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18 December 2008

What does that rash mean?

Has your child come out in spots? Do a spot check with our guide to 12 childhood rashes with fever as symptom.

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Has your child come out in spots? Do a spot check with our guide to 12 childhood rashes with fever as symptom.

Roseola

Roseola infantum (baby measles) is a mild viral infection common in children aged six months to two years.

Typical symptoms are a sudden raised temperature (39-40 deg C), irritability and maybe even a fever convulsion. Fever remains high for three days. A faint spotty pink rash then appears on the body and neck, the fever disappears and the child is better. The rash persists for up to four days. There may be swelling around the eyes and enlarged lymph glands at the back of the head.

The virus that causes roseola is extremely widespread. By the time we're adults most of us have been infected and often carry the virus.

An infant is commonly infected by a parent when immunity from the mother wears off at six months. Some infants don't have the rash, only a feverish illness or cold symptoms. Don't give an antibiotic; it won't help. Paracetamol (½-1 teaspoon) will make the child feel better and may prevent a fever convulsion.

Feeding is usually not badly affected and breastfeeding should be continued where applicable. Roseola is almost always a harmless illness. It may be more severe in children with chronic illnesses or lowered resistance.

Measles (rubeola)

Measles, a viral infection, rarely occurs in infants under nine months. Younger children are protected by antibodies passed on from the mother (provided she had measles herself as a child or was vaccinated).

Symptoms are a sudden onset of fever, fretfulness, a runny nose, red watering eyes and coughing, all worsening over three days. Young children may have severe diarrhoea.

Later tiny white spots on a red base are seen on the insides of the cheeks. After three or four days of fever a blotchy red rash appears. The rash first comes out on the neck and face then spreads and steadily worsens over two to three days until it covers most of the body.

Only then will the fever subside and the rash gradually clear. As it clears the skin may have a darkish colour with fine scaling. Give paracetamol to reduce fever and plenty of fluids. Antibiotics are not indicated except for complications such as ear infection or pneumonia. The child is no longer infectious from about five days after the rash appeared.

Most otherwise healthy children recover completely within about 10 days. But young infants, malnourished children and those with chronic illnesses or immune suppression may suffer various complications - serious gastroenteritis, croup, bronchopneumonia or even progressive TB.

A rare complication is inflammation of the brain (encephalitis) which can set in at the height of the illness. Measles is completely preventable by vaccination at nine and 18 months.

German measles (rubella)

German measles is most common in school-age children. In younger children the illness may pass unnoticed.

Fever is not a prominent feature; the rash may just appear suddenly or follow a day or two after having a sore throat and being mildly unwell. Tiny flat pink spots appear first on the face before rapidly spreading to the body and limbs.

The spots merge into a general redness the next day and the rash is usually gone by the third day. The lymph glands at the back of the head and in the upper neck are tender and enlarged. The child is otherwise well.

Some children, and especially adolescents, have troublesome joint pains. The illness is generally very mild and no specific treatment is required. The greatest danger is when an expectant mother contracts German measles during early pregnancy since the fetus may be severely affected by the rubella virus.

This is the main reason for routine immunisation with a triple MMR vaccine that prevents measles, mumps and rubella.

Rare complications are inflammation of the brain and a bleeding disorder due to low numbers of platelets in the blood. Consult a doctor if the child bruises easily or red spots appear on the skin.

Erthema Infectosium ('slapped cheek disease')

This viral infection is generally a very mild illness with slight fever followed by the appearance of a rash.

It is most common in children of school-going age but often causes no symptoms at all. The first sign is trademark very red cheeks with some paleness around the mouth.

Then a spotty, red, slightly itchy rash comes out on the body and limbs. It gradually clears in a week to three weeks but persists longest on the limbs as a lacy pattern which may come and go with changes in temperature such as cold weather or a hot bath.

Sometimes the initial fever may be more severe, with headache and muscle or joint pains before the rash comes out. The virus is spread by droplets exhaled through the breath. No specific treatment is needed in the average case. Isolation is not required as it is not infectious once the rash is noticed.

This virus infection also attacks the cells that form red blood cells. This has no ill effects in otherwise healthy children. But children with chronic blood conditions such as haemolytic anaemia or malignancy may develop profound anaemia.

Joint pains may sometimes be a problem, especially in older children and adults. The illness is also known as fifth disease.

Scarlet fever

Scarlet fever is caused by certain strains of streptococcus bacteria. It usually occurs in children older than four years. Typically the child suddenly complains of a sore throat, headache and abdominal pain, and has a high fever.

A rash appears after two to three days, first in the armpits and groin, spreading to the body and limbs. The skin folds are more intensely red. The cheeks are flushed and there is paleness round the mouth.

The tongue first has a white coating and later turns strawberry red. The glands in the neck are tender and enlarged. Without treatment the temperature settles after about 10 days.

There is a fine peeling of the face, body and especially hands and feet. An antibiotic is essential to eradicate the infection and the first choice is still penicillin - by injection or by mouth and in severe cases intravenously. A child who is allergic to penicillin should receive erythromycin.

Paracetamol will ease the sore throat and bring down the temperature. Scarlet fever can be dangerous although it is now less severe than in the past.

Possible complications are an abscess in the tonsils, sinusitis, ear infection, inflammation of the kidneys and rheumatic fever. The child should be kept away from other children until the rash fades.

Glandular fever (infectious mononucleosis)

This usually occurs in older children; rarely in those under 10 years. A severe throat infection with fever is the most common symptom.

Most cases have general enlargement of lymph glands in the neck, armpits and groin. Other features may be swelling around the eyes, abdominal pain (due to enlargement of the spleen and liver) and occasionally jaundice.

In about 10 per cent of cases a spotty red rash will be seen. In children who have been given the antibiotic ampicillin or one of its derivatives an extensive generalised rash appears.

The cause is the Epstein-Barr virus. This virus causes only mild non-specific illness in younger children - or no symptoms at all.

There is no specific treatment and antibiotics (especially ampicillin) are contraindicated. Ampicillin should never be given to a child with a sore throat in case the child has glandular fever.

Although mostly mild and self-limiting this is an unpredictable illness with a number of possible complications. A medical opinion should always be sought if the condition is suspected.

Kawasaki disease

This is a rare but dangerous illness. It can occur in children aged between one and eight years.

The temperature rises suddenly and the child feels ill. After two days of fever there is redness of the eyes and a sore red mouth, lips, tongue and throat.

There is frequently enlargement of the neck glands. A generalised rash appears (often involving the nappy area) and this can take several forms. Characteristically there is swelling and redness of the hands and feet.

The child is acutely ill and may have several other complaints - diarrhoea and vomiting, abdominal pain, headache or stiff neck. The temperature stays high for five to 10 days without treatment, then settles.

The cause is still unknown but is presumed to result in inflammation of the tiny blood vessels, which can spread to larger vessels, especially in the heart.

Fortunately there is a specific treatment that can prevent complications and hasten recovery.

Admission to hospital is essential. For this reason parents should know about this disease and consult a doctor about any feverish illness with these symptoms.

The main complication is damage to the coronary arteries and heart. If it's undiagnosed symptoms of heart disease may appear only months or years later.

Kawasaki disease and meningococcal infection can be fatal. Seek medical attention immediately.

Meningococcal infection

This dangerous infection can affect any age.

The infection may be present only in the bloodstream or it may rapidly lead to meningitis. If the latter the symptoms are fever, headache, vomiting and neck stiffness, often with convulsions and disturbed consciousness.

If the former the picture is less clear-cut - fever, vomiting, rapid breathing and heart rate, and muscle pains.

A rash starts off as a few scattered red spots anywhere on the body, rapidly becoming big, dark-purple spots which look like bruises.

The red spots on the skin don't turn white when you press on them. In the worst cases shock rapidly ensues - cold extremities, a poor pulse and extensive bruising. Bleeding into internal organs can occur. The child may die within three to four hours.

The cause is a bacterium called meningococcus or neisseria, which is present in the throat and causes infection only in certain cases. It's now known that some families have less resistance to this bacterium due to certain immune defects. There is an effective treatment but admission to hospital is required.

Chickenpox (varicella)

Chickenpox is a common illness. Any age can be affected but it is particularly severe in newborns and often also in adults.

The illness starts with fever and feeling unwell with more severe and prolonged symptoms in older patients. In many the first symptom is an itchy rash which consists of a crop of spots that become raised and within hours turn into small round blisters.

A series of crops then appear on the face, scalp, body and limbs. After three to four days the blisters contain pus, then form scabs which dry out. The lesions may also develop in the mouth, around the eyes or in the genital area. Severity may vary from just a few spots to a profuse rash covering the entire body.

Typically spots at different stages (red spot, blisters and blisters with pus) are present at the same time and a few spots are almost always present on the scalp.

The scabs separate after seven to 14 days. The spots can easily become infected due to scratching. Infection takes more than two weeks after contact to appear so when it occurs in a school or hospital ward chickenpox is difficult to eradicate.

No treatment is required for mild cases and bed rest is unnecessary. Calamine lotion will ease the itching and dry out blisters.

Avoid aspirin. Infected spots require a local antiseptic solution and if severe, an antibiotic. Although mostly mild chicken pox is unpredictable on rare occasions there may be complications such as pneumonia and encephalitis.

Shingles (herpes zoster)

Shingles is mostly a complaint in older people but it's not rare in children, especially those with lowered resistance to infection.

Spots suddenly appear in a group on half the body or head. These become blisters of various sizes which may burst, leaving raw areas, and become infected. In adults, but not generally in children, the rash may be preceded by pain, which can persist for long periods after the rash has healed.

Shingles mostly occurs on the body but is more serious if it affects the eye region or ear.

It's caused by the same virus that causes chickenpox and which has lain dormant in a nerve since a bout of chickenpox months or years ago.

The virus then travels down the nerve to infect the nerve's area of skin. Children can also catch chickenpox from someone with shingles.

The illness is usually mild in children and paracetamol will control pain. Keep the skin sores dry and clean. Healing is slow and a white scar may remain.

Damage to the cornea of the eye and paralysis of the face are rare complications.

Cold sores (herpes simplex)

A child's first contact with the "cold sore virus" may result in a troublesome acute infection in the mouth.

It starts with a rise in temperature and soon painful ulcers erupt anywhere in the oral cavity - in the throat, inside the cheeks or on the tongue. The sores are really little blisters which rapidly burst, leaving a raw surface.

At the same time the gums become red and swollen. The fever and infection can last for a week or more during which the child is sick and irritable. Because feeding is painful nutrition may suffer and this is especially important in children who are already malnourished or have another illness.

Blisters and sores may also appear on the outside of the lips, on the fingers (from sucking) and elsewhere.

After the infection the virus persists for life, living in a nerve in the head. It may be activated by any infection, such as a cold, and blisters will appear on the lips. Most people carry the herpes simplex virus. There are two types: type 1 is responsible for most mouth infections in children; type 2 produces blisters in the genital area in adolescents and adults and may be sexually transmitted.

Paracetamol three times a day will control pain and fever. It is important to maintain nutrition with frequent small, bland, milk-based feeds.

Effective anti-herpes agents are available and are given particularly to children with chronic illnesses or in complicated cases.

Both forms can cause severe generalised infections in newborns. Special care must therefore be given to women with genital herpes.

Herpes simplex may cause severe inflammation of the brain.

Did you know?
This virus persists for life, living in a nerve in the head. It may be reactivated by a cold.

Hand, foot and mouth disease

This viral infection is most common in summer when it may occur in outbreaks.

There is little fever and the first sign may be a disinclination to feed or eat. A few small ulcers will be seen on the tongue or elsewhere in the mouth. Soon painless pearl-like blisters appear on the palms and soles and on the outside of the hands and feet. All heal in about a week.

This is a mild infection and no treatment is required.

Even though many of these infections are mild it's advisable to call a doctor to identify the cause whenever a child develops a rash. Rashes are often highly infectious and this has implications for other family members and the community.

Treatment for children with a fever

Fever is the body's way of fighting off viruses or bacteria. In certain cases however a fever is more serious.

A child's temperature isn't always an accurate indication of how sick he is. Flu or a cold can easily push up a child's temperature to over 39 deg C, even though he might not be particularly sick. Some extremely dangerous infections cause hardly any increase in a child's - and especially a baby's - temperature and might even cause it to drop.

Children with a fever usually breathe faster and their hearts beat more rapidly. If a child has a fever but still feels like playing, eats and drinks normally and keeps on smiling, you need to watch him but you don't have to rush him to the doctor.

You do need to see a doctor if . . .

  • Your baby is younger than three months and has a temperature of more than 38 deg C.
  • Your child is older than three months and has a temperature of more than 40 deg C.
  • Your child is older than three months and has a temperature of between 38 deg C and 40 deg C but doesn't want to eat or drink, has constant diarrhoea or nausea, shows signs of dehydration or has short spells of fever a few nights in a row, or if the fever doesn't drop within 72 hours after sponging your child down and administering children's paracetamol or ibuprofen.
  • <
  • Your child is younger than two years and the fever doesn't drop within 24 hours of doing the above.

911- Rush to your doctor if your child has a fever and . . .

  • Cries inconsolably for hours and is extremely irritable.
  • Is very listless and struggles to wake up.
  • Has a rash that looks like bruising.
  • Struggles to breathe.
  • Leans forward and drools.
  • Has what appears to be an epileptic attack or fit.
  • The lips, tongue and nails are blue.
  • His neck is stiff and he has a bad headache.
  • His body is limp and he struggles to move.
  • The fontanel on his head bulges.

This story originally appeared in Pulse magazine. Buy the latest copy, on newsstand now, for more fascinating stories in the world of health and wellness.

YOU Pulse; Spring, September 2007

 
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