After a week’s camping holiday this child has developed multiple red spots, which were widespread over his whole body. The child has been scratching the spots, and hadn’t slept very well the night before.

The father requests treatment for insect bites which he assumes have come from the camping holiday. He says other members of the family weren’t affected. Close inspection reveals small blisters at the site of each spot, some of which has crusted over.

QUESTIONS

1. This is a typical presentation of insect bites, with large areas of the body affected at the same time. True or false?

2. As in this case, insect bite rashes usually develops a few days after the initial bites are received. This is the result of an allergic reaction to the bite. True or false?

3. Although other members of the family aren’t affected, this condition is contagious. True or false?

4. An elderly relative currently has shingles, and had been in contact with the child a week before. This is the likely source of the rash. True or false?

5. Urgent referral to a GP is recommended so that antiviral medication can be prescribed within the first 48 hours. True or false?

DISCUSSION

1. False. Insect bites usually occur in clusters where the insect has come into contact with the body.

2. False. This rash is typical of chicken pox, not insect bites, with widepread vesicles and crusting on older lesions.

3. True. Chicken pox is caused by a virus which is present in the vesicles. Generally immunity develops after the first infection and so recurrent infection is uncommon.

4. True. Although shingles can’t be caught, it is caused by the same virus which causes chicken pox. Shingles lesions will shed this virus which can cause chicken pox.

5. False. In an otherwise fit and healthy child antiviral medication isn’t recommended.