This document provides information on common childhood infections and rashes. It discusses bacterial infections like meningococcal septicaemia and impetigo, viral rashes including measles, mumps, and varicella, fungal infections such as tinea capitis, parasitic infestations like head lice and scabies, and rashes associated with systemic diseases. It also covers neonatal rashes, provides clinical features and management guidelines, and includes a quiz to test knowledge.

1. COMMON CHILDHOOD
INFECTIONS AND RASHES
Sue Lowe

2. OBJECTIVES
 Bacterial infections
 Viral rashes
 Fungal infections
 Parasitic infestations
 Rashes associated with systemic disease
 Neonatal and congenital rashes
 Quiz!

3. MENINGOCOCCAL SEPTICAEMIA
 MORTALITY 5-10% (90% if DIC)
 MORBIDITY 10%
(Deafness, neurological problems, amputations)
 Peak incidence < 4yrs
 Immunisation programme includes Men C
60% of bacterial meningitis in UK due to Men B

4. MENINGOCOCCAL SEPTICAEMIA
 CLINICAL FEATURES:
 Fever, non-specific malaise, lethargy, vomiting,
meningism, resp distress, irritability, seizures
 Maculopapular rash common early in disease
 Petechial rash seen in 50-60%

5. MENINGOCOCCAL SEPTICAEMIA
 MANAGEMENT IN PRIMARY CARE
 IMMEDIATE IV/IM ANTIBIOTICS
 Benzylpenicillin 1.2g > 10yrs
 Benzylpenicillin 600mg 1-9yrs
 Benzylpenicillin 300mg < 1yr
 CONTACT PROPHYLAXIS
 Rifampicin 600mg bd 2/7 > 12yrs
 Rifampicin 10mg/kg bd 2/7 1-12yrs
 Rifampicin 5mg/kg bd 2/7 < 1yr

6. MENINGOCOCCAL SEPTICAEMIA

7. IMPETIGO
 Staph Aureus or Gp A Strep Pyogenes
 Classically ruptured vesicles with honey-coloured
crusting
 May be bullous
 More common in pre-existing skin disease
 Very contagious, rapid spread
 Commonly starts around face/mouth
 Rx. Topical fusidic acid or oral flucloxacillin
 Advice re nursery/school

8. IMPETIGO

9. STAPHYLOCOCCAL SCALDED SKIN
 Caused by Staphylococcal exfoliative toxin
 Erythematous tender skin, progressing to
desquamation after 24-48hrs
 Nikolsky sign
 62% < 2yrs, 98% < 5yrs
 BCs usually negative in children
 Usually febrile, may rapidly progress to
dehydration/shock
 Rx. Systemic antistaphylococcal abx., emollients,
may need IV fluids

10. STAPH SCALDED SKIN

11. SCARLET FEVER
 Gp A beta-haemolytic Strep
 2-4 days post-Streptococcal pharyngitis
 Fever, headache, sore throat, unwell
 Flushed face with circumoral pallor
 Rash may extend to whole body
 Rough ‘sandpaper’ skin
 Desquamation after 5/7, particularly soles and palms
 School age children
 White strawberry tongue
 Dx. Throat swab, ASO titres
 Rx. Penicillin 10/7

12. SCARLET FEVER

13. SCARLET FEVER

14. VARICELLA
 Incubation 14-21 days
 Mild prodromal illness
 Rash: Face, scalp, trunk, spreads centrifugally
 Macules – papules – vesicles – pustules – crusts
 Complications: encephalitis, pneumonia,
superceded Staphylococcal infection,
disseminated disease in immunocompromised
 Advice to pregnant mothers

15. MEASLES
 Unwell child
 Incubation 7-14 days
 Fever, conjunctival suffusion, coryza
 Maculopapular rash starting on face and
progressing to whole body
 Koplik’s spots are pathognomonic
 Complications: Otitis media, pneumonia,
hepatitis, myocarditis, encephalomyelitis, SSPE

16. MEASLES

17. MUMPS
 Incubation 14-21 days, infectious for 1 week
after parotid swelling develops
 Painful salivary gland in 2/3
 Bilat or unilat
 May be parotid (60%) or parotid and
submandibular (10%)
 Complications: Encephalitis, transient deafness,
epididymo-orchitis, pancreatitis, myocarditis

18. OTHER COMMON VIRAL
INFECTIONS
 Slapped cheek = Fifth disease = Parvovirus B19
= Erythema infectiosum
 Hand, foot and mouth (Coxsackie A and B)
 Roseala infantum (HHV-6)
 HSV
 Molluscum
 Rubella
 EBV
 HPV

19. MOLLUSCUM CONTAGIOSUM

20. FUNGAL INFECTIONS
 Dermatophyte fungi
 (Trichophyton, Epidermophyton, Microsporum)
 Tinea capitis
 Tinea cruris
 Tinea pedis
 Tinea ungium
 Tinea corporis
 Annular, scaling, erythematous lesions
 Systemic Rx usually required for scalp and nail infections
(obtain mycological confirmation first)

21. TINEA CAPITIS

22. FUNGAL INFECTIONS
 PITYRIASIS VERSICOLOUR
 Hypopigmented patches on upper chest, neck, arms
 Usually settle spontaneously
 CANDIDA
 Classically causes oral thrush and nappy rash in infants
 Vulvovaginitis in adolescent girls
 Intertriginous lesions (neck, groin, axilla)
 Chronic mucocutaneous Candidiasis may occur in cell-
mediated immune deficiencies
 Disseminated disease may be life-threatening in
immunocompromised individuals

23. PARASITIC INFECTIONS
 HEAD LICE
 Most common aged 4-11 years
 Treatments include wet combing, permethrin or
malathion (use lotions in preference to
shampoos)
 Repeat treatment after 1 week to ensure all
unhatched ova killed
 Do not need to treat whole family but screen
with thorough wet combing

24. PARASITIC INFECTIONS
 SCABIES
 Highly contagious, spread by skin contact
 Commonly papules, vesicles, pustules, nodules
 Burrows are pathognomonic
 Intractable pruritus, worse at night and in web spaces
 Rx. With permethrin, malathion or crotamiton (use
aqueous preparations in children as alcoholic
preparations may cause stinging and wheeze)
 Repeat treatment after 1 week
 Treat whole household

25. PARASITIC INFECTIONS
 THREADWORMS
 Usually present with pruritus ani
 May see worms in faeces
 Diagnosis on history or ‘sticky tape’ test
 Rx. Mebendazole 100mg – repeat 14 days later
 Treat whole family

26. RASHES ASSOCIATED WITH
SYSTEMIC DISEASE
 Erythema multiforme
 Stevens Johnson syndrome
 Erythema nodosum
 SLE
 Dermatomyositis
 JIA
 Malignancy
 Drugs
 Kawasaki’s
 Familial Mediterrean Fever

27. ERYTHEMA MULTIFORME

28. STEVENS JOHNSON SYNDROME

29. NAPPY RASH
 Irritant/ammoniacal
 Candida
 Seborrhoeic dermatitis
 Atopic eczema
 Psoriasis
 Non-accidental injury

30. NAPKIN CANDIDIASIS

31. COMMON NEONATAL RASHES
 Milia
 Salmon patch (stork mark)
 Mongolian blue spot
 Erythema toxicum neonatorum
 Strawberry naevus (capillary haemangioma)
 Port wine stain (naevus flammeus)
 Sebaceous naevi
 Congenital melanocytic naevus

32. MONGOLIAN BLUE SPOT

33. PORT WINE STAIN

34. CONGENITAL GIANT
MELANOCYTIC NAEVUS

35. QUIZ
 1 yr old Amy presents with a history of
coryzal symptoms, general malaise and
high fever (390C). After 3 days, her
temperature returns to normal. 12 hours
later, she develops a maculopapular rash
over her trunk. What is the most likely
diagnosis?

36. QUIZ
 The following are associated with infection with
Group A beta haemolytic Streptococcus?
 Neonatal meningitis
 Glomerulonephritis
 Scarlet fever
 Toxic shock syndrome
 Pneumonia

37. QUIZ
 The following are included in the current UK
immunisation programme:
 Men C at pre-school booster
 BCG at birth
 MMR at 2 months
 DT and polio at 15 years
 Pertussis at pre-school booster

38. QUIZ
 The following may cause fever and a widespread
rash?
 Ulcerative colitis
 Acute lymphoblastic leukaemia
 Familial Mediterrean Fever
 Candidiasis
 Juvenile idiopathic arthritis

39. QUIZ
 13 year old Neville is a homozygote for
sickle cell disease and usually has a Hb of
8.0g/l. Following a mild URTI, he presents
to his GP complaining of increased
lethargy. A FBC reveals Hb 5.0, WCC 4.0,
plt 90. What is the most likely cause?

40. QUIZ
 True or false:
 Topical antifungals are effective in tinea capitis
 Oral antifungals are always indicated in pityriasis
versicolour
 Candida is the most likely cause of a vaginal discharge in
a continent school age child
 Genital warts are common in children

41. QUIZ
 Which of the following are notifiable diseases?
 Meningococcal meningitis
 Rubella
 CMV
 Campylobacter
 Parvovirus B19

42. QUIZ
 Which of the following are required to make a
diagnosis of Kawasaki’s disease?
 Fever of 2 days duration
 Purulent conjunctivitis
 Polymorphous rash
 Mucosal involvement
 Involvement of hands and feet