2. 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
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4. 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
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8. 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
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9. 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
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14. Paramyxovirus.
IP—8 to 12 days.
Period of communicability.
4—Rash—5.
Rash starts from face &
behind ears.
KOPLIKS SPOTS.
Diagnosis mostly clinical
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17. - 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.
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18. 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.
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19. 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.
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20. 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.
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22. 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%)
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24. 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
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25. 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.
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26. 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
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28. 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
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30. Herpes virus varicellae
IP- 10 to 21 days
Papulesvesicles 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
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32. 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
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33. 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
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34. ◦ 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
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35. 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
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36. 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
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38. 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
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40. 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
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41. 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.
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48. 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
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49. 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.
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50. 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.
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51. 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
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54. 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
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55. 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.
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56. Acute, self limited illness,oral
transmission
Epstein-Barr virus.
IP-30 to 50 days.
Clinical features
Atypical lymphocytosis.
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58. Major jones criteria.
Trunk, upper arms,legs
never on face
Maculopapular, raised edges
central clearing,circular shape
Not itchy/painful.
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59. 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
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63. Superficial infection
of the dermis
Two types:
◦ Impetigo contagiosa
◦ Bullous impetigo
Etiology
◦ Group A ß hemolytic streptococcus
◦ Coagulase positive S. aureus
Treatment : Erythromycin.
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68. Most common rickettsial infection in US
Abrupt fever, headache, and myalgia
Rash from extremities towards trunk
Maculespetechiae
Treatment
◦ Tetracycline
◦ Doxycycline
◦ Chloramphenicol
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70. Enteroviruses
◦ coxsackieviruses A and B
◦ echoviruses
Vesicular lesions, may be petechial
Associated with aseptic meningitis,
myocarditis
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