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Exanthems/rashes are common in childhood and account for a large number of consultations in primary care and attendances to the emergency department. They are typically caused by allergic reactions, by viruses and occasionally by severe life-threatening bacterial infections. A careful history (including prodrome, associated symptoms, exposure to infectious contact, foreign travel, animals and immunization status), examination of the rash (including distribution, morphology, nature and site) and generalized examination (including presence of conjunctivitis, genital lesions, enanthems, hepatosplenomegaly and lymphadenopathy) can inform diagnosis. Molecular testing has led to a cause being identified in approximately 50% of cases. Early diagnosis is particularly important in the context of severe systemic infection, in immunocompromised hosts and in pregnancy. This review outlines the most common infectious exanthems, including measles, rubella, varicella, erythema infectiosum, roseola infantum and enterovirus infection.

We describe the youngest case to date of a 2 year old child who developed central skull base osteomyelitis (SBO) initially presenting with a fever, vomiting and sore throat. An extremely rare complication of mastoiditis following otitis media in children is SBO which can present with non-specific symptoms. This report describes the first case of symptomatic ischaemic stroke secondary to SBO in an immunocompetent child. We review the literature of the management and the potential cerebrovascular complications of central SBO in children secondary to otolaryngological infection.

L-ficolin is a pattern-recognition molecule which binds lipoteichoic acid and Gram-positive bacteria and activates the lectin pathway of complement. Five common functional polymorphisms have recently been identified in the FCN2 gene which encodes L-ficolin: three promoter polymorphisms (at positions -986, -602 and -4) which affect serum L-ficolin concentration, and two non-synonymous polymorphisms (Thr236Met and Ala258Ser) which influence carbohydrate binding. We studied the frequencies of these polymorphisms in individuals with invasive pneumococcal disease (IPD) and a control group. Although the five FCN2 polymorphisms were each present in the UK Caucasian population studied, no significant associations were observed between the FCN2 polymorphisms and susceptibility to IPD. This is in contrast to mannose-binding lectin deficiency, which we have previously shown to be associated with increased susceptibility to IPD. Although we are unable to exclude small effects of FCN2 genetic variation on susceptibility to IPD, the result suggests that L-ficolin may not be critical for host defence against pneumococcal infection.