Fever with

Rashes
By Tung Yoang Vern
Causes of fever with rashes
Varicella zoster
● Chickenpox & shingles
● Transmission: respiratory droplets Chickenpox
● Symptoms: fever, itchy vesicular rashes
● Complications: secondary bacterial infection, encephalitis, purpura fulminans
● Treatment: oral aciclovir
● Vaccine: Human varicella zoster immunoglobulin (VZIG)

Impetigo
Impetigo
● Localised staphylococcal / streptococcal skin infections
● Erythematous macules on face, neck and hands that may become vesicular/pustular/bullous
● Rupture of vesicles with fluid exudation -> honey coloured crusted lesions
● Treatment: topical antibiotics, nasal cream (if there is nasal carriage)
HHV6 & HHV7
● Infect children who are 2 years and below
● Exanthem subitum
● Transmission: oral secretions of family member Exanthem subitum
● Symptoms: high fever, malaise, macular rashes

Enteroviruses
● Examples: coxsackie viruses, echoviruses, polioviruses
● Transmission: fecal-oral route
● Symptoms: rashes over the trunk consisting petechiae
● Can cause hand, foot and mouth disease, herpangina or meningitis Herpangina
Parvovirus
Erythema infectiosum
● Slapped cheek syndrome
● Transmission: respiratory secretions, vertical transmission from mother to fetus, blood transfusion
● Symptoms: erythema infectiosum, fever, malaise, headache, myalgia, maculopapular rashes

Lyme disease
● Spirochaete Borrelia Burgdorferi Erythema migrans
● Transmission: hard ticks
● Symptoms: erythema migrans, fever, headache, malaise, myalgia, arthralgia, lymphadenopathy
● Treatment: doxycycline, amoxicillin
Boils
● Infections of hair follicles or sweat glands
● Treatment: systemic antibiotics
Boils

Scalded skin syndrome

● Exfoliative staphylococcal toxin -> separation of epidermal skin through granular cell layers
● Symptoms: fever, malaise, purulent, crusting, localised infection around eyes, nose & mouth
● Management: IV anti-staphylococcal antibiotics, analgesia, monitor fluid balance

Scalded skin syndrome

Dengue
Fever
By Shobigaa Ganesan
Definition
Dengue (break-bone fever) is a viral infection that spreads from mosquitoes to people. It is more
common in tropical and subtropical climates.Dengue virus infections affect all age groups.

Classification
Criteria for dengue with or without warning signs
Probable dengue Warning signs

- Live in and travel to dengue endemic - Intense abdominal pain or tenderness

area
- Fever and any 2 of the following
1. Nausea and vomiting
2.Rash
3.Aches and pain
4.Positive tourniquet test
5. Leukopenia
- Any warning signs
Laboratory:
Rapid combo test which include Dengue NS1
and dengue IgM/IgG antibodies
- Persistent vomiting
- Clinical fluid accumulation
- Mucosal bleed
- Lethargy, restlessness
- Liver enlargement > 2 cm
Laboratory:
Increase in haematocrit with concurrent rapid
decrease in platelet count
Criteria for severe dengue
1. Severe plasma leakage leading to:

- Shock (Dengue Shock Syndrome)

- Fluid accumulation (pleural effusion, ascites) with respiratory distress

2. Severe bleeding

3. Severe organ involvement

- Liver: elevated transaminases (AST or ALT > 1000)

- CNS : impaired consciousness, seizures
- Heart and other organ involvement
P D
H E
A N
S G
E U
S E
Management
● Assess airway, breathing, obtain baseline hematocrit
● Commence fluid resuscitation with Normal Saline or Ringer’s lactate at 10-20 ml/kg over 1 hour
for compensated shock
● When the vitals are stable and HCT falls, plan a gradually reducing IV fluid regimen with serial
monitoring of vitals, urine output and 6-8 hourly HCT
● Oral rehydration solutions may suffice when vomiting subsides and hemodynamic stable
● A monitoring fluid regimen may be required for 24-48 hours until danger subsides
● If oral intake is tolerated, can reduce IVF more rapidly.
● When there is stable hemodynamics, HCT and general well being, the patient can be discharged
Tuberculosis
By: Ooi Li Wen
Definition:
The presence of symptoms, signs and /or radiographic findings caused by MTB
complex (Mycobacterium tuberculosis or Mycobacterium bovis).

Classifications:
High risk groups: Clinical features:
Diagnosis: Diagnostic Work-up:
Efforts should be made to collect clinical specimens for AFB
smear, cytopathology or histopathology, special stains and AFB
culture to assure confirmation of diagnosis and drug
susceptibility.
Treatment:
Treatment:
Monitoring of Drug Complication of TB:
Toxicity:
Prevention (BCG Vaccine):
Breast-feeding and the Mother
with Pulmonary Tuberculosis:
Summary (Management of TB in Paediatrics):
Hepatitis
By Sakthivel Singkaravel
Definition:
Hepatitis is an inflammation of the liver that is caused by a variety of infectious viruses and
noninfectious agents leading to a range of health problems, some of which can be fatal.

Diagnostic test for hepatitis:

Blood Tests
- Complete blood count, urine for urobilinogen, liver function test and serology
biomarkers
- The results of a blood test can confirm the type of viral hepatitis, the severity of the
infection, whether an infection is active or dormant, and whether someone is currently
contagious.
Type of Hepatitis Signs and Symptoms Diagnostic test

Hepatitis A Fever,Headache,Malaise, IgM antibodies

Jaundice

Hepatitis B Severe liver IgM antibodies

damage(chronic disease
occurs)

Hepatitis C Same as HBV more chronic PCR of viral RNA

Hepatitis D Severe liver damage and IgM antibodies

high mortality rate

Hepatitis E Pregnant women at high IgM antibodies,PCR of viral

risk and show high mortality RNA.
rate,not chronic disease.
Nice to know: Which Hepatitis is common in
paediatrics patients?
Hepatitis A. it is mostly a food-borne illness and can be spread through contaminated
water and unwashed food. It is the easiest to transmit, especially in children, but is
also the least likely to damage the liver and is usually mild and is completely resolved
within six months.
Thank You!