Overview

• Mumps ⇒

  • Sx → enlargement of parotid glands (parotitis). Raised amylase.
  • Mx → notify HPU, supportive management, school exclusion for 5 days after parotid swelling.
    • Red Flags → signs of meningism and epididymo-orchitis in males. May also cause pancreatitis.

• Measles ⇒

  • Rarely seen now due to immunisation programmes.
  • Sx:
    • Prodromal Phase → irritable, conjunctivitis, fever.
    • Koplik Spots → white spots in mouth.
    • Rash → starts behind ears then to whole body.
    • No lymphadenopathy.
  • Complications → otitis media (most common), pneumonia (most common cause of death), encephalitis (after 1-2w), SSPE - Subacute Sclerosing Panencephalitis (after 7 years), febrile convulsions.
  • School exclusion for 4 days following initial rash onset. Notify HPU.

  <aside> 💡 Mearsles → rash starts behind ear + otitis media is most common complication.

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• Rubella ⇒

  • Transmitted through respiratory droplets. Now less common due to vaccinations. Incubation 14-21 days.
  • Most at risk populations are unvaccinated pregnant women, due to risk of congenital rubella syndrome.
  • Sx → fever, arthralgia, pink rash that starts on face and spreads to rest of body. Suboccipital and postauricular lymphadenopathy.
  • School exclusion for 5 days following initial rash onset. Notify HPU.
  • Ix → serological testing (IgM antibodies).

• Parvovirus B19 ⇒

  • Erythema Infectiosum / Fifth Disease / Slapped Cheek Syndrome → viral illness caused by parvovirus B19.
  • Often occurs in outbreaks, ie. in school settings. Spread by respiratory droplet transmission.
  • Sx → fever, coryzal symptoms, diarrhoea, initially rose-red rash on cheeks. Progresses to maculopapular (lace) like rash in trunk and limbs.
    • No need for school exclusion, child is not infectious once the rash emerges.
  • Mx → self-limiting, supportive treatment.

• Chickenpox (VZV) ⇒

  • Caused by primary infection with varicella zoster virus. Reactivation of dormant virus in dorsal root ganglion causes shingles.
  • Incubation period is 10-21 days. Infective for 4 days before rash until 5 days after rash first appeared.
  • Sx → fever initially. Itchy rash starting on head/trunk then spreading. Papular then vesicular then crust over.
  • Mx →
    • Supportive → paracetamol (if fever), hydration, trim nails, calamine lotion, school exclusion (infective until all lesions have crusted over).
    • Avoid NSAIDs (NO IBRUPROFEN) → can increase risk of secondary bacterial infection of lesions (necrotising fasciitis - chickenpox is a risk factor for invasive group A streptococcal soft tissue infections).
      • Secondary Bacterial Infection (sudden high fever after initial improvement + acute illness) → IV flucloxacillin + aciclovir.
  • Complications → pneumonia, encephalitis, disseminated haemorrhagic chickenpox.

Making Diagnosis

Clinical Features

Investigations

Management Plan

Complications →

Prognosis →