FEVER and RASH

Disease Etiology Incidence/ Incubation Transmission Pathogenesis Clinical Manifestations Diagnosis Complications Management and Prognosis
Epidemiology period Prevention
Measles -SS enveloped -measles 8-12 days Portal of entry -causes necrosis of resp Incubation 8-12days -leukopenia, -M&M highest in <5yo -supportive Pneumonia and encephalitis-
RNA, vaccine through tract epithelium and lymphocytosis (exp <1yo) -immunocompromised- complications in most of deaths
paramyxoviridae, changed *patients respiratory tract lymphocytic infiltrate Prodromal -lowers serum retinol Ribavirin (not licensed
Morbiliivirus epidemiology infectious from or conjunctivae -Histology of rash- IC - mild fever, -Serologic concentrations yet) SSPE
-humans only -2 dose vaccine 3 days following contact edema and keratosis with conjunctivitis with confirmation- IgM -persistent infection with altered
host policy BEFORE up with large formation of syncytial photophobia, coryza, in serum Pneumonia- MOST Vitamin A measles virus
-2 impt proteins to 4-6 days droplets or small giant cells cough and inc fever - appears 1-2 days COMMON cause of -single dose -had measles at young age
1) Hemagglutinin AFTER onset droplet aerosols -fusion of infected cells – - Koplik’s spots- AFTER onset of DEATH >1yo – 200, 000 IU (<2yo) and deficient M or matrix
(H) Protein of the rash w/ virus WARTHIN FINKELDEY represent enanthem, rash, detectable -may manifest as 6mos-1yo- 100, 000 IU protein)
2) Fusion (F) GIANT CELLS- pathognomonic sign for 1 month giant cell pneumonia <6mos- 50, 000 IU -begins 7-13 years after infection
protein *shed measles Virus may remain pathognomonic of (appears 1-4 days prior (Strep pneum, Hib,
virus 7 days suspended in air measles to onset of rash) 4x rise in IgG after Staph aureus) *repeat the next day Initial
after exposure for 1 hour 2-4 weeks -croup, tracheitis, and if with evidence of -subtle behavioral changes
to 4-6 days 4 phases Exanthem bronchiolitis ophtha dse- 4 weeks 2nd
after onset of 1) Incubation (8-12) - Sxs increase in viral isolation from after -massive myoclonus, involuntary
rash - measles migrate to intensity until 1st day of blood, urine, resp Acute Otitis Media – movements
regional LN rash secretions most common MEASLES VACCINE 3rd
*immune - primary viremia- - Sxs subside with onset COMPLICATION -recommended 2 doses - involuntary movement
compromised- spreads virus to of rash (cephalocaudal) (12-15 mos and 4-6 yo) disappears
shed measles RES - Rash fades over 7 -suppressed PPD -if given <12 mos, give -choreo athetosis, immobility,
during - 2dary viremia- days, desquamation --diarrhea, vomiting, 2 doses again dystonia, lead pipe rigidity
DURATION of spreads to body - Cough lasts longest dehydration, febrile -dementia, stupor, coma
disease surfaces (up to 10 days) seizures AE: fever (after 6-12 4th
- CLADS/generalized days) -loss of centers that support
2) Prodromal lymphadenopathy may Measles Encephalitis Rash, transient breathing, BP, heart rate, death
- begins after 2nd be present -post infectious, thrombocytopenia
viremia immune mediated -don’t give to pregnant Diagnosis
- epithelial necrosis Inapparent measles -clinical onset begins women, 1. measles AB in CSF
and giant cell - Subclinical- passively during exanthem and 2.EEG findings
formation acquired Ab and manifests as seizures, POSTEXPOSURE 3. histopath and isolation of viral
- virus shedding recipients of blood lethargy, coma, - vaccine- effective if antigen in brain tissue
begins products irritability given within 72
- Do not shed virus and -CSF lymphocytic hours of exposure CSF
3) Exanthematous do not transmit pleocytosis, elev - Immune globulin- - elevated IgG and IgM
- with onset of rash infection protein effective if given -EEG-myoclonic phase-
antibody production -immune comp- within 6 days after suppression burst episodes
begins, viral Atypical measles occurs 1-10 months exposure
replication sxs - Those who received after - Competent- Tx:
subside original formalin 0.25ml/kg -supportive
inactivated vaccine- Hemorrhagic - Compromised -RCT of oral Isoprinosine vs
4) Recovery circulating immune measles/black 0.5ml/lg IM, max Isoprinosine + IFN IV for 6
complexes, abnormal measles 15ml months
response to vaccine - Indicated for
- High fever and -Keratitis, myocarditis <6mos, pregnant,
headache with immunocompromis
petechial and purpuric ed
rash on extremities
(centripetal)
- Usually with
pneumonia and pleural
effusiion

Goodluck!  - Colleen Carlos TMC

Disease Etiology Incidence/ Incubation Transmission Pathogenesis Clinical Manifestations Diagnosis Complications Management Prognosis
Epidemiology period Prevention
Rubella -Togaviridae, -2 dose vaccine 14-21 days *period of highest -lymphoreticular -low grade fever, sore -leukopenia, Post infectious Postnatal- supportive Excellent
RUbivirus, recommendation (2-3 weeks) communicability inflammation and throat, red eyes, neutropenia, thrombocytopenia IVIg or corticosteroids-
German SSRNA highest in from 5 days mononuclear perivascular headache, malaise, thrombocytopenia - 2 wks after rash for severe Reinfection- significant increase
measles or 3 -humans only preschool and BEFORE to 6 and meningeal infiltration anorexia, suboccipital, -petechiae, epistaxis, thrombocytopenia in IgG and/or an IgM response in
day measles known host school age days AFTER -virus replicates in resp postauricular, anterior most common- GI bleeding, self an individual with preexisting
-more severe children onset of the rash epith, spreads to regional cervical lymph Rubella IgM limiting CRS- cardiac, audio, rubella
in adults nodes -1st manifestation- enzyme ophtha, neuro
-Congenital Viral shedding -Viremia- intense from 10- usually the rash, begins in immunosorbent Arthritis evaluation
Rubella from 17 days after infection face, centrifugal, rash assay -within 1 week of rash
syndrome nasopharynx- 10 -Viral shedding from fades on face as it -small joints of hands Prevention
days after nasopharynx- 10 days extends to body others -self limiting -postnatal- isolate for 7
infection and up after infection and up to 2 -FORCHHEIMER -IgM capture days
to 2 weeks of weeks of onset of rash SPOTS- rose colored assay, reverse Encephalitis -CRS- contact
onset of rash spots or petechiae on soft transcriptase PCR - most serious precautions until 1
CRS palate or viral culture -2 forms month
*children with *AOG at time of infection -rash lasts for 3 days, no 1) Post infectious
CRS excrete <11 weeks high risk desquamation -within 7 days rash pregnant women
virus until 1YEAR >16 wks defects onset, headache, exposed
OLD uncommon CRS seizures, confusion, 1) obtain blood
-tissue necrosis due to -Nerve deafness- single coma, focal neuro specimen
vascular insufficiency, most common finding signs, ataxia ASAP for
chrom breaks, protein -IUGR rubella IgG
inhibitor causing mitotic -Retinal findings- salt and 2) Progressive specific Ab
arrest pepper retinopathy-most Rubella testing, then
common ocular Pancencephalitis save 1 aliquot
abnormality (PRP 2) if (+)- mom is
-Unilateral/bilateral -rare, similar SSPE, immune
cataracts- most serious virus isolated in brain
eye finding tissue (unlike post if negative
-PDA most frequently infectious) 1) obtain 2nd
reported cardiac defect -death after 2-5 years specimen
(next PA stenosis) after 2-3
-Interstitial pneumonitis, others: GBS, weeks, test
Meningoencephalitis, peripheral neuritis with saved
PRP, thyroid, glaucoma aliquot
2) if both
negative
3) obtain 3rd
specimen and
test with
saved
specimen
4) if both 2nd
and 3rd
NEGATIVE-
infection NOT
occurred
5) if (+) in either
1-
INFECTION
HAS occurred

maternal education-
option to terminate OR
Immune globulin
0.55ml/kg IM

Vaccine
-postexposure- give
within 3 days
-do NOT administer
Goodluck!  - Colleen Carlos TMC
 during or within 28 days
of pregnancy
Disease Etiology Incidence/ Incubation Transmission Pathogenesis Clinical Manifestations Diagnosis Complications Management Prevention Prognosis
Epidemiology period
Mumps Paramyxoviridae, -decreased after Ranges from Via respiratory -targets salivary glands, -prodrome lasting 1-2 Leukopenia with Meningitis with or w/o Supportive, antipyretics Schedule of Usually
Rubula MMR 2 dose 12-25 days droplets CNS, pancreas, testes days (fever, headache, lymphocytosis encephalitis- most MMR vaccine excellent
2 surface vaccine - also thyroid, ovaries, vomiting, achiness) common complication
glycoproteins Usually 16-18 *virus shed in heart, kidneys, liver -Parotitis (unilateral then Parotitis- elevatd Do not
-HN days saliva 7 days becomes bilat) – peaks in serum amylase Meningoencephalitis administer to
(hemagglutinin BEFORE to 7 -initial viral replication- 3 days then subsides -neurotropic, enters pregnant
neuraminidase) days AFTER epithelium of upper resp over 7 days Virus isolated from CNS via choroid women, with
-F (Fusion) parotid swelling tract, spreads to adjacent -Morbilliform rash secretions, CSF, plexus anaphylaxis or
LN, viremia- spreading -edema over sternum urine- serologic -may occur before, egg allergy
*max infectious 1- virus to targeted tissues testing with or after (most
2 days BEFORE -increae in IgG commonly 5 days Health care
to 5 days AFTER necrosis of infected cells (cross react with after parotitis) workers given
parotid swelling and lymphocytic inflamm parinfluenza) 2 doses >28
infiltrate -EIA for mums IgM infants- fever, days apart
*isolation period 5 (recent infection) malaise, lethargy
days after onset swelling of tissues in older- fever (94%),
of parotid swelling testes- focal ischemic vomiting (84%),
infarcts headache, parotitis,
neck stiffness (71%),
lethargy seziures
-sxs resolve 7-10
days

Orchitis/Oophoritis
-2nd only to parotitis-
occurs in postpuberty
-fever, chills, exquisite
pain and swelling
testes
-oophoritis-
uncommon females

Pancreatitis
-fever, epi pain,
vomiting
-assoc with
subsequent DM

Cardiac
-myocarditis

Arthritis
-arthralgia, mono or
migratory polyarthritis
-within 3 weeks of
parotid swelling

Thyroiditis
- rare
- -some result in
hypothyroidism

Goodluck!  - Colleen Carlos TMC

 Disease Etiology Incidence/ Incubation Transmission Pathogenesis Clinical Manifestations Diagnosis Management Complications Prevention
Epidemiology period
Erythema -member -rash illness and Fifth disease- Respiratory route, -primary target erythroid Erythema Infectiosum (Fifth Disease) Serologic tests No specific antiviral Arthralgias/ Isolation for 1
Infectiosum Erythrovirus, plastic crisis- 4-28 days large droplet cell line, transient arrest in - prodrome- mild, low grade fever, headache, therapy arthritis may week, avoid
(Fifth infects animals most prevalent (average 16- spread erythropoiesis URTI, lymphadenopathy B19 IgM- develops persist contact with
Disease) -B19 and -5-15yo 17 days) - hallmark- characteristic rash, 3 stages after infection, IVIg- sometimes used pregnant
bocavirus- only 2 Also -aplastic crisis- direct 1) slapped cheek-facial flushing persists for 6-8 weeks Aseptic women
Parvos that infect transmissible in result of virus 2) 2nd- diffuse macular erythema to trunk and Fetal hydrops- meningitis,
humans blood and blood -exanthem and arthritis- proximal extremities B19 IgG- marker of intrauterine RBC encephalitis,
products post infectious 3) 3rd – central clearing, rash becomes lacy past infection or transfusions peripheral
phenomena and reticulated, spares palms and soles immunity neuropathy

Chronic hemolytic Arthropathy Anti B19 IgM – best Incidence of

anemia- when infected
with B19, requires
transfusion
Impaired humoral
immunity- inc risk for
serious infection,chronic
RBC aplasia,
thrombocytopenia and
neutropenia
Fetal hydrops- profound
fetal anemia and high
output cardiac failure
- in adolescents, females common, range from marker of acute stroke after
diffuse polyarthralgia to frank arthritis infection aplastic crisis
- hands, wrists, knee and ankles, resolves in 2- increased
4 weeks Serologic diagnosis
unreliable in immune
Transient Aplastic Crisis compromised
- occurs in patients with chronic hemolytic
disease, SCD, thalassemia, hereditary
spherocytosis, pyruvate kinase deficiency
Immunocompromised
- chronic anemia most common manifestation,
sometimes with neutropenia,
thrombocytopenia, complete marrow
suppression

Fetal Infection
- 2nd trimester most sensitive stage but can
occur anytime

Myocarditis
- cells have P antigen- receptor for
virus

Other Cutaneous Manifestations

- PPGSS (papular purpuric “gloves and socks”
syndrome)- fever, pruritus, painful edema and
erythema localized to distal extremities
- Self limited, resolves within a few weeks

Disease Etiology Incubation Transmission Pathogenesis Clinical Manifestations Diagnosis Management Prognosis
Incidence/ Epidemiology period Diagnosis and
Prevention
Varicella -neurotropic human virus, DS DNA 10-21 days Oropharnygeal -replicates in lymphoid Varicella Varicella -infants 4x risk
Zoster -2 dose vaccine reduced disease secretions and tissue, brief subclinical - begins 14-16 days after exposure, prodromal - Acyclovir not routinely dying
-Herpes zoster virus- rare in <10yo, fluid of skin viremia spreads in RES symptoms present 24-48 hrs before rash VZV identified by: recommended
Causes increased in those >45yo lesions by -second viremia- appears -direct fluorescne - 20mkdise q6 (max 800mg) for 5 mortality-
primary, latent -in adults assoiated with post airborne spread cutaneous lesions, lasts - fever and other sxs resolve within 2-4 days assay of cells from days, start within 24 hours for pneumonia,
and recurrent herpetic neuralgia –varicella vaccine- and direct contact 3-7 days after rash onset fluid from lesions max effect CNS
infections can establish latent infection and -immunocompromised- - rash central, simultaneous lesions in various -rapid culture with - IV therapy for disseminated complications,
-predispost to reactivate as herpes zoster transported back continued viral replication stages of evolution, average 300 immunofluorescence disease 2ndary
Staph and to mucosa during -virus transported back to staining - Foscarnet if acyclovir is resistant infections
Strep A late incubation sensory axons to dorsal Breatkthrough varicella -PCR amplification
infections period, spread to root ganglia to spinal cord, - 1 dose vaccinated- 1/5 will have varicella testing Herpes Zoster if exposed to
contacts 1-2 days where latent infection in - occurs in a person vaccinated >42 days - oral acyclovir to prevent post VZV isolate
before neurons and satellite cells before onset of rash, caused by wil type VZV Tzanck smear- poor herpectic neuralgia for 8-21 days
appearance of occur - 1st 2 weeks after vaccine- wild type VZV, sensitivity - iv for immune compromised after exposure
the rash occurring before vaccine because they

Goodluck!  - Colleen Carlos TMC

 - 14 days- 42 days- wild or vaccine strains VZV IgG- determine are infectious
- atypical rash, <50 lesions, shorter duration, immune status if hx
fewer complications, no fever equivocal COMPLICATIONS Varicella
- <50 less contagious, >50 contagious vaccine- 2 dos
bacterial infections regimen
Progressive Varicella - (Staph aureus and group A
- those immune compromised, corticosteroids strep) Post
- severe abdominal pain, hemorrhagic vesicles, - recurrence of fever 3 days after exposure
visceral organ involvement, coagulopathy, rash -vaccine given
severe hemorrhage within 3-5
Encephalitis and Cerebellar ataxia days after
Neonatal Varicella - mort <5y- >20 yo exposure
- fatal if mom has varicella 5 days prior to 2 - gradual onset of gait
days after delivery (no maternal antibodies disturbance, nystagmus, slurred - VariZIg for
formed yet) speech, neuro symptoms 2-6 immune
- if >5 days prior to delivery and >30 weeks days after onset of rash comp,
AOG, mild varicella - clinical recovery within 24-72 pregnant and
- infant given VariZIG or IVIg and acyclovir hours and complete neonates
10mkdose q8 1vial for every
Pneumonia 10kg
Congenital Varicella Syndrome Congenital varicella - most of morb and mort, starts 1-
- high risk in moms infected <13 wks AOG and -viral DNA in tissue 6 days after onset of rash -IVIg
13-20wks AOG samples by PCR 400mg/kg
- cicatrial (zigzag, dermatomal) skin scarring, -VZV specific IgM administered
limb hypoplasia, neurologic (microcephaly, antibody – in cord within 96
cortical atrophy, seizures, MR), eye blood sample hours of
(chorioretinitis, microphthalmia, cataracts), exposure
renal (hydronephrosis), ANS (neurgenic
bladder, aspiration pneumonia) neonates- 1
- Varicella Ig and acyclovir may be given vial VariZig

Herpes Zoster
- postherpetic neuralgia- frequent complication
- childnre- mild rash, acute neuritis minimal,
complete resolution in 1-2 weeks

Disease Etiology Incidence/ Epidemiology Transmission Pathogenesis Clinical Manifestations Diagnosis Complications Management Prevention Prognosis

Roseola HHV 6 and HHV Peak age of infection – 6-9 From saliva of -causes viremia - high fever, resolves after Viral culture- gold Covulsions- most Supportive None Self limiting
Infantum -exanthema months (after maternal AB wane) asymptomatic -induce apoptosis of T 3 days, with appearance standard but not common complication
subitum or sixth adults cells of blanching moribilliform available For encephalitis-
disease Congenital infection -affects primary T cells, rash lasts 1-3 days Encephalitis, status ganciclovir, foscarnet
-unique is integrated in telomere Congenital monocytes, NK cells, -ulcers (Nagayama spots) Viral DNA by PCR epilepticus and cidofovir
-HHV6 A and B - end of human chromosomes, infection also astrocytes, also B cells, and reverse
passed via germline occurs megakaryocytes, -irritability, inflamed transcriptase PCR
endothelial tympanic membrane,
-primary infection followed rhinorrhea, congestion, GI Indirect immune
by lifelong latency at symptoms, fluorescence,
various sites ELISA,
mean dration of illness 6 immunoblot
days

Goodluck!  - Colleen Carlos TMC

 Disease Description/ Epidemiology/ Incubation Transmission Pathogenesis Clinical Diagnosis Complications Management Prevention Prognosis
Etiology Incidence period Manifestations
Toxic shock TSST 1 producing Menstruating TSST1- causes massive Abrupt onset, high Bacterial cultures Nafcillin, 1st Menstrual TSS- 30%
syndrome strains women 15-25yo loss of fluid from fever, vomiting, (though not generation recurrence rate if with
tampons intravascular space after diarrhea, sore necessary) cephalosporin, no antibitocis
IL1 and TNF release throat, headache Vancomycin,
Nonmenstrual -produced in envt with myalgia clindamycin Recovery 7-10 days
TSS- nasal neutral pH, high PCO2 and -diffuse macular
packing, wound aerobic O2-vagina rash appears Fluids, Mortality rate- 3%
infections, within 24 hrs wth inotropes,
sinusitis, hyperemic corticosteroids,
pneumonia, pharyngeal IVIg
empyema, conjunctival,
abscess, burns, vaginal membrane
osteomyelitis -altered
consciousness,
oliguria,
hypotension,
shock
-desquamation
after 7-10 days
-hair and nail loss
after 1-2 months

Disease Description/ Epidemiology/ Incubation Transmission Pathogenesis Clinical Diagnosis Complications Management Prevention Prognosis
Etiology Incidence period Manifestations
N meningitides Commensal Slight male Contagious 7 Nasopharyngeal -Enter respiratory tract, -fever and occult -isolation of fluid Vasculiltis, DIC Pen G 250,000- Antibiotic Mortality rate 10%
colonizers of the predominance days before colonization usually nasopharyngeal bacteremia to from blood, CSF, and hypotension 400, 000 ukday- prophylaxis- for those
Meningococcus nasopharyx the onset of leads to asym colonization,asymptomatic sepsis and shock synovial fluid drug of choice exposed to oral Poor prognostic
Invasive disease- illness ptomatic weeks to months Focal skin secretions 7 days factors- hypothermia/
Identified by its common among colonization 1)bacteremia w/o -CSF-the infarctions- Cefotaxime/ before onset of extreme
ability to FERMENT young children which persists -produce IgA protease that sepsis morphologic and grafting Ceftriaxone illness hyperpyrexia,
glucose and lactose weeks to may assist in colonization of 2) clinical hypotension/ shock,
50% cases <2yo months mucous membranes meningococcemia characteristics of Purpura fulminans Rifampin 10mkdose purpura fulminans,
Cell wall has lipid A 25% > 30yo w/o meningitis the CSF are those causes gangrene q12 for 4 doses seizures,
containing -meningococci adhere to 3) meningitis with of bac men- CSF of extremities- Or leukopenia, DIC, the
lipooligosaccharides risk factors- viral nonciliated epithelial cells or without cultures amputation Ceftri 125mg IM (<12 presence of
(LOS) including infections by their type IV pili. meningococcemia sometimes yo) petechiae <12 hrs
endotoxin (influenza) positive in Adrenal 250mg IM >12yo before admission,
crowding, -once in epithelium, enter Acute patients with hemorrhage, Cipro > 18yo absene of meningitis,
Meningococcal underlying bloodstream, serum Ab meningococcemia meningo with no endophthalmitis, low or normal ESR-
disease caused by chronic diseases against meningococcal -pharyngitis, fever, CSF pleocytosis arthritis, Vaccine all signifies rapid
serogroups A, B, C, and LES surface antigen can block myalgias, endocarditis, -quadrivalent vaccine progression
W135 and Y. this dissemination by weakness, detection of pericarditis, composed of
Outbreaks initiation of complement vomiting, diarrhea, capsular myocarditis, capsular
Strains defined defined as >3 mediated bacterial lysis—if headache polysachharide pneumonia, lung polysaccharides
accdg to scheme of cases in 3month no antibodies, -MCP rash in 7% antigens by rapid abscess, renal groups A, C, Y and
serogroup (capsule period meningococcemia wil of cases latex agglutination infarcts, avascular W135
polysaccharide), develop -limb pain, tests in CSF necrosis of the
serotype porB porA Genetic myalgias, refusal epiphysis MPSV4- unreliable in
immunotype (LOS) exchange with -the degree of activation of to walk-primary leukocytosis, childnre < 2yo, for
commensal the complement and complaint in 7% leukocytopenia, Deafness- most adults, approved for
strains-serotype clotting cascades, the cases increased frequent children 2-10yo
changes, and concentrations of circulating -cold hands/feet, neutrophils and neurologic sequel
Phase variation cytokines, and risk of fatal abnormal skin band neutrophils, MCV4 (diphtheria
among proteins disease correlate with the color early signs elevated ESR and Cerebral arteritis, based protein
ca happen concentration of meningo -fulminant CRP< venous conjugate- for 11-55
LOS in plasma meningo-disease hypoalbuminemia, thrombosis, yo, causes transient
Goodluck!  - Colleen Carlos TMC
 progresses rapidly hypocalcemia, subdural fever and local
-diffuse vasculitis and DIC over hours to metabolic acidosis empyema, brain redness, pain,
are common- focal septic shock abscess, ataxia, swelling more than
hemorrhage and necrosis characterized by seizures, MPSV4
seen in skin can also be prominent blindness
seen in heart, CNS, petechiae and
mucouse membranes, purpura (purpura Non suppurative
adrenals fulminans), complications-
hypotension, DIC, immune complex
-myocarditis present in acidosis, adrenal mediated- seen 4-
more than 50% hemorrhage, renal 9 days after
failure, myocardial illness- arthritis
-WATERHOUSE failure, and coma and cutaneous
FRIEDRICHSON vasculitis
SYNDROME- diffuse Meningococcal (erythema
adrenal hemorrhage without meningitis- most nodosum)-most
vasculitis common clinical common
manifestation,
Host-Natural immunity may headache, Reactivation of
develop after repeated photophobia, latent herpes
colonization with different vomiting, nuchal simplex virus
subgroups rigidity, seizures common
and focal neuro
Infants –high carriage rate signs, cerebral
of N lactamica- contributes edema
to development of immunity
against meningo, have Chronic meningo
maternally derived IgG in -rare, fever, non
1st 3 months of life toxic appearance,
arthralgias,
-those with complement headache, rash
deficiencies (properdin, similar to
factor D, Terminal disseminated
component deficiencies- gonococcal
develop N mening infection
infections -6-8 weeks

recurrent infection more

common in terminal
component deficiency

Disease Etiology/incidence Pathogenesis Clinical Manifestations Diagnosis Differentials Treatment

PE
Kawasaki -vasculitis with predilection -affects medium sized arteries, 1) Fever (high, unremitting and unresponsive to antibiotics) for at least 5 days Atypical or incomplete KD Adenovirus – with IVIg 2g/kg
Goodluck!  - Colleen Carlos TMC
Disease for coronary arteries
-evidence of infectious
trigger, genetics
-KD associated antigen
described in cytoplasmic
inclusion bodies
-fever and diffuse rash –
superantigen activity (like
STSS)
-common environmental
trigger in genetically
predisposed individuals
-2-3 yrs old, < 5 yrs
Acute Common in 6-15 yrs old
Rheumatic -due to immunologic reaction (delayed sequelae) of group A
Fever beta hemolytic strep of pharynx
-infection precedes ARF by 2-6 weeks
Goodluck!  - Colleen Carlos TMC
predilection for coronary
arteries
-edema of endothelial and
smooth muscle cells with
infiltration of vascular wall by
PMNs and macrophages
-inflammation involves all 3
layers of vascular wall, with
destruction of internal elastic
lamina
-loss of structural integrity
weakens vessel wall and results
in dilation, saccular or fusiform
aneurysm
-thrombi may form in lumen and
over time vascular wall may
become fibrotic  arterial
stenosis or occlusion
2) 4 of 5 – persistent fever but have exudative pharyngitis and High dose aspirin (80-
- Changes in extremities: Acute: erythema of palms, soles, edema of hands less than 4 characteristics conjunctivitis 100mg/kg/day q6 hours)
and feet
Subacute: periungal peeling of fingers, toes in weeks 2 LABS Scarlet fever – rapid -ideally within 10 days of onset
and 3 (1-3 -leukocyte normal to clinical response to
weeks after onset of illness elevated antibitoics unlike KD, and -aspirin dose decreased if px
- polymorphous exanthema (maculopapular, erythema multiforme, groin -normo, normo anemia is ocular findings rare afebrile for 48 hours (3-
area) common 5mg/kg/day as single dose
- bilateral bulbar and conjunctival injection without exudate -PC normal in 1st week, Measles – with exudative
- changes in lips and oral cavity: erythema, lip cracking strawberry tongue, increases by 2nd or 3rd week conjunctivitis, Koplik -aspirin continued for 6-8
diffuse injection of oral and pharyngeal mucosa spots, rash that begins weeks after onset,
- CLADS (>1.5cm) usually unilateral -sterile pyuria, mild inc of on face and hairline discontinued if normal 2decho,
LFT, hyperbilirubinemia if still with findings continue
Other symptoms common in 10 days prior to dx of Kawasaki may ne present Cervical lymphadenitis with aspirin therapy
- GIT (vomiting, diarrhea, abdominal pain) – 65% pxs
- Respiratory (interstitial infiltrates, effusion) – 30% pxs 2decho Leptospirosis – with hx IVIg resistant KD – persistence
- Significant irritability likely due to aseptic meningitis, mild hepatitis, hydrops -coronary artery exposure to water, have of fever 36 hrs after completion
of gallbladder dimensions in 1st 10 days renal and hepatic failure of IVIg completion
- Urethritis and meatitis with sterile pyuria of illness good predictors of -another dose IVIg 2g/kg given
- Arthritis – may occur early in illnesss or 2nd or 3rd week, small or large joints involvement Toxic shoxk syndrome –
may be affected -performed at diagnosis not seen in KD – renal other therapies
- Less consistent with KD: exudative conjunctivitis and pharyngitis, and after 2-3 weeks of insufficiency, -IV Methylpred
generalized lymphadenopathy, bullous, pustular or vesicular rashes illness coagulopathy, -Cyclophosphamide and
-if normal, repeat after 6-8 pancytopenia and plasmapheresis (less common)
Cardiac involvement weeks myositis -Infliximab (if second dose IVIg
- myocarditis (tachycardia out of proportion to fever) -if normal during diagnosis, ineffective
- diminished LV systolic function repeat f 1decho and lipid Drug reactions (SJS) –
- pericarditis with small pericardial effusion can also occur profile after 1 year different skin lesions COMPLICATIONS
- mild mitral regurgitation—disappears over time -2decho with stress testing—
- coronary artery aneurysms 25% in untreated pxs in 2nd-3rd week Systemic onset JIA – also possible angiography of
- giant aneurysms (>8mm diameter) high risk for rupture, thrombosis fever and rash but has aneurysm, stent implantation
- can also have aneurysms axillary, popliteal or iliac (pulsating mass) diffuse lymphadenopathy -long term ASA therapy – flu
and hepatosplenomegaly vaccination to reduce Reye
3 clinical phases syndrome
1. acute febrile phase – fever, lasts 1-2 weeks PROGNOSIS -can continue ASA after
2. subacute phase – desquamation, thrombocytosis, aneurysms, sudden -recurs in 1-3% varicella vaccine but usually
death , lasts 2 weeks -50% of coronary artery diff antiplatelet given
3. Convalescent phase – all clinical signs of illness have disappeared, ESR abn regress to normal by
back to normal, 6-8 wks after onset of illness 1-2 yrs old -live vaccines given 11 mos
-advise pxs healthy diet, after IVIg
exercise, avoid smoking,
lipid monitoring
JONES critera (2 major, 1 minor) ASO – reliable evidence of Mgnt
Major prior infection - Benzathine PCN
1. Polyarthritis – large joints, migratory - Anti inflamm
2. Carditis – 50%, tachycardia, murmur (MR or AR), pericarditis, cardiomegaly (salicylates)
or signs of heart failre - Bed rest
3. Subcutaneous nodules – firm, painless, nonpruritic mobile nodules on
extensor surfaces of large and small joints, spine and scalp Propylaxis
4. Erythema marginatum – serpiginous, non pruritic, evanescent rash , on - IM Benzathine PCN
trunk G (1.2M units every
5. Syndenham’s chorea- uncommon, usually after infection 28 days
Minor - If allergic, macrolide
1. fever (temp 38.2-38.9C) but not as effective)
2. arthralgia
3. previous RF
4. Leukocytosis
5. Elevated ESR/CRP
6. Prolonged PR interval