Coxsackie virus: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*[[Fever]], malaise, [[upper respiratory infection]], lymphadenopathy | *Brief prodrome with [[Fever]], malaise, [[upper respiratory infection]], lymphadenopathy | ||
* | *Common: | ||
* | **[[Herpangina]]: painful oral vesicles with erythematous base which then ulcerate | ||
*Parotitis | ***Vesicles located in anterior oral cavity (most common on tongue and buccal mucosa) | ||
*Orchitis | **[[Hand-foot-and-mouth disease]]: herpangina + red papules that become gray vesicles on hands and/or feet | ||
*Acute [[pericarditis]] | *Less common: | ||
*[[Myocarditis]] | **[[Parotitis]] | ||
**[[Orchitis]] | |||
**Acute [[pericarditis]] | |||
**[[Myocarditis]] | |||
**[[Meningitis]], [[encephalitis]] | |||
**Some children get a desquamation of the nails around 2 weeks afterwards (self resolves) | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Peds Rash DDX}} | |||
{{Bullous rashes DDX}} | |||
==Evaluation== | ==Evaluation== | ||
*Clinical diagnosis, based on history and physical examination | |||
**If unsure, see [[Pediatric Fever]] | |||
==Management== | ==Management== | ||
*No specific therapy for most; self-limited | |||
*[[NSAIDS]] and cool liquids for pain | |||
*Encourage good hand hygiene to prevent spread | |||
*Some recommend Magic Mouthwash/oral lidocaine if not tolerating PO intake, although evidence suggests no better than placebo<ref>Hopper S. et al. Topical lidocaine to improve oral intake in children with painful infectious mouth ulcers: a blinded, randomized, placebo-controlled trial. Ann Emerg Med. 2014 Mar;63(3):292-9</ref> | |||
'''In infants, do NOT use oral lidocaine due to risk of lidocaine toxicity and FDA black box warning'''<ref>FDA recommends not using lidocaine to treat teething pain. http://www.fda.gov/Drugs/DrugSafety/ucm402240.htm</ref><ref>Curtis LA, Dolan TS, Seibert HE. Are one or two dangerous? Lidocaine and topical anesthetic exposures in children. J Emerg Med 2009;37:32-39</ref> | |||
==Disposition== | ==Disposition== | ||
*Discharge with close outpatient followup to ensure adequate PO intake. | |||
==See Also== | ==See Also== | ||
*[[Pediatric fever]] | |||
*[[Hand-foot-and-mouth disease]] | |||
*[[Herpangina]] | |||
*[[Enteroviral Infections]] | |||
*[[Pediatric Rashes]] | |||
==External Links== | ==External Links== | ||
| Line 24: | Line 43: | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:ID]] | |||
Revision as of 17:49, 20 August 2017
Background
Clinical Features
- Brief prodrome with Fever, malaise, upper respiratory infection, lymphadenopathy
- Common:
- Herpangina: painful oral vesicles with erythematous base which then ulcerate
- Vesicles located in anterior oral cavity (most common on tongue and buccal mucosa)
- Hand-foot-and-mouth disease: herpangina + red papules that become gray vesicles on hands and/or feet
- Herpangina: painful oral vesicles with erythematous base which then ulcerate
- Less common:
- Parotitis
- Orchitis
- Acute pericarditis
- Myocarditis
- Meningitis, encephalitis
- Some children get a desquamation of the nails around 2 weeks afterwards (self resolves)
Differential Diagnosis
Pediatric Rash
- Atopic dermatitis
- Bed bugs
- Contact dermatitis
- Drug rash
- Erythema infectiosum (Fifth disease)
- Hand-foot-and-mouth disease
- Henoch-schonlein purpura (HSP)
- Herpangina
- Herpes simplex virus (HSV)
- Infectious mononucleosis
- Meningitis
- Measles
- Molluscum contagiosum
- Roseola infantum
- Rubella (German measles)
- Scabies
- Scarlet fever
- Smallpox
- Varicella (Chickenpox)
Vesiculobullous rashes
Febrile
- Diffuse distribution
- Varicella (chickenpox)
- Smallpox
- Monkeypox
- Disseminated gonococcal disease
- DIC
- Purpural fulminans
- Localized distribution
Afebrile
- Diffuse distribution
- Bullous pemphigoid
- Drug-Induced bullous disorders
- Pemphigus vulgaris
- Phytophotodermatitis
- Erythema multiforme major
- Bullous impetigo
- Localized distribution
- Contact dermatitis
- Herpes zoster (shingles)
- Dyshidrotic eczema
- Burn
- Dermatitis herpetiformis
- Erythema multiforme minor
- Poison Oak, Ivy, Sumac dermatitis
- Bullosis diabeticorum
- Bullous impetigo
- Folliculitis
Evaluation
- Clinical diagnosis, based on history and physical examination
- If unsure, see Pediatric Fever
Management
- No specific therapy for most; self-limited
- NSAIDS and cool liquids for pain
- Encourage good hand hygiene to prevent spread
- Some recommend Magic Mouthwash/oral lidocaine if not tolerating PO intake, although evidence suggests no better than placebo[1]
In infants, do NOT use oral lidocaine due to risk of lidocaine toxicity and FDA black box warning[2][3]
Disposition
- Discharge with close outpatient followup to ensure adequate PO intake.
See Also
External Links
References
- ↑ Hopper S. et al. Topical lidocaine to improve oral intake in children with painful infectious mouth ulcers: a blinded, randomized, placebo-controlled trial. Ann Emerg Med. 2014 Mar;63(3):292-9
- ↑ FDA recommends not using lidocaine to treat teething pain. http://www.fda.gov/Drugs/DrugSafety/ucm402240.htm
- ↑ Curtis LA, Dolan TS, Seibert HE. Are one or two dangerous? Lidocaine and topical anesthetic exposures in children. J Emerg Med 2009;37:32-39