Common childhood illnesses

Where does the chicken pox rash usually occur

Trunk and face

Which of the following is NOT recommended for chicken pox

Ibuprofen is not recommended for treating chickenpox because it has been associated with an increased risk of severe bacterial skin infections, such as necrotizing fasciitis. This condition can be life-threatening and may go undetected due to ibuprofen's anti-inflammatory properties

With a scarlet fever rash what does it feel like and what other parts of the body experience peeling skin ?

Like sandpaper, the skin can peel on the toes. Peels when the body is healing as toxins are released and that causes peeling

Which of the following is a bacterial infection

Scarlet fever is the only one.

A child has a temperature of 38.5 degrees and has had it for 3 days, with no other symptoms, Ibuprofen is working well to reduce the temperature, would you refer to GP?

No

Complications of measles

Ear infections that can lead to deafness

Encephalitis

Diarrhoea

Very high temperature

Management of scarlet fever

• Notifiable disease

• characteristic rash covering the body in children infected with Group A beta haemolytic streptococcus.

• morbidity and mortality has reduced with use of AB

• GABHS carried in nasal pharynx asymptomatically in 10 to 15 percent of children

• most commonly evolves from a tonsillar or pharyngeal focus

• secretes a toxin that in susceptible individuals results in rash of scarlet fever

• only 10 percent who have infection develop fever

• highly contagious

• transmission occurs via airborne respiratory particles dispersed by coughing, sneezing or direct contact

• incubation period of 2 to 4 days after fever (over 38 degrees), with S/S of exudative tonsillitis (sore throat, headache, abdominal pain, myalgia, malaise and vomiting)

• petechiae and red macules present on hard and soft palate with uvula

• on day one there is white strawberry tongue which develops into red raw tongue with papillae on day 4 or 5

• rash develops 24 to 48 hours after fever

• rash begins on neck and chest

  • disseminates to trunk and extremities’ ‘generalised erythema

  • progresses to look like sunburn with goose pimples

  • spots have sandpaper texture

Diagnosis is clinical but confirmation of GABHS can be done with throat swab - 90 % sensitivity.

Antistreptolysin O titres detect the presence of streptococcal antibodies; this test confirms recent but not active infection.

First-line treatment is a 10-day course of penicillin; there should be rapid resolution of symptoms within 24 hours. Erythromycin can be used if there is penicillin allergy.

Hand foot and mouth disease

• common, self-limiting, viral infection that causes blisters on the hands, feet, and inside or around the mouth.

• It mainly affects children under the age of 5 years.

• most common during warm weather, usually in the late summer or early autumn.

• usually caused by the Coxsackie virus

• Transmission occurs via direct contact with blister fluid or droplets spread from the mouth

• The illness usually begins with one or all of the following: fever, sore throat, loss of appetite, and lethargy.

• The incubation period is typically 3–6 days and children remain infectious until the blisters have ruptured and healed (usually 7–10 days).

• Skin findings typically include:

  • Blisters on the tops of the hands, feet and/or palms, and soles. Lesions

    usually:

    • Feel tender

    • Evolve over time from flat pink macules to small, elongated, red-greyish blisters

    • Are often oval rather than round

    • Peel off within a week, without leaving a scar.

• Small blisters (vesicles) and ulcers may develop

  in and/or around the lips and mouth and the back of the throat. These can sometimes be very painful. Oral intake may be significantly impacted, especially in infants and younger children.

• In children with eczema, or past eczema, blisters, flat red macules and papules may develop over other areas of the skin, especially the buttocks and sometimes on the arms, legs, and genital skin.

Atypical HFMD can result in a more widespread rash and blistering. Features may include:

• Red, crusted macules and papules without blistering

• Large blisters (bulla)

• Targetoid (bulls-eye, or target-shaped) lesions

• Nail shedding

• Involvement of atypical or unusual sites such as the ears.

What is the differential diagnosis for hand, foot, and mouth disease?

• Bacterial infections: such as Group A Streptococcus and Staphylococcus aureus, may cause similar blistering skin lesions, eg, bullous impetigo.

• Other viral infections such as human parechoviruses, herpes simplex virus, adenoviruses, varicella zoster virus, Epstein-Barr virus, and human herpesvirus 6 and 7.

• Bullous insect bite reactions may also present on the hands and feet in children.

• Pompholyx eczema.

General measures

Pain relief

• Simple analgesia such as paracetamol or ibuprofen as needed.

• Antiseptic mouthwashes or topical soothing agents (eg, lignocaine) can be used in children with painful oral/palatal ulcers.

• Aspirin should not be used routinely due to the risk of Reye syndrome.

Hydration

• Constantly offer the child sips of water/juice to prevent dehydration.

• If oral intake is poor, nasogastric or intravenous fluids may be indicated.

Blister care

• Leave blisters to dry naturally.

• Do not pierce/rupture the blisters to reduce contagion.

• Keep the blisters clean and apply non-adherent dressings to erosions.

How to prevent nappy rash

• caused as human waste develops into ammonia if left in damp environment

• causes irritation to the skin

• put barrier cream after nappy change if you notice redness and irritation

• use anti-fungal - clotrimazole 1 %

• prevention through giving nappy free time everyday e.g. one hour 2 to 3 times a day to allow the air to circulate

• avoid using baby wipes as they are quite perfumed

• use just water with cotton wools for initial stages

• can develop in fungal infection due to damp warm environment

• bacterial infection can develop if there has been excoriations in the skin allowing bacteria to enter

• recommend to change nappy before eating

• change nappy afterwards as well - dont let it just sit there

• ordinary nappy rash - red and improves after a couple days

• fungal nappy rash - bright red with spots, seek GP advice. May need anti-fungal cream

• bacterial nappy rash - bright, red, hot, swollen with fever. Seek urgent GP advice. May need AB treatment

Chicken pox

Rash can occur in 3 different stages

1. red spots on chest or face

2. spots spread elsewhere, produce blisters which are pus filled

3. spots scab over and produce a crust

Treatment

• take paracetamol for pain

• anti-inflammatory not recommended

• Calamine lotion good for soothing skin

• cooling gels are also effective

• keep hydrated

Caused by varicella zoster