slapped cheeks”cheeks” with with circum-oral pallor circum-oral pallor
22ndnd stage: body rash., stage: body rash., reticulated lacy reticulated lacy erythematous erythematous eruptioneruption on the on the proximal extremities, proximal extremities, buttocks and trunk buttocks and trunk
The third phase The third phase lasts one to three lasts one to three weeks and consists weeks and consists of the reticulated of the reticulated lacy lesions lacy lesions intermittently intermittently recurringrecurring especially especially when provoked by when provoked by warm temperature, warm temperature, sunlight, emotion or sunlight, emotion or exerciseexercise
TreatmentTreatment
rest, fluids, and rest, fluids, and pain relievers (do pain relievers (do not use aspirin if not use aspirin if your child has your child has fever), but watch fever), but watch for signs of more for signs of more serious illnessserious illness
66th Diseaseth Disease
ROSEOLA INFANTUMROSEOLA INFANTUM
Rainbow after StormRainbow after Storm
6th
Maculopapular RashMaculopapular RashMeasles G M 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- FC2- Encephalopathy
TT AsymptomaticGancyclovir : immune deficiency, encephalopathy
PROPH
66thth
Human Herpes Human Herpes Viruses 6*Viruses 6*
IP: 10 dayIP: 10 day AgeAge
Most cases present Most cases present within the first 2 within the first 2 years of life, with years of life, with peak occurrence in peak occurrence in infants aged 9-21 infants aged 9-21 months.months.
CPCP Fever (often up to 40°C) 3days Fever (often up to 40°C) 3days
before rashbefore rash
Rash (fades within a few hours Rash (fades within a few hours to 2 d) to 2 d)
Maculopapular or Maculopapular or erythematous erythematous
Typically beginning on the Typically beginning on the trunk and may spread to involve trunk and may spread to involve the neck and extremities the neck and extremities
Nonpruritic Nonpruritic Blanches on pressureBlanches on pressure Listlessness , IrritabilityListlessness , Irritability
F Seizures (6-15%) F Seizures (6-15%) Diarrhea (68%) Diarrhea (68%) Cough (50%)Cough (50%)
CPT CPT
Extremely rare manifestationsExtremely rare manifestations Encephalitis, Encephalitis, fulminant hepatitis, fulminant hepatitis, hemophagocytic syndrome, and hemophagocytic syndrome, and disseminated infection with HHV-6disseminated infection with HHV-6
What is the lesion?What is the lesion?
A child with fever, throat pain, A child with fever, throat pain, halitosis and generalized erythema. halitosis and generalized erythema. Oral exam showed red tongue and Oral exam showed red tongue and tonsilstonsils
SCARLET FEVERSCARLET FEVER
By : Bacteria toxinBy : Bacteria toxin Fever + tonsillitis + rashFever + tonsillitis + rash
Maculopapular RashMaculopapular RashMeasles 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
Rash
Without
fever
Rainbow
After
storm
Fever; chivering, headache
Tonsillitis : throat pain, fetor oris
Abd pain, V, D
enanthm Koplick,s no RED TONSILS WITH MEMBRANE
RED PHARYNX WITH MEMBRANE
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
G ErythemaG Erythema
Better feltBetter felt Sandpaper likeSandpaper like Fade on pressureFade on pressure
Generalized Erythema
Better felt than seen
Pastia lines
Scarlet FeverScarlet Fever
Finely nodular erythematous rash with
sandpaper or goose-flesh texture
End by End by
Desquamation Desquamation peelingpeeling
Treatment Treatment 1- specific: AB for 10 days1- specific: AB for 10 days 2- non specific2- non specific 3- treatment of complications3- treatment of complications
Complications:Complications: ACUTE ACUTE LATE LATE 1-Local 1-Local 1- A 1- A
Rheumatic FRheumatic F 2-Systemic2-Systemic 2- ADGN2- ADGN
Maculo - Papular RashMaculo - Papular RashMeasles G M 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
Rash
Without
fever
Rainbow
After
storm
Fever
enanthm Koplick,s no RED TONSILS WITH strawberry tongue
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
SweatSweat rashrash
The result of The result of blocked sweat blocked sweat ducts, heat rash ducts, heat rash looks like small red looks like small red or pink pimples. or pink pimples. Appearing over an Appearing over an infant's head, infant's head, neck, and neck, and shoulders shoulders
INFECTIOUSINFECTIOUS MONONUCLEOSIS MONONUCLEOSIS
FeverFever Exudative tonsillitisExudative tonsillitis Generalized lymphadenopathyGeneralized lymphadenopathy Splenomegaly ± hepatomegalySplenomegaly ± hepatomegaly RashRash Other manifestationsOther manifestations
MUMPS (EPIDEMIC PAROTITIS)MUMPS (EPIDEMIC PAROTITIS) Viral infectionViral infection Incubation period Incubation period
14-24 days 14-24 days Moderate rise of Moderate rise of
temperature but temperature but hyperpyrexia may hyperpyrexia may be encountered. be encountered. One or both One or both parotids may parotids may enlarge. The enlarge. The swelling usually swelling usually subsides in 7-10 subsides in 7-10 daysdays
raising the lobule of ear and raising the lobule of ear and extending anterior to it. extending anterior to it. The swelling is tender and the pain The swelling is tender and the pain increases by sour drinksincreases by sour drinks
MumpsMumps
MUMPSMUMPS
What to do in a case of MumpsWhat to do in a case of Mumps
TreatmentTreatment Symptomatic and supportive. Symptomatic and supportive. Analgesics to relieve pain. Analgesics to relieve pain. The mouth should be kept clean The mouth should be kept clean
and a fluid diet is needed until and a fluid diet is needed until swelling subsides. .swelling subsides. .
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