DR HUSSEIN ABDELDAYEM

PROF OF PEDIATRIC NEUROLOGY.

Alex University
Egypt
 TREATMENTOF ANY FEBRILE
CHILD
NON SPECIFIC TREATMENT

SPECIFIC TREATMENT: antiviral or

antibacterial drugs

PREVENTION AND COMPLICATION

TREATMENT
as vaccine or Immunoglobin
 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
 RASHES

Rashes can be classified as:

Macular, maculopapular eruptions

Papulo-vesicular or bullous
eruptions
Petechial or hemorrhagic eruptions.

Ulcerative eruptions

Nodular eruptions.
 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
 Vesiculo-papular
Urticaria
Post-Allergen as
insect bite
Very itchy
papulesvesiclesex
co-riation and 2ry
infection
No scalp
No mm
Over the extensor
surfaces, palms, soles
 C/P
Describe
distribution: maximum, other areas
Itchy
MM
 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)
 Vesicle: collection of clear fluid
(<5mm in diameter)

Bulla: like vesicle, but > 5 mm

Pustule: Collection of Pus

 Patches : large lesion due to
gathering of macules

Plaque: flat topped palpable

lesion (gathering of papules)
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.
 Wheal: Transient,
slightly raised lesion
with pale center and
pink margin. Seen in
urticaria.

Telangectasia:
Dilated capillaries
visible on skin
surface
Maculo-papular DD
 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
 Vesiculopapular Rash
Chicken pox (varicella)
Herpes zoster
Herpes simplex
Hand-foot-mouth syndrome
Impetigo
Scabies
urticaria
 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
Clinical Manifestations of Chicken Pox

Incubation period 11-21 days.

Catarrhal stage: mild fever and
malaise precede the typical infectiverash by

24 hours.
The rash starts by small red papules infective
that pass into vesicles on an
erythematous base.
It starts on the trunk and spreads to
the face, scalpNON
and extremities.
infective
Pruritis is usually present. Vesicles
produce a crust that falls with no scar.
 Varicella CP
1- Prodroma: mild
2- rash:
skin: pleomorphic,
centripetal
itchy
tear drop
vesicles, scabs
mm: conj, oral, vagina
 Chicken Pox
Pleomorphic:
pleomorphic
macules
papules
tear drop vesicles
scabs (crusts)
Chicken Pox
pleomorphic
Start at trunk
Then face and scalp
centripet
al
 centripetal

Start at trunk
Then face and scalp
Mucus Membrane
 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.
VARICELLA /ZOSTER
INFECTIONS
NEONATAL VARICELLA
 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 bells
Respiratory: laryngitis, virus pn
Liver: Reye, hepatitis
Heart: all 3
Renal: GN
Extremities: arthritis , myositis
Eyes : keratitis
 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
 Herpes zoster
Same virus VZ in
immune persons
Very painful
vesicles
Along dermatome
of peripheral
nerves
Unilateral
unimorphic
 Herpes simplex infections

See stomatitis DD
 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.
 . This clinical picture is highly
characteristic of hand, foot, and
mouth disease,
Typical skin lesions are elliptical
vesicles surrounded by an
erythematous halo.
.
 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
 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
 Impetigo
Staph or
streptococcus
No constitutional
signs
Starting peri-oral
or nasolabiol folds
No mm
 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 of the body
TT: 1- AB local (ointment)
2- oral AB ( 10 days for streptococcus)
 Vesiculo-papular
Urticaria
Post-Allergen as
insect bite
Very itchy
papulesvesiclesex
co-riation and 2ry
infection
No scalp
No mm
Over the extensor
surfaces, palms, soles
 Scabies
Itchy more at night
Mostly covered
areas and
interdigital
Pleomorphic +
burrows
Positive history of
contacts
 Maculo-papular DD
Measles
GM
R infantum
E infectiosum
I Mono
Scarlet fever
collagen disease
drug rash
 MEASLES
Rubeola
What causes the
disease?
Measles is caused
by a virus called
Morbillivirus, a
RNA virus
paramyxovirus

IP: 10 days
 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 Kopliks before rash

exanthm With fever

CPT RESP/
CNS/SKIN/ITP/GIT/AN
ERGY

TT NON SPECIFIC
isolation

PROPH VACCINE 6MO

Ig G
 Fever
Catarrhal stage
Fever
Red eyes: (bloody shot
eyes) Conjunctivitis
photophobia
Sneezing , running nose
Sore throat
Cough
General malaise
Body aches
Kopliks spots
 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- Kopliks spots on
the buccal
mucosa .
 Fever
(3-5 days after the onset of
catarrhal stage)
KOPLIKS
SPOTS on
buccal mucosa .
{tiny white spots
inside the
mouth }
 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
 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
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)
( 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
 End by
Desquamation : (Branny)
 Measles
I Day Before the Rash
Measles Rash : Face
Measles Rash
On Dark Skin
MEASLES
 End by
Desquamation : (Branny)
 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.
 Complications
1- Respiratory 2- Activation of
complications : latent pulmonary
Otitis media T.B
Measles
pneumonia
Secondary
bacterial
broncho
pneumonia
 3- Neurological 5- Digestive tract :
complications : Diarrhea
Encephalomyelitis Vomiting
Aseptic meningitis Dehyration
Subacute sclerosing
Acidosis
panencephalitis
Cancrum oris

4- skin and MM Ulcerative stomatitis

- Hemorrhagic rash
- Bleeding from 6- Impaired
mucus membranes immunity .
 GERMAN MEASLES

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

 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

 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
Rash + Enlarged lymph
nodes
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.
 CONGENITAL RUBELLA
MR, microcephaly,
hydrocephalus,
CP
Cataract,
microphthalmia
SNHL
CCD: PDA, ASD
JODM
CHRONIC
RUBELLA: up to a
year
Congenital rubella
syndrome
 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
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.
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.
 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.
 Diagnosis of Infectious
Mononucleosis
 Diagnosis of Infectious Mononucleosis
(cont.)
 4- SCARLET FEVER
bacterial toxin of GABHS

See later
5
th disease
 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
ERYTHEMA INFECTIOSUM
('slapped cheek')

RASH WITHOUT FEVER

 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
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
 starts with flu-like
symptoms,
followed by afebrile
, asymptomatic
rash:
1st stage: a face
slapped
cheeks with
circum-oral pallor
 2nd stage: body rash.,
reticulated lacy
erythematous
eruption on the
proximal extremities,
buttocks and trunk
 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
 Treatment
rest, fluids, and
pain relievers (do
not use aspirin if
your child has
fever), but watch
for signs of more
serious illness
6
th Disease
ROSEOLA INFANTUM

6th

Rainbow after Storm

 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
 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.
 F Seizures (6-15%)
CP Diarrhea (68%)
Cough (50%)

Fever (often up to 40C) 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
 CPT
Extremely rare manifestations
Encephalitis,
fulminant hepatitis,
hemophagocytic syndrome, and
disseminated infection with HHV-6
 What is the lesion?
A child with fever, throat pain,
halitosis and generalized erythema.
Oral exam showed red tongue and
tonsils
 SCARLET FEVER
By : Bacteria toxin
Fever + tonsillitis + rash
 Maculopapular Rash
Measles GM 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
 G Erythema

Better felt
Sandpaper like
Fade on pressure
Generalized Erythema

Better felt than seen

Pastia
lines
 Scarlet Fever

Finely nodular
erythematous rash
with
sandpaper or
goose-flesh texture
 End by
Desquamation
peeling
 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
 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
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
 INFECTIOUS
MONONUCLEOSIS
Fever
Exudative tonsillitis
Generalized lymphadenopathy
Splenomegaly hepatomegaly
Rash
Other manifestations
 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
raising the lobule of ear and
extending anterior to it.
The swelling is tender and the pain
increases by sour drinks
 Mumps
MUMPS
 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. .
Thank u