Highly febrile child >39C, fever more than five days not responding to antipyretic, Unilateral Cervical lymphadenopathy (history of prominent neck swelling), polymorphous rash and strawberry tongue+ red lips. swelling and peeling of hands and feet, and red eyes(non-purulent) . Child will not be eating, may be dehydrated. Coronary aneurysms.

Mnemonic: CRASH + Burn: Conjunctivitis, Rash, Adenopathy, Strawberry tongue, Hands and feet swelling, ≥5days of fever.

The distractor in this case is that he met  a child few days ago diagnosed with chicken pox ...be careful!!! 

Scarlet fever: Age 5-15 years, fever, sandpaper like rash, mild generalised LNs.

Measles: Fever, conjunctivitis with photophobia,

cough, coryza, mild generalised LNs.

Koplik’s spots (tiny white spots on bright red background found on buccal mucosa of cheeks), rash (florid maculopapular appears after 4d—becomes confluent)

Complications: bronchopneumonia, otitis media, stomatitis, corneal ulcers, gastroenteritis, appendicitis, encephalitis (1 in 1000 affected children), subacute sclerosing panencephalitis (rare), unvaccinated child of any age, notifiable disease.

Glandular fever infectious mononucleosis:

Caused by EBV. Spread by droplet infection and direct contact (‘kissing disease’); 4–14d incubation period. Consider in teenagers/young adults presenting with sore throat lasting >1wk. Other symptoms/signs: malaise, fatigue, lymphadenopathy, enlarged spleen, palatal petechiae, tonsillar exudates± maculopapular rash (10–20%).

After introduction, "I understand your child has been ill and has been seen previously by one of our nurses"

"Can you take me through what`s been happening"

Open Q Ask for more information about the fever.

FODIPARA:

frequency, on and off, constant, how many episodes.; onset(gradual/sudden),

duration (Kawasaki >5days),

intensity: fever measured by parents?, highest recorded, (Kawasaki usually has a very high fever >39C). if not measured warm to touch?

Progression: worse, stable improved

Aggr: recent travel history, contact with: patient with fever, rash (careful history of contact with patient with chickenpox...its a trap)

Relieving factors: meds(Kawasaki may have little to relief from antipyretics).

Associated symptoms: Ask about neck swelling mentioned in the prompt.

Do a paediatric infection screen:

3 in the head:

Meningitis (rash, shyness to light, neck stiffness),

Acute otitis media (tugging of the ears while crying, ear discharge) ,

URTIs (sneezing runny nose hoarseness)

3 in the torso:

Acute bronchiolitis /Pneumonia (breathing problems, cough)

Gastroenteritis (diarrhoea, vomiting, changes in poo, travel hx, contact hx)

UTI(crys when peeing, smelly pee) and Nappy rash

3 others: Encephalitis (weakness, seizures), Septic arthritis & osteomyelitis (swollen limb or joint, not moving a part of the body, not bearing weight) and Kawasaki (fever>5days, lips, hand and feet swelling, red eyes) disease.

Red Flag

Dehydration!!!!!!!!!!!!: Eating, drinking, passing urine, crying without tears, lethergy, drowsiness, "he has not been himself"

Kawasaki disease is an illness that causes inflammation in your child’s blood vessels, especially the ones that supply the heart (coronary arteries). It mostly affects children under 5 years old. While we don’t yet know the exact cause, doctors believe it may be triggered by an overactive immune response to an infection. Your child may have:

A high fever (lasting 5+ days) that doesn’t improve with usual medicines

Red eyes (without pus or crust)

A rash (often on the torso or groin)

Swollen, red lips and tongue (sometimes called “strawberry tongue”)

Swollen, red hands and feet (later, skin may peel)

Swollen lymph nodes (usually on one side of the neck).

Is it serious?

Yes, it can be—but early treatment helps prevent complications. Without treatment, Kawasaki disease can lead to heart problems, including weak spots in the coronary arteries (aneurysms). The good news is that most children recover fully with proper care.

There is no diagnostic test for Kawasaki disease. Diagnosed is made clinically based on features above.

Urgent admission (Key decision): Child should be admitted for bedrest, further assessment, monitoring and treatment as soon as possible.

Early treatment (<10d after onset) with IV immunoglobulin and aspirin. reduced incidence and severity of aneurysm formation as well as giving symptom relief.

Serial echocardiography to monitor development of aneurysms, will be done even after discharge from hospital.

If cardiac complications are found: Refer to paediatric cardiologist. patient may need long term anticoagulant therapy with ECG and Echo monitoring. with regular follow ups.