Downloaded 181 times
Uploaded byDr. Rubz
Fever with rash by Dr.Eugene
The document discusses two common causes of fever with rash in children: varicella zoster virus, which causes chickenpox and can establish lifelong latency leading to shingles upon reactivation; and Kawasaki disease, an acute febrile illness of unknown origin that can cause coronary artery aneurysms as a serious complication. It provides details on the clinical presentation, diagnostic criteria, treatment and prognosis of both conditions.
More Related Content
![Approach to a_child_with_rash[1]](https://cdn.slidesharecdn.com/ss_thumbnails/approachtoachildwithrash1-180504150522-thumbnail.jpg?width=640&height=640&fit=bounds)
Similar to Fever with rash by Dr.Eugene
Fever with rash by Dr.Eugene
- 1. Fever with Rash Fever With Rash Chooi Yuo Hao (Eugene) 1
- 2. •Varicella Zoster Virus(VZV) • Perinatally acquired varicella •Kawasaki Disease Fever With Rash 2
- 3. History Taking • Introduction •Chief complaints • HOPI • Past history (Medical and Surgical) • Birth history Fever With Rash • Feeding history • Developmental history • Immunization history • Drug history • Family history 3 • Social and environmental history
- 4. Physical examination • Generalexamination • Systemic examination Fever With Rash 4
- 5. Varicella Zoster Virus(VZV) • 1 of the known human herpes viruses • Varicella Zoster Virus (VZV) – Chicken Pox • Herpes Zoster – Shingles • Neurotropic human herpes virus with similarities to Fever With Rash herpes simplex virus • Air-borne and highly contagious disease • Causes primary, latent and recurrent infections • Increased morbidity and mortality in adolescent, adults, and immunocompromised persons 5 • Predisposed to severe group A streptococcus and Staphylococcus aureus infection
- 6. Clinical Manifestation • Prodromalsymptoms • Nausea, loss of appetite, aching muscle and headache • Fever (mostly low grade), malaise, 24-48hrs later associated with vesicular rash (successive crops of pruritic vesicles that evolve to pustules, crusts and Fever With Rash at times scar4) • Rashes starts from the scalp, face or trunk, upper extremities and lower extremities • Some children might not have prodromal symptoms, they begins with vesicular rash and fever 6
- 7. Fever With Rash 7 Varicella lesion
- 8. Fever With Rash 8 Vesicular rash of chicken pox
- 9. Fever With Rash 9 Haemorrhagic chickenpox
- 10. Complications • Bacterial superinfection • Staphylococcal • Streptococcal • May lead to toxic shock syndrome or necrotizing fasciitis • Central nervous system Fever With Rash • Generalized encephalitis • Aseptic meningitis • Immunocompromised • Haemorrhagic lesions • Pneumonitis • Progressive and disseminated infection 10 • Disseminated intravascular coagulation
- 11. Treatment • Antiviral treatment– Acyclovir • Human varicella zoster immunoglobulin (ZIG) is recommended for high-risk immunosuppressed individuals Fever With Rash 11
- 12. Prognosis • Quite goodexcluded immunosuppressed patients • Resolves spontaneously – self limited • Mortality rate 2-3 per 100,000 cases Fever With Rash 12
- 13. Prevention • Difficult toprevent as the infection is highly contagious for 24-48 hour before the rash appears. • Live attenuated VZV vaccine can be administer • Postexposure prophylaxis – VZV vaccine or oral Fever With Rash acyclovir Beware of admitting a chickenpox contact to a clinical area with immunocompromised children 13
- 14. Perinatally Acquired Varicella •Maternal infection (onset of rash) within 5 days before and 2 days after delivery • Mortality rate is high, due to severe pulmonary disease or widespread necrotic lesions of viscera Fever With Rash • The production and transplacental passage of maternal antibodies that modify the course of illness in new-borns • Exposed susceptible women can be protected with varicella zoster immune globulin (VZIG) and treated with acyclovir. 14
- 15. • Women withvaricella lesions should be isolated from their newborns, breast feeding is contraindicated; when all the lesions have crusted, breast feeding should be commence • Neonates with varicella lesions should be isolated Fever With Rash from other infants but not from their mothers. • Infants born in the high-risk period should also receive zoster immune globulin and are often also given acyclovir prophylactically 15
- 16. Summary • Primary, latentand recurrent infections • Primary infection is manifested as varicella – chickenpox • Results in establishment of a lifelong latent infection of sensory ganglion neurons • Reactivation of the latent infection causes herpes zoster – shingles Fever With Rash • Increase morbidity and mortality in adolescents, adults and immunocompromised persons, and predisposes to severe group A streptococcus and Staphylococcus aureus infections • Can be treated with antiviral drugs • Initial infection can be prevented by immunization with live- attenuated VZV vaccine 16
- 17. Kawasaki Disease • Alsoknown as acute febrile mucocutaneous syndrome • A systemic febrile condition affecting children usually <5 years old • Aetiology remains unknown, possible bacterial Fever With Rash toxins or viral agents with genetic predisposition • Aneurysms of the coronary arteries are an important complication • Affects children 6 months – 4 years old, with a peak at the end of the first year 17
- 18. Diagnostic criteria • Exclusivediagnosis • Fever (HGF, remittent and unresponsive to antibitics) lasting at least 5 days • At least 4 out of 5 of the following • Bilateral non-purulent conjunctivitis Fever With Rash • Mucosal changes of the oropharynx (injected pharynx, red lips, dry fissured lips, strawberry tongue) • Change in extremities (oedema and/or erythema of the hands or feet desquamation, beginning periungually) • Rash (usually truncal), polymorphous but not vesicular • Cervical lymphadenopathy 18 • Illness not explained by other disease process
- 19. Fever With Rash 19 Red, cracked lips and conjunctiva inflammation
- 20. Fever With Rash Congestionof bulbar conjunctiva 20
- 21. Fever With Rash 21 Strawberry tongue
- 22. Fever With Rash 22 Peeling of fingers
- 23. Fever With Rash Desquamationof the fingers 23
- 24. Fever With Rash Indurativeedema 24
- 25. Other helpful signs • Indurated BCG scar • Perianal excoriation, irritability • Altered mental state • Aseptic meningitis Fever With Rash • Transient arthritis • Diarrhoea, vomiting, abdominal pain • Hepatoslenomegaly • Hydrops of gallbladder • Sterile pyuria 25
- 26. Investigation • Full bloodcount • Anaemia, leukocytosis, thrombocytosis • ESR and CRP elevated • Serum albumin <3gdl; Raised alanine Fever With Rash aminotrasaminase (ALT) • Urine > 10 wbc/hpf • Chest x-ray, ECG • Echocardiogram in the acute phase and repeat at 6-8 weeks or earlier if indicated 26
- 27. Fever With Rash Coronaryangiogram demonstrating giant aneurysms of the LAD with obstruction and giant aneurysms of the RCA with 27 area of severe narrowing
- 28. Complication • Coronary vasculitis,usually within 2 weeks of illness • Asymptomatic • Myocardial infection • Fever With Rash Myocardial infarction • Pericarditis • Myocarditis • Endocarditis • Heart failure • Arrhythmias 28
- 29. • Incomplete KawasakiDisease (kindly refer to the 2nd edition of paeds protocol pg 115) • Atypical Kawasaki Disease (kindly refer to the 2nd Fever With Rash edition of paeds protocol pg 115) 29
- 30. Fever With Rash 30 Evaluation of Suspected Incomplete Kawasaki Disease
- 31. Treatment • Primary treatment • IV Immunoglobulins 2 Gm/kg infusion over 10-12 hours Therapy <10 days of onset effective in preventing Fever With Rash coronary vascular damage • Oral Aspirin 30 mg/kg/day for 2 weeks or until patient is afebrile for 2-3 days 31
- 32. Maintenance • Oral Aspirin3-5 mg/kg daily (anti-platelet dose) for 6-8 weeks or until ESR and platelet count normal If coronary aneurysm present, then continue aspirin Fever With Rash until resolves Alternative: Oral Dipyridamole 3-5mg/kg daily 32
- 33. Prognosis • Complete recoveryin children without coronary artery involvement • Most (80%) 3-5mm aneurysm resolve • 30% of 5-8mm aneurysm resolve • Prognosis worst for aneurysms > 8mm; mortality Fever With Rash 1~2% • Good prognosis for aneurysms <4mm 33
- 34. Summary • Mainly affectsinfants and young children • The diagnosis is made on clinical features such as • Fever lasting at least 5 days • At least 4 out of 5 of the following • Bilateral non-purulent conjunctivitis Fever With Rash • Mucosal changes of the oropharynx (injected pharynx, red lips, dry fissured lips, strawberry tongue) • Change in extremities (oedema and/or erythema of the hands or feet desquamation, beginning periungually) • Rash (usually truncal), polymorphous but not vesicular • Cervical lymphadenopathy • Complications – Coronary artery aneurysms and 34 sudden death • Treatment – Intravenous immunoglobulin and aspirin
- 35. References • Hussein Imam,Ng H.P., Thomas T. (2008). Paediatrics Protocols for Malaysian Hospitals (2nd edition): pg 6,78,115- 116 • Lissauer T., Clayden G. (2007). Illustrated textbook of Paediatrics (3rd edition): pg 230-232, 237-238 Fever With Rash • Kliegman R.M., Beherman R.E., Jenson H.B., Stanton B.F. (2007). Nelson textbook of Paediatrics (18th edition) • Klaus W., Richard A.J. (2009). Fitzpatrick’s Color Atlas & Synopsis of Clinical Dermatology (6th edition): pg 833 • Kliegman R.M., Marcdante K.J., Beherman R.E., Jenson H.B. (2007). Nelson Essentials of Paediatrics (5th edition): pg 470- 472 35
- 36.