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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