for medical students , master of FM and PEDO

1. DR HUSSEIN ABDELDAYEM
PROF OF PEDIATRIC NEUROLOGY.
Alex University
Egypt

2. TREATMENTOF ANY FEBRILE CHILD
 NON SPECIFIC TREATMENT
 SPECIFIC TREATMENT: antiviral or antibacterial drugs
 PREVENTION AND COMPLICATION TREATMENT
as vaccine or Immunoglobin

3. 1- NON SPECIFIC
 General measures
 Bed rest.
 Diet:
 Symptomatic treatment:
 For fever: Sponging with tap water and antipyretics but avoid over­
dosage and prolonged use.
 For constipation, headache
 Supportive measures:
 Fluids for dehydrated patients

4. RASHES
Rashes can be classified as:
 Macular, maculopapular eruptions
 Papulo-vesicular or bullous eruptions
 Petechial or hemorrhagic eruptions.
 Ulcerative eruptions
 Nodular eruptions.

5. INFECTIOUSE DISEASES CAUSING
MACULOPAPULAR RASH
 MEASLES
 GERMAN MEASLES
 SCARLET FEVER
 ROSEOLA INFANTUM
 ERYTHEMA INFECTIOSUM
 EBV(INFECTIOUSE
MONONUCLEOSIS)
 OTHERS ENTEROVIRUS or
COXASACKIE VIRUD
INFECTIONS WITH RASH

6. Vesiculo-papular
Urticaria
 Post-Allergen as insect
bite
 Very itchy
 papules→vesicles→exco
-riation and 2ry infection
 No scalp
 No mm
 Over the extensor
surfaces, palms, soles

7. C/P
 Describe
 distribution: maximum, other areas
 Itchy
 MM

8. Iry lesions
 Macule: Flat lenticular size
circumscribed area (<5 mm- <1cm)
of change in skin color
 Papule: small lenticular size (<5mm- 1cm)
Circumscribed elevation of the skin
 Nodule: Solid, circumscribed elevation of the
skin whose greater part is beneath skin surface
(felt more than seen)

9. Vesicle: collection of clear fluid
(<5mm in diameter)
 Bulla: like vesicle, but > 5 mm
 Pustule: Collection of Pus

10.  Patches : large lesion due to
gathering of macules
 Plaque: flat topped palpable
lesion (gathering of papules)

11. Non blanching
Hgic rash
 Petechiae are less
than 2 mm in
diameter
 Purpuric lesions
vary from 2 mm to
1 cm
 Ecchymoses are
larger than 1 cm.

12.  Wheal: Transient,
slightly raised lesion
with pale center and pink
margin. Seen in urticaria.
 Telangectasia: Dilated
capillaries visible on skin
surface

13. Maculo-papular DD

17. What is the lesion
 A child with rash (red macules, red papules,
vesicles) over the trunk and few over the face
and scalp. History of sneezing and cough one
day before

18. Vesiculopapular Rash
 Chicken pox (varicella)
 Herpes zoster
 Herpes simplex
 Hand-foot-mouth syndrome
 Impetigo
 Scabies
 urticaria

19. Varicella (Chickenpox)
 V-Z Virus
 Transmission:
1- skin contact
2- droplets
3- air born transmission
 Contagiousness :
1-2 d before rash
till all lesions are crusted
All ages
Most 2-8 ys

20. Clinical Manifestations of Chicken Pox
 Incubation period 11-21 days.
 Catarrhal stage: mild fever and malaise precede
the typical rash by 24 hours. infective
 The rash starts by small red papules that pass
into vesicles on an erythematous base. infective
 It starts on the trunk and spreads to the face,
scalp and extremities. Pruritis is usually present.
Vesicles produce a crust that falls with no scar.
NON infective

21. Varicella CP
 1- Prodroma: mild
 2- rash:
skin: pleomorphic, centripetal
itchy
tear drop
vesicles, scabs
mm: conj, oral, vagina

22. Chicken Pox
 Pleomorphic:
pleomorphic
macules
papules
tear drop vesicles
scabs (crusts)

23. Chicken Pox
pleomorphic

24. Start at trunk
Then face and scalp
centripetal

25. centripetal
Start at trunk
Then face and scalp

26. Mucus Membrane

27.  It is a droplet infection and infectivity occurs 24 hours
before, and up to scaling of all rash ( usually 7 days after
the appearance of the characteristic rash) . Dry scales are
non-infective.

30. VARICELLA /ZOSTER
INFECTIONS

31. NEONATAL VARICELLA

32. Complications
 Skin: 2ry bacterial infection Hgic varicella
 Blood complications: ITP, internal hge, purpura fulminans
 CNS: encephalitis, cerebellitis, transverse myelitis, GBS, cranial
ns palsy as optic neuritis or bell’s
 Respiratory: laryngitis, virus pn
 Liver: Reye, hepatitis
 Heart: all 3
 Renal: GN
 Extremities: arthritis , myositis
 Eyes : keratitis

33. TT of Varicella (Chickenpox)
 1- non specific
 2- specific: acyclovir
 3- complications treatment: AB, IV acyclovir
REYE SYNDROME
prophylaxis: active ( LA vaccine) > 1y age SC once
passive (VZIG) within 6 days of exposure

35. Herpes zoster
 Same virus VZ in
immune persons
 Very painful vesicles
 Along dermatome of
peripheral nerves
 Unilateral
 unimorphic

36. Herpes simplex infections
See stomatitis DD

38. WHAT IS THE LESION
 4-year-old boy presented with a 5-day history of
mild fever and malaise and a 3-day history of a
vesicular rash involving his hands , feet, tongue ,
and buttocks.

39.  . This clinical picture is highly characteristic of
hand, foot, and mouth disease,
 Typical skin lesions are elliptical vesicles
surrounded by an erythematous halo.
 .

40. Hand – Foot – Mouth Syndrome
 Coxsackie virus A16 or
enterovirus 71
 contagious childhood
illness starts with a fever,
then painful mouth sores
and a non-itchy rash with
blisters on hands, feet,
and sometimes buttocks
and legs follow

46. TREATMENT OF HFMS
 The patient was treated
supportively at home
without medication. At
follow-up 1 week later,
his systemic symptoms
had improved and the
skin lesions were
resolving

48. Impetigo
 Staph or streptococcus
 No constitutional signs
 Starting peri-oral or
nasolabiol folds
 No mm

49. Impetigo
 red sores or blisters that
can break open, ooze,
and develop a yellow-
brown crust.
 Impetigo can be spread
to others through close
contact or by sharing
items like towels and
toys. Scratching can also
spread it to other parts
TT: 1- AB local (ointment)
of the body
2- oral AB ( 10 days for streptococcus)

51. Vesiculo-papular
Urticaria
 Post-Allergen as insect
bite
 Very itchy
 papules→vesicles→exco
-riation and 2ry infection
 No scalp
 No mm
 Over the extensor
surfaces, palms, soles

52. Scabies
 Itchy more at night
 Mostly covered areas and
interdigital
 Pleomorphic + burrows
 Positive history of
contacts

54. Maculo-papular DD
 Measles
 GM
 R infantum
 E infectiosum
 I Mono
 Scarlet fever
 collagen disease
 drug rash

55. MEASLES
Rubeola
What causes the disease?
 Measles is caused by a
virus called Morbillivirus, a
paramyxovirus
RNA virus
IP: 10 days

56. Maculopapular Rash
Measles GM R infant E infect Scarlet
AE RNA virus
transm Droplets, contact with
articles
IP 1-2 wk (10d)
Prodrom +ve fever, conj, cough,
cc, LN
enanthm Koplik’s before rash
exanthm With fever
CPT RESP/
CNS/SKIN/ITP/GIT/A
NERGY
TT NON SPECIFIC
isolation
PROPH VACCINE 6MO
Ig G

57. Fever
Catarrhal stage
 Fever
 Red eyes: (bloody shot eyes)
Conjunctivitis
 photophobia
 Sneezing , running nose
 Sore throat
 Cough
 General malaise
 Body aches
 Koplik’s spots

58. Fever
(3-5 days after the onset of catarrhal stage)
 Enanthem stage :
1-Small red spots on the
soft palate .
2- Small red spots on the
hard plate .
3- Koplik’s spots on the
buccal mucosa .

59. Fever
(3-5 days after the onset of catarrhal stage)
 KOPLIK’S SPOTS
on buccal mucosa .
{tiny white spots inside the
mouth }

60. When is my child infectious?

From 4 days (2 to 5
days) before the rash
appears

until about 4 days
after the rash has started
— which is often when it
starts to disappear

61. RASH
( on the 5th day of the illness )
Exanthem stage :
 Fever
 Rash :
 Type : Maculopapular
rash
 Site: general mainly
at the hair line of
face
 forehead
 back of the neck
 behind the ears

62. Rash
 appears around the fifth
day of the disease
 may last 4 to 7 days
 usually starts on the head
and spreads to other
areas,
 maculopapular rash
appears as both macules
(flat, discolored areas)
and papules (solid, red,
elevated areas) that later
merge together
(confluent)

63. ( on the 5th day of the illness )
RASH
shape
 Blotchy
 Irregular
 Large red patches
 Varying size and shape
 Characteristically
coalesces (geographic
pattern}
 With mild itching

64. End by
 Desquamation : (Branny)

65. Measles
I Day Before the Rash

68. Measles Rash : Face

69. Measles Rash
On Dark Skin

70. MEASLES

78. End by
 Desquamation : (Branny)

79. How to manage Measles
PROPHYLAXIS:
During routine immunization:
 Measles vaccine alone.
 Or combined with German measles and mumps vaccine
(MMR) in the second year.
TREATMENT: SPECIFIC + NON SPECIFIC
 No available antiviral drugs are effective against measles.
 Symptomatic treatment
 Antimicrobials for complications as otitis media and
pneumonia.

80. Complications
1- Respiratory 2- Activation of latent
complications : pulmonary T.B
 Otitis media
 Measles pneumonia
 Secondary bacterial
broncho pneumonia

81.  3- Neurological 5- Digestive tract :
complications :  Diarrhea
 Encephalomyelitis  Vomiting
 Aseptic meningitis
 Dehyration
 Subacute sclerosing
panencephalitis  Acidosis
 Cancrum oris
 4- skin and MM  Ulcerative stomatitis
- Hemorrhagic rash
- Bleeding from mucus 6- Impaired immunity .
membranes

83. GERMAN MEASLES
IP: 2-3 weeks the rubella virus which is a togavirus.

84. Maculopapular Rash
Measles GM R infant E infect Scarlet
AE RNA virus
transm Droplet
Intrauterine
IP 2-3 w
Prodrom No/mild cc + LN
enanthm Mild
exanthm Mild
CPT Cong
infection/ITP/arthritis/CNS
TT NON SPECIFIC
PROPH Vaccine/ IgG

85. GERMAN MEASLES
 Mild short catarrhal stage
 The rash starts around
the hairline and affects
the face and neck first. It
will then spread to the
body and the arms and
legs.
 the rash a fine
appearance
IP: 2-3 weeks

86. Rash + Enlarged lymph nodes

87. Congenital Rubella Syndrome:
 It represents a type
of congenital viral
infection. The
rubella virus can
cross the placenta
and infect the fetus
resulting in either
death or severe
malformations.

88. CONGENITAL RUBELLA
 MR, microcephaly,
hydrocephalus, CP
 Cataract,
microphthalmia
 SNHL
 CCD: PDA, ASD
 JODM
 CHRONIC
RUBELLA: up to a
year

89. Congenital rubella syndrome

91. When is my child infectious?
 A person with rubella will be infectious from
one week before the rash starts until 4 days after
the rash has started. However, newborn children
who are infected may be infectious for a few
months

92. What to do in a case of Measles & German Measles
Active vaccination either alone or in combination
with measles and mumps (MMR) after the first
year of age, pregnant women should NEVER
receive the vaccine.
Pregnant mothers should avoid exposure to
rubella.
No specific treatment.
Symptomatic treatment and antibiotics for
superadded bacterial infections.

93. Management of Pregnant Women Exposed to
Rubella:
Do an antibody test immediately as an emergency
measure:
 If found to be immune, she is reassured and
pregnancy continued.
 If found to be susceptible then serial, antibody tests
are done, if it shows subclinical infection abortion is
induced.
 If abortion is not accepted, immune serum globulin
(ISO) is indicated.

95. INFECTIOUS MONONUCLEOSIS (glandular
fever)
occurs in
adolescents and
young adult.
Caused by Epstein-
Barr virus (EBV).
The onset is usually
insidious and
occurs after an
incubation period
of 4 to 14 days.

96.  Diagnosis of Infectious Mononucleosis

97.  Diagnosis of Infectious Mononucleosis (cont.)

99. 4- SCARLET FEVER
 bacterial toxin of GABHS
See later

100. 5
th disease

101. What is your Diagnosis?
 A 5-year-old boy presents to
clinic with an afebrile rash
involving his extremities and
trunk for three days . Past
history revealed the boy had
mild fever that resolved
without sequelae one week
prior. His rash began three
days prior with flushed
cheeks and then spread

102. ERYTHEMA INFECTIOSUM
('slapped cheek')
RASH WITHOUT FEVER

103. Maculopapular Rash
Measles GM R infant E infectiosum Scarlet
AE Parvovirus B 19, DNA
transm DROPLET
IP 1-2 WK
Prodrom RASH WITHOUT FEVER
Recur with hot showers, exercise, sun
enanthm WBC normal
Low reticulocyte
exanthm SLAPPED CHEEKS, general MP rash
of lacy like , itchy
CPT 1- aplastic crises
2- ITP
3- arthralgia, arthritis
TT Asymptomatic
IV IgG in aplasia
PROPH

104. Fifth disease ('slapped cheek')
Erythema Infectiosum
 Parvovirus B19 (DNA)*
 A contagious and usually
mild illness that passes in
a couple weeks,
 Spread by coughing and
sneezing, it's most
contagious the week
before the rash appears

105.  starts with flu-like
symptoms,
 followed by afebrile ,
asymptomatic rash:
 1st stage: a face “
slapped cheeks”
with circum-oral pallor

107.  2nd stage: body rash.,
reticulated lacy
erythematous
eruption on the
proximal extremities,
buttocks and trunk

108.  The third phase lasts one
to three weeks and
consists of the reticulated
lacy lesions intermittently
recurring especially when
provoked by warm
temperature, sunlight,
emotion or exercise

109. Treatment
 rest, fluids, and pain
relievers (do not use
aspirin if your child has
fever), but watch for
signs of more serious
illness

110. 6
th Disease

111. ROSEOLA INFANTUM
6th
Rainbow after Storm

112. Maculopapular Rash
Measles GM R infant E infect Scarlet
AE Human herpesviruses 6,7
transm droplet
IP 1-2 w (10 days)
Prodrom High fever up to FC
enanthm Wbc increased then decreased
exanthm Generalized MP
No post stain
LN
CPT 1- FC
2- Encephalopathy
TT Asymptomatic
Gancyclovir : immune deficiency,
encephalopathy
PROPH

113. 6 th
 Human Herpes Viruses 6*
 IP: 10 day
 Age
Most cases present within
the first 2 years of life, with
peak occurrence in infants
aged 9-21 months.

114. F Seizures (6-15%)
CP Diarrhea (68%)
Cough (50%)
 Fever (often up to 40°C) 3days before
rash
 Rash (fades within a few hours to 2 d)
Maculopapular or erythematous
Typically beginning on the trunk and
may spread to involve the neck and
extremities
Nonpruritic
Blanches on pressure
 Listlessness , Irritability

116. CPT
Extremely rare manifestations
 Encephalitis,
 fulminant hepatitis,
 hemophagocytic syndrome, and
 disseminated infection with HHV-6

117. What is the lesion?
 A child with fever, throat pain, halitosis and
generalized erythema. Oral exam showed red
tongue and tonsils

118. SCARLET FEVER
 By : Bacteria toxin
 Fever + tonsillitis + rash

119. Maculopapular Rash
Measles G M E infect R infant Scarlet
AE virus Erythrogenic toxin of : GABHS
transm droplet DROPLET
IP 1 – 2 wk 2-3 wk 1 -2 wk 1-7 days ( 3 days)
Prodrom severe mild Fever; chivering, headache
Tonsillitis : throat pain, fetor oris
Abd pain, V, D
Rash Rainbow
enanthm Koplick,s no
Without After
RED TONSILS WITH MEMBRANE
RED PHARYNX WITH MEMBRANE
fever storm
TONGUE: white then red strawberries
exanthm severe Mild –
moderate
Generaslized erythema fade on p
Goose skin
Pastia line
Circumoral pallor
End with peeling towards fingers
CPT All congenital
infection
---- FC Local IMMEDIATE
Remote DELAYED AGN. RH FEVER
TT AB FOR 10 DAYS
SYMPTOMATIC
PROPH LEUCOCYTOSIS, +ve culture
ASOT, Ag detection

123. G Erythema
 Better felt
 Sandpaper like
 Fade on pressure

124. Generalized Erythema
Better felt than seen

125. Pastia lines

136. Scar let Fever
Finely nodular
erythematous rash
with
sandpaper or
goose-flesh texture

143. End by
 Desquamation peeling

144. Treatment
 1- specific: AB for 10 days
 2- non specific
 3- treatment of complications
Complications:
ACUTE LATE
1-Local 1- A Rheumatic F
2-Systemic 2- ADGN

146. Maculo - Papular Rash
Measles GM E infect R infant Scarlet
AE virus Erythrogenic toxin of : GABHS
transm droplet
IP 1 – 2 wk 2-3 wk 1 -2 wk 1-7 days ( 3 days)
Prodrom severe mild Fever
enanthm Koplick,s no
Rash Rainbow
RED TONSILS WITH strawberry tongue
Without After
fever storm
exanthm severe Mild –
moderate
Generaslized erythema fade on p
Better felt than seen
CPT All congenital
infection
---- FC Local IMMEDIATE
Remote DELAYED AGN. RH FEVER
TT Symptomatic AB FOR 10 DAYS
SYMPTOMATIC

147. Sweat rash
 The result of blocked
sweat ducts, heat rash
looks like small red or
pink pimples. Appearing
over an infant's head,
neck, and shoulders

148. INFECTIOUS
MONONUCLEOSIS
 Fever
 Exudative tonsillitis
 Generalized lymphadenopathy
 Splenomegaly ± hepatomegaly
 Rash
 Other manifestations

154. MUMPS (EPIDEMIC PAROTITIS)
 Viral infection
 Incubation period 14-
24 days
 Moderate rise of
temperature but
hyperpyrexia may be
encountered. One or
both parotids may
enlarge. The swelling
usually subsides in 7-10
days

155. raising the lobule of ear and extending anterior
to it.
The swelling is tender and the pain increases by
sour drinks

156.  Mumps

157. MUMPS

161. What to do in a case of Mumps
Treatment
 Symptomatic and supportive.
 Analgesics to relieve pain.
 The mouth should be kept clean and a fluid
diet is needed until swelling subsides. .

162. Thank u