Infectious Childhood Conditions

• Impetigo


  • Non-bullous impetigo is caused by Staphylococcus aureus, Streptococc-us pyogenes or a combination of both. Bullous impetigo is caused by Staphylococcus aureus
  • Rash is vesicular (blisters), which burst leaving moist golden crusts on the skin. Redness may develop under the patch. Occurs mainly on the face, especially around the mouth, chin and nose. No other symptoms present
• Impetigo treatment

  1. Less than 3 lesions/clusters= non bullous. If infection is mild and very localized, treat with either topical hydrogen peroxide (P) cream or fusidic acid cream (POM) (three times a day for 5 days)

  2. If impetigo is more widespread or bullous treat with an oral antibiotic: Oral flucloxicillin (four times a day for 7 days) is recommended first line. Oral clarithromycin (twice a day for 7 days) can be considered as an alternative if the person is allergic to penicillin
• Meningitis


  • Overall in the UK, Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae type b (Hib) are the most common causative organisms of acute bacterial meningitis
• Meningitis treatment


  1. Call 999

  2. Rash: empirical IV benzylpenicillin if cannot reach hospital

  3. No rash: empirical IV benzylpenicillin or cefotaxime if cannot reach hospital

  4. Classic test for meningitis, if rash doesn't blanch: Babies soft spot bulging
• Molluscum contagiosum


  • Molluscum contagiosum virus (MCV), a member of the Poxviridae family
  • Rash appears as pearly-white slightly pink wart like lumps, with central punctum (dimple). White cheesy exudate is seen on squeezing. Occurs in clusters mainly on face and axillae, rare on palms and soles. No other symptoms present
• Non-specific viral rash


  • Unknown (any virus)
  • Widespread blotchy red spots, slightly itchy, commonly affecting most of the body appearing suddenly and disappearing after a few days. Can be associated with other symptoms such as mild fever and cough
• Non-specific viral rash treatment

  1. No cure. Symptomatic treatment

  2. Fluids

  3. Paracetamol or ibuprofen for fever

  4. Antihistamine for itch
• Ringworm Practical Measures :

  Wear loose-fitting clothes made of cotton or a material designed to keep moisture away from the skin, maintain good hygiene by washing affected skin areas daily, after washing dry thoroughly, especially in the skin folds, avoid scratching as this may spread infection , do not share towels, and wash them frequently , wash clothes and bed linen frequently to eradicate fungal spores
• Roseola treatment

  1. No cure. Symptomatic treatment

  2. Fluids, rest

  3. Paracetamol or ibuprofen for pain or fever

  4. Not necessary for the child to stay off school or nursery once feeling well
• Rubella (German measles)


  • Rubella is a single‐stranded ribonucleic acid (RNA) virus in the family Togaviridae
  • Rash is macular, pinpoint spots starting on face and moving quickly to trunk. Cold-like symptoms and swollen glands in neck appear 5 days before rash. Typically resolves within a week
• Rubella treatment


  1. Notifiable disease (within 3 days)

  2. No cure. Symptomatic treatment

  3. Fluids, rest

  4. Paracetamol or ibuprofen for pain

  5. Stay away from work/school at least 5 days from when rash appears
• Scarlet fever


  • Bacteria Streptococcus pyogenes, also known as group A streptococcus (GAS)
  • Bright red rash starting as small spots on neck and upper chest and spreading to other parts of body; face becomes flushed. Rash blanches on pressure. Initial signs are sore throat and fever. Tongue becomes pale and coated with red spots (strawberry tongue) and after a few days, whole tongue looks red. Child feels generally unwell with headache and vomiting. Resolves within 1 week
• Scarlet fever treatment


  1. Notifiable disease (within 3 days)

  2. Stay away from work/school at least 24 hours after starting antibiotic treatment. Or 2-3 wks without antibiotics

  3. Fluids, rest

  4. Paracetamol or ibuprofen for pain and fever

  5. Wash their hands frequently (for example before preparing and eating food, and after sneezing), avoid sharing eating utensils and towels, and dispose of handkerchiefs promptly

  6. Phenoxymethylpenicillin (penicillin V) qds for 10 days first line. Alternative is amoxicillin. Or azithromycin once a day for 5 days if penicillin allergy

  7. Refer if spreading

  8. Contact GP
• Slapped cheek disease/syndrome (Fifth disease) (Parvovirus B19)


  • Parvovirus B19 is a member of the Parvoviridae family of single-stranded DNA viruses
  • Rash appears as a bright red scald on one or both cheeks, giving impression of being slapped and is painless. More widespread, faint rash sometimes seen on body. Other symptoms include mild headache, mild fever and joint pain
• Slapped cheek disease/syndrome treatment

  1. No cure. Symptomatic treatment

  2. Fluids, rest

  3. Paracetamol or ibuprofen for pain or fever

  4. Child should no longer be infectious once the rash develops, and it is not necessary for the child to stay off school or nursery
• Chickenpox is caused by the Varicella-zoster virus
• Chicken pox symptoms: Spots on the face and trunk in crops, develop into small blisters which burst and crust over, once this happens they are no longer infections
• Chickenpox identifying features is very itchy spots, fever, headache and malaise (prodromal)
• There is no cure for chickenpox, itch relief e.g chlorphenamine or calamine cream, paracetamol or calpol for fever not ibuprofen as it makes infection worse
• General practical measures for all conditions are fluids, analgesics and rest
• Avoid itching chickenpox e.g loose clothing, cut nails or wear mittens
• Chicken pox lasts for 10 days
• Glandular fever is caused by epstein-barr virus and takes 1-2 months to develop after infection
• Symptoms of Glandular fever : Fever, sore throat, swollen neck glands in neck or armpits, fatigue, less commonly chills and sweats, loss of appetite and rashes.
• Glandular fever usually resolves within 2-3 weeks
• Glandular fever has no cure, fluids and paracetamol for fever
• Hand, foot and mouth disease (Enteroviruses)
• HFandM disease causes: Sore throat, fever, loss of appetite experienced a few days before mouth ulcers and rash. Spots can blister and become painful

  
• HFandM disease lasts 7-10days, plenty of fluids and rest, paracetamol/ibuprofen and keep of school. Caution if exposed during pregnancy, see doctor
• Impetigo hygiene measures: Washes affected areas with soap and water regularly, in particular after touching a patch of impetigo, avoids scratching affected areas, avoids sharing towels, face cloths, and other personal care products and thoroughly cleans potentially contaminated toys and play equipment
• Impetigo - Stay away from school/work until lesions are healed, dry and crusted over or 48 hours after initiation of antibiotics
• Impetigo lasts 3 weeks without treatment
• Measles (Paramyxovirus) - A maculopapular rash, red and blotchy behind ears, head and neck, takes 2-3 days to spread down to trunk and limbs.
• Measles signs is high fever, conjunctivitis and runny nose, cough, diarrhoea and Koplik spots (white) inside mouth. Blanching brown and reddish spots
• Refer Measles if : Shortness of breath, earache, confusion or convulsions
• Measles- stay away from school until fully recovered or at least 4 days from when rash appears
• Measles - fluid and rest, paracetamol/ibuprofen for fever and pain
• Measles cases should be notified to local health team within 3 days.
• Discuss MMR vaccination if not already ( Mumps, Measles Rubella)
• Refer to GP for monitoring