Fever With Skin Rash in Children
Rubella(German Measles)
(3 day Measles)
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· It was initially recognized as resembling measles & was closely studied by German Physicians. Later on, continued to be called as German Measles.
· Post natal infection with rubella à mild disease,
· Low grade fever, sore throat, red eyes, headache,
· Suboccipital, posterior auricular, anterior cervical lymphnodes are enlarged.
· Petechiael haemorrhages on soft palate.
· Rashes for 3 days
· Thrombocytopenia, Arthritis, Encephalitis & Progressive rubella panencephalitis are known complications.
Congenital Rubella Syndrome
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· Maternal rubella infection in first trimester (embryogenesis) à defects in 90% of the off springs
· Nerve deafness (single most common)
· CHD (PDA, Pulmonarystenosis, Septal defects)
· Cataract
· Salt & pepper ratinopathy
· Microcephaly
· Hepatosplenomegaly
· Thrombocytopenia.
· Rubella vaccine to all girls is most effective preventive measure for congenital rubella syndrome
Infectious Mononucleosis (EBV)
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· Fever of long duration, malaise, fatigue, sore throat, abdominal pain
· Marked pharyngotonsillitis, periorbital oedema, generalized tender lymphadenopathy, hepatosplenomegaly
· Soft Splenomegaly is the characteristics, rupture spleen following trivial injury is known
· Epitrochlear LN is almost pathognomonic
· Macular rash, precipitated or aggravated by ampicillin / amoxicillin.
· Infectious mononucleosis is named because of the mononuclear lymphocytosis with atypical lymphocytes that accompany the clinical syndrome
· It is also called as kissing disease due to transmission of EBV by oral kissing in adolescents.
· It was called as glandular disease due to lymphadenopathy.
· EBV infection can occur without manifestations of disease, while infectious mononucleosis means clinical manifestations of EBV infections.
· Transmission by,
× Exposure to saliva.
× Oral kissing in adolescents.
× Blood transfusion.
× Bone marrow transplantation.
× No spread by droplets, fomites or sexual contact.
· Pharyngitis is often associated with whitish or gray – green exudates having an offensive odour
Erythema Infectiosum (Fifth disease)
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· Parvovirus B19
· 5 to 15 years of age
· Prodromal symptoms à Rash of “slapped cheek” appearance à spreads to trunk & extremities
· Complications like arthropathy, ITP, aseptic meningitis, transient aplastic crisis in patients with chronic hemolytic anaemia, HLH, hydrops fetalis, myocarditis
Hand – Foot and Mouth Disease
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· Frequently caused by coxasackievirus A 16, also by enterovirus 71, coxasackie A virus 5, 7, 9 & 10
· Mild illness, with or without low grade fever
· Inflamed oropharynx, scattered vesicles on tongue, buccal mucosa, palate lips, may ulcerate
· Maculopapular, vesicular &/or pustular lesions over hands, feet, buttocks, groins
· Hand – Foot & Mouth disease by enterovirus 71 is frequently severe, neurological disease, pulmonary haemorrhage, shock & rapid death
Dengue Fever
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· High grade fever
· Blanchable erythematous flush (measly look)
· Swollen face, injected eyes, redness of ears,
· Maculopapular rash may develop on the top of erythematous flush
· Catarrh, typical characteristics of respiratory virus is missing
· Headache, retro – orbital pain, photophobia, backache, myalgia, arthralgia, anorexia etc
· Petechiael spots & mucous membrane bleeding (nose, gum, conjunctiva) may be seen
Chikungunya
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· 3 months Male.
· Fever high grade 7 days.
· Irritable.
· Generalized hyperpigmentation 3 days.
· H/o chikungunya to mother.
· Chikungunya RT – PCR: Detected.
Chikungunya
· Chikungunya named is derived from stooped position of the patient due to severe arthralgia in a case of chikungunya.
· Chikungunya is the mosquito born arboviral disease.
· It is transmitted to human through day – biting mosquitoes, Aedes aegypti & Aedes albopictus. Some cases of blood born transmission also have been reported. Fetomaternal transmission has been documented during pregnancy mainly in perinatal period.
· Sudden onset of fever with polyarthralgia more often bilateral symmetric pattern, myalgia, headache, fatigue & skin rashes are common symptoms. Fever may rise upto 104. F & may be associated with rigors. Fever may last upto 7days.
· Atypical & Severe manifestations
× Vesiculobullous skin lesions, Hyperpigmentation.
× Febrile seizures.
× Meningoencephalitis.
× GBS.
× Encephalopathy.
× Cerebellar syndrome.
× Myocarditis, arrhythmias.
× Acute Renal failure.
Bleeding dyscrasias.
Aspirant pilots have anziety towards his glasses 2. The following ophthalmological conditions are disqualifying for initial issue medical examinations: (a) History/ evidence of recurrent keratitis (b) Keratoconus (c) Macular degeneration (d) Hereditary degeneration which interferes with visual acuity and/or visual fields (e) Retinitis Pigmentosa (f) Retinal Detachment (g) Retinal vascular disorders with exudates or neovascularisation (h) Optic neuritis and optic atrophy (i) Central Serous Retinopathy (j) Glaucoma (k) Any intraocular surgery (l) Manifest squint 3. students for initial issue medical examination having corneal / congenital lenticular opacities which are non-progressive and do not interfere with vision may be considered fit for flying duties. 4. Lattice Degeneration (LD) and retinal holes. LD of the retina is a common vitreo-retinal degeneration. High risk features in LD which may predispose to retinal detachment (RD) include extent of LD more than three clock hours, p...
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