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Notes Pedia Fever and Rash
Notes Pedia Fever and Rash
Disease Etiology Incidence/ Incubation Transmission Pathogenesis Clinical Manifestations Diagnosis Complications Management and Prognosis
Epidemiology period Prevention
Measles -SS enveloped -measles 8-12 days Portal of entry -causes necrosis of resp Incubation 8-12days -leukopenia, -M&M highest in <5yo -supportive Pneumonia and encephalitis-
RNA, vaccine through tract epithelium and lymphocytosis (exp <1yo) -immunocompromised- complications in most of deaths
paramyxoviridae, changed *patients respiratory tract lymphocytic infiltrate Prodromal -lowers serum retinol Ribavirin (not licensed
Morbiliivirus epidemiology infectious from or conjunctivae -Histology of rash- IC - mild fever, -Serologic concentrations yet) SSPE
-humans only -2 dose vaccine 3 days following contact edema and keratosis with conjunctivitis with confirmation- IgM -persistent infection with altered
host policy BEFORE up with large formation of syncytial photophobia, coryza, in serum Pneumonia- MOST Vitamin A measles virus
-2 impt proteins to 4-6 days droplets or small giant cells cough and inc fever - appears 1-2 days COMMON cause of -single dose -had measles at young age
1) Hemagglutinin AFTER onset droplet aerosols -fusion of infected cells – - Koplik’s spots- AFTER onset of DEATH >1yo – 200, 000 IU (<2yo) and deficient M or matrix
(H) Protein of the rash w/ virus WARTHIN FINKELDEY represent enanthem, rash, detectable -may manifest as 6mos-1yo- 100, 000 IU protein)
2) Fusion (F) GIANT CELLS- pathognomonic sign for 1 month giant cell pneumonia <6mos- 50, 000 IU -begins 7-13 years after infection
protein *shed measles Virus may remain pathognomonic of (appears 1-4 days prior (Strep pneum, Hib,
virus 7 days suspended in air measles to onset of rash) 4x rise in IgG after Staph aureus) *repeat the next day Initial
after exposure for 1 hour 2-4 weeks -croup, tracheitis, and if with evidence of -subtle behavioral changes
to 4-6 days 4 phases Exanthem bronchiolitis ophtha dse- 4 weeks 2nd
after onset of 1) Incubation (8-12) - Sxs increase in viral isolation from after -massive myoclonus, involuntary
rash - measles migrate to intensity until 1st day of blood, urine, resp Acute Otitis Media – movements
regional LN rash secretions most common MEASLES VACCINE 3rd
*immune - primary viremia- - Sxs subside with onset COMPLICATION -recommended 2 doses - involuntary movement
compromised- spreads virus to of rash (cephalocaudal) (12-15 mos and 4-6 yo) disappears
shed measles RES - Rash fades over 7 -suppressed PPD -if given <12 mos, give -choreo athetosis, immobility,
during - 2dary viremia- days, desquamation --diarrhea, vomiting, 2 doses again dystonia, lead pipe rigidity
DURATION of spreads to body - Cough lasts longest dehydration, febrile -dementia, stupor, coma
disease surfaces (up to 10 days) seizures AE: fever (after 6-12 4th
- CLADS/generalized days) -loss of centers that support
2) Prodromal lymphadenopathy may Measles Encephalitis Rash, transient breathing, BP, heart rate, death
- begins after 2nd be present -post infectious, thrombocytopenia
viremia immune mediated -don’t give to pregnant Diagnosis
- epithelial necrosis Inapparent measles -clinical onset begins women, 1. measles AB in CSF
and giant cell - Subclinical- passively during exanthem and 2.EEG findings
formation acquired Ab and manifests as seizures, POSTEXPOSURE 3. histopath and isolation of viral
- virus shedding recipients of blood lethargy, coma, - vaccine- effective if antigen in brain tissue
begins products irritability given within 72
- Do not shed virus and -CSF lymphocytic hours of exposure CSF
3) Exanthematous do not transmit pleocytosis, elev - Immune globulin- - elevated IgG and IgM
- with onset of rash infection protein effective if given -EEG-myoclonic phase-
antibody production -immune comp- within 6 days after suppression burst episodes
begins, viral Atypical measles occurs 1-10 months exposure
replication sxs - Those who received after - Competent- Tx:
subside original formalin 0.25ml/kg -supportive
inactivated vaccine- Hemorrhagic - Compromised -RCT of oral Isoprinosine vs
4) Recovery circulating immune measles/black 0.5ml/lg IM, max Isoprinosine + IFN IV for 6
complexes, abnormal measles 15ml months
response to vaccine - Indicated for
- High fever and -Keratitis, myocarditis <6mos, pregnant,
headache with immunocompromis
petechial and purpuric ed
rash on extremities
(centripetal)
- Usually with
pneumonia and pleural
effusiion
maternal education-
option to terminate OR
Immune globulin
0.55ml/kg IM
Vaccine
-postexposure- give
within 3 days
-do NOT administer
Goodluck! - Colleen Carlos TMC
during or within 28 days
of pregnancy
Disease Etiology Incidence/ Incubation Transmission Pathogenesis Clinical Manifestations Diagnosis Complications Management Prevention Prognosis
Epidemiology period
Mumps Paramyxoviridae, -decreased after Ranges from Via respiratory -targets salivary glands, -prodrome lasting 1-2 Leukopenia with Meningitis with or w/o Supportive, antipyretics Schedule of Usually
Rubula MMR 2 dose 12-25 days droplets CNS, pancreas, testes days (fever, headache, lymphocytosis encephalitis- most MMR vaccine excellent
2 surface vaccine - also thyroid, ovaries, vomiting, achiness) common complication
glycoproteins Usually 16-18 *virus shed in heart, kidneys, liver -Parotitis (unilateral then Parotitis- elevatd Do not
-HN days saliva 7 days becomes bilat) – peaks in serum amylase Meningoencephalitis administer to
(hemagglutinin BEFORE to 7 -initial viral replication- 3 days then subsides -neurotropic, enters pregnant
neuraminidase) days AFTER epithelium of upper resp over 7 days Virus isolated from CNS via choroid women, with
-F (Fusion) parotid swelling tract, spreads to adjacent -Morbilliform rash secretions, CSF, plexus anaphylaxis or
LN, viremia- spreading -edema over sternum urine- serologic -may occur before, egg allergy
*max infectious 1- virus to targeted tissues testing with or after (most
2 days BEFORE -increae in IgG commonly 5 days Health care
to 5 days AFTER necrosis of infected cells (cross react with after parotitis) workers given
parotid swelling and lymphocytic inflamm parinfluenza) 2 doses >28
infiltrate -EIA for mums IgM infants- fever, days apart
*isolation period 5 (recent infection) malaise, lethargy
days after onset swelling of tissues in older- fever (94%),
of parotid swelling testes- focal ischemic vomiting (84%),
infarcts headache, parotitis,
neck stiffness (71%),
lethargy seziures
-sxs resolve 7-10
days
Orchitis/Oophoritis
-2nd only to parotitis-
occurs in postpuberty
-fever, chills, exquisite
pain and swelling
testes
-oophoritis-
uncommon females
Pancreatitis
-fever, epi pain,
vomiting
-assoc with
subsequent DM
Cardiac
-myocarditis
Arthritis
-arthralgia, mono or
migratory polyarthritis
-within 3 weeks of
parotid swelling
Thyroiditis
- rare
- -some result in
hypothyroidism
Fetal Infection
- 2nd trimester most sensitive stage but can
occur anytime
Myocarditis
- cells have P antigen- receptor for
virus
Disease Etiology Incubation Transmission Pathogenesis Clinical Manifestations Diagnosis Management Prognosis
Incidence/ Epidemiology period Diagnosis and
Prevention
Varicella -neurotropic human virus, DS DNA 10-21 days Oropharnygeal -replicates in lymphoid Varicella Varicella -infants 4x risk
Zoster -2 dose vaccine reduced disease secretions and tissue, brief subclinical - begins 14-16 days after exposure, prodromal - Acyclovir not routinely dying
-Herpes zoster virus- rare in <10yo, fluid of skin viremia spreads in RES symptoms present 24-48 hrs before rash VZV identified by: recommended
Causes increased in those >45yo lesions by -second viremia- appears -direct fluorescne - 20mkdise q6 (max 800mg) for 5 mortality-
primary, latent -in adults assoiated with post airborne spread cutaneous lesions, lasts - fever and other sxs resolve within 2-4 days assay of cells from days, start within 24 hours for pneumonia,
and recurrent herpetic neuralgia –varicella vaccine- and direct contact 3-7 days after rash onset fluid from lesions max effect CNS
infections can establish latent infection and -immunocompromised- - rash central, simultaneous lesions in various -rapid culture with - IV therapy for disseminated complications,
-predispost to reactivate as herpes zoster transported back continued viral replication stages of evolution, average 300 immunofluorescence disease 2ndary
Staph and to mucosa during -virus transported back to staining - Foscarnet if acyclovir is resistant infections
Strep A late incubation sensory axons to dorsal Breatkthrough varicella -PCR amplification
infections period, spread to root ganglia to spinal cord, - 1 dose vaccinated- 1/5 will have varicella testing Herpes Zoster if exposed to
contacts 1-2 days where latent infection in - occurs in a person vaccinated >42 days - oral acyclovir to prevent post VZV isolate
before neurons and satellite cells before onset of rash, caused by wil type VZV Tzanck smear- poor herpectic neuralgia for 8-21 days
appearance of occur - 1st 2 weeks after vaccine- wild type VZV, sensitivity - iv for immune compromised after exposure
the rash occurring before vaccine because they
Herpes Zoster
- postherpetic neuralgia- frequent complication
- childnre- mild rash, acute neuritis minimal,
complete resolution in 1-2 weeks
Disease Etiology Incidence/ Epidemiology Transmission Pathogenesis Clinical Manifestations Diagnosis Complications Management Prevention Prognosis
Roseola HHV 6 and HHV Peak age of infection – 6-9 From saliva of -causes viremia - high fever, resolves after Viral culture- gold Covulsions- most Supportive None Self limiting
Infantum -exanthema months (after maternal AB wane) asymptomatic -induce apoptosis of T 3 days, with appearance standard but not common complication
subitum or sixth adults cells of blanching moribilliform available For encephalitis-
disease Congenital infection -affects primary T cells, rash lasts 1-3 days Encephalitis, status ganciclovir, foscarnet
-unique is integrated in telomere Congenital monocytes, NK cells, -ulcers (Nagayama spots) Viral DNA by PCR epilepticus and cidofovir
-HHV6 A and B - end of human chromosomes, infection also astrocytes, also B cells, and reverse
passed via germline occurs megakaryocytes, -irritability, inflamed transcriptase PCR
endothelial tympanic membrane,
-primary infection followed rhinorrhea, congestion, GI Indirect immune
by lifelong latency at symptoms, fluorescence,
various sites ELISA,
mean dration of illness 6 immunoblot
days
Disease Description/ Epidemiology/ Incubation Transmission Pathogenesis Clinical Diagnosis Complications Management Prevention Prognosis
Etiology Incidence period Manifestations
N meningitides Commensal Slight male Contagious 7 Nasopharyngeal -Enter respiratory tract, -fever and occult -isolation of fluid Vasculiltis, DIC Pen G 250,000- Antibiotic Mortality rate 10%
colonizers of the predominance days before colonization usually nasopharyngeal bacteremia to from blood, CSF, and hypotension 400, 000 ukday- prophylaxis- for those
Meningococcus nasopharyx the onset of leads to asym colonization,asymptomatic sepsis and shock synovial fluid drug of choice exposed to oral Poor prognostic
Invasive disease- illness ptomatic weeks to months Focal skin secretions 7 days factors- hypothermia/
Identified by its common among colonization 1)bacteremia w/o -CSF-the infarctions- Cefotaxime/ before onset of extreme
ability to FERMENT young children which persists -produce IgA protease that sepsis morphologic and grafting Ceftriaxone illness hyperpyrexia,
glucose and lactose weeks to may assist in colonization of 2) clinical hypotension/ shock,
50% cases <2yo months mucous membranes meningococcemia characteristics of Purpura fulminans Rifampin 10mkdose purpura fulminans,
Cell wall has lipid A 25% > 30yo w/o meningitis the CSF are those causes gangrene q12 for 4 doses seizures,
containing -meningococci adhere to 3) meningitis with of bac men- CSF of extremities- Or leukopenia, DIC, the
lipooligosaccharides risk factors- viral nonciliated epithelial cells or without cultures amputation Ceftri 125mg IM (<12 presence of
(LOS) including infections by their type IV pili. meningococcemia sometimes yo) petechiae <12 hrs
endotoxin (influenza) positive in Adrenal 250mg IM >12yo before admission,
crowding, -once in epithelium, enter Acute patients with hemorrhage, Cipro > 18yo absene of meningitis,
Meningococcal underlying bloodstream, serum Ab meningococcemia meningo with no endophthalmitis, low or normal ESR-
disease caused by chronic diseases against meningococcal -pharyngitis, fever, CSF pleocytosis arthritis, Vaccine all signifies rapid
serogroups A, B, C, and LES surface antigen can block myalgias, endocarditis, -quadrivalent vaccine progression
W135 and Y. this dissemination by weakness, detection of pericarditis, composed of
Outbreaks initiation of complement vomiting, diarrhea, capsular myocarditis, capsular
Strains defined defined as >3 mediated bacterial lysis—if headache polysachharide pneumonia, lung polysaccharides
accdg to scheme of cases in 3month no antibodies, -MCP rash in 7% antigens by rapid abscess, renal groups A, C, Y and
serogroup (capsule period meningococcemia wil of cases latex agglutination infarcts, avascular W135
polysaccharide), develop -limb pain, tests in CSF necrosis of the
serotype porB porA Genetic myalgias, refusal epiphysis MPSV4- unreliable in
immunotype (LOS) exchange with -the degree of activation of to walk-primary leukocytosis, childnre < 2yo, for
commensal the complement and complaint in 7% leukocytopenia, Deafness- most adults, approved for
strains-serotype clotting cascades, the cases increased frequent children 2-10yo
changes, and concentrations of circulating -cold hands/feet, neutrophils and neurologic sequel
Phase variation cytokines, and risk of fatal abnormal skin band neutrophils, MCV4 (diphtheria
among proteins disease correlate with the color early signs elevated ESR and Cerebral arteritis, based protein
ca happen concentration of meningo -fulminant CRP< venous conjugate- for 11-55
LOS in plasma meningo-disease hypoalbuminemia, thrombosis, yo, causes transient
Goodluck! - Colleen Carlos TMC
progresses rapidly hypocalcemia, subdural fever and local
-diffuse vasculitis and DIC over hours to metabolic acidosis empyema, brain redness, pain,
are common- focal septic shock abscess, ataxia, swelling more than
hemorrhage and necrosis characterized by seizures, MPSV4
seen in skin can also be prominent blindness
seen in heart, CNS, petechiae and
mucouse membranes, purpura (purpura Non suppurative
adrenals fulminans), complications-
hypotension, DIC, immune complex
-myocarditis present in acidosis, adrenal mediated- seen 4-
more than 50% hemorrhage, renal 9 days after
failure, myocardial illness- arthritis
-WATERHOUSE failure, and coma and cutaneous
FRIEDRICHSON vasculitis
SYNDROME- diffuse Meningococcal (erythema
adrenal hemorrhage without meningitis- most nodosum)-most
vasculitis common clinical common
manifestation,
Host-Natural immunity may headache, Reactivation of
develop after repeated photophobia, latent herpes
colonization with different vomiting, nuchal simplex virus
subgroups rigidity, seizures common
and focal neuro
Infants –high carriage rate signs, cerebral
of N lactamica- contributes edema
to development of immunity
against meningo, have Chronic meningo
maternally derived IgG in -rare, fever, non
1st 3 months of life toxic appearance,
arthralgias,
-those with complement headache, rash
deficiencies (properdin, similar to
factor D, Terminal disseminated
component deficiencies- gonococcal
develop N mening infection
infections -6-8 weeks
Acute Common in 6-15 yrs old JONES critera (2 major, 1 minor) ASO – reliable evidence of Mgnt
Rheumatic -due to immunologic reaction (delayed sequelae) of group A Major prior infection - Benzathine PCN
Fever beta hemolytic strep of pharynx 1. Polyarthritis – large joints, migratory - Anti inflamm
2. Carditis – 50%, tachycardia, murmur (MR or AR), pericarditis, cardiomegaly (salicylates)
-infection precedes ARF by 2-6 weeks or signs of heart failre - Bed rest
3. Subcutaneous nodules – firm, painless, nonpruritic mobile nodules on
extensor surfaces of large and small joints, spine and scalp Propylaxis
4. Erythema marginatum – serpiginous, non pruritic, evanescent rash , on - IM Benzathine PCN
trunk G (1.2M units every
5. Syndenham’s chorea- uncommon, usually after infection 28 days
Minor - If allergic, macrolide
1. fever (temp 38.2-38.9C) but not as effective)
2. arthralgia
3. previous RF
4. Leukocytosis
5. Elevated ESR/CRP
6. Prolonged PR interval