Life-Threatening Rashes

Life-threatening rashes are uncommon, and your child usually appears quite ill if he or she has a life-threatening rash. If you suspect your child may have a life-threatening rash, you should go to your hospital's emergency department immediately.

Fever and petechiae

Petechiae are small red or purplish spots on the skin that don't fade when you press on them. Petechiae are due to broken capillaries in the skin. Petechiae without fever can occur in the head and neck after forceful coughing. Most children with petechiae and fever have a mild viral illness. However, fever and petechiae are also seen with bacterial sepsis, especially with meningococcal disease. This disease is highly fatal and extremely contagious. Any child with a fever and petechiae should be seen by a doctor immediately.

• Symptoms



• Petechiae are red dots on the skin that do not fade when pressure is applied. The dots represent bleeding from the capillaries leaving a small, temporary blood blister in the skin.



• Children with petechiae may appear healthy or very ill.



• Treatment



• Petechiae resolve completely without any treatment. However, a doctor should evaluate your child to determine that a serious disease process is not present.



• Your child may need blood tests and X-rays to find the cause of the petechiae and fever.



• Occasionally, a child also requires a lumbar puncture (spinal tap) to be sure meningitis is not the cause.

Meningococcemia

Also called, meningococcal sepsis, meningococcemia is a life-threatening bacterial invasion of the blood by bacteria called Neisseria meningitidis. This disease is seen primarily in the winter and spring in children younger than 2 years, but epidemics can occur in any season. Meningococcemia is spread from the nose and mouth of other people. Good hygiene and hand washing can help decrease the risk of transmission. Children exposed to people with this disease need to be evaluated by their doctor and possibly be put on antibiotics to protect them from getting the disease. (Other bacteria such as Haemophilus influenzae, Streptococcus pneumoniae, and Staphylococcus aureus can cause similar syndromes.)

• Symptoms



• Fever and a petechial rash are present.



• Headache, congestion, nausea, vomiting, and muscle aches may also occur.



• The rash may start out as small bumps or raised blisters but develop into petechiae.



• Petechiae are broken capillaries in the skin that cause red dots that do not disappear when pressure is applied to the skin.



• Treatment



• Take a child with the symptoms of meningococcemia to your hospital's emergency department immediately.



• Blood tests, including blood cultures, may be needed, as may X-rays and a spinal tap, to fully evaluate your child.



• Meningococcemia is treated in the hospital with IV antibiotics. Intensive care therapy may also be required.



• Meningococcal sepsis is often fatal even with appropriate antibiotic therapy. Early treatment and close observation are needed.

Rocky Mountain spotted fever

Rocky Mountain spotted fever (RMSF) is a disease spread by tick bites, but often the child and parent may not remember any bite. The ticks carry infection with the bacteria Rickettsia rickettsii. In spite of its name, it is more common in the Southeast than in the Rocky Mountains. It tends to occur in the warmer months of April through September when ticks are more active and outdoor exposures are more likely to occur. Rocky Mountain spotted fever can be fatal even in young healthy adults, but with early diagnosis and treatment with appropriate antibiotics, the mortality rate is low.

• Symptoms



• About two to 14 days after the tick bite, the child develops a sudden fever (101 F or more), headache, muscle aches, and rash. Only 3% of patients will initially have rash, fever and headache.



• The rash usually appears on the second to fifth day of the illness.



• The rash begins as red spots on the wrists and ankles and spreads inward to the trunk. The rash begins as flat, red marks which blanch with pressure. Later on, the classic rash will become raised and may have a non-blanching red center. However, 9%-12% of patients will not develop a rash at all.



• The rash may involve the palms of the hands and soles of the feet but usually does not involve the face. As the rash progresses, it becomes petechial (does not blanch with pressure), with red to purplish dots or even small bruises.



• Treatment



• Contact your physician immediately if you suspect your child has RMSF or with any concerns of a tick-related illness.



• RMSF treatment must be started early as the blood tests may not turn positive for up to 10 days after the start of the illness. Treatment must be started before this time to avoid serious complications.



• Most children are put in the hospital and given antibiotics.



• Prevention



• The most effective means to prevent Rocky Mountain spotted fever and many other tick-transmitted diseases (such as Lyme disease or ehrlichiosis) is to keep from getting bitten by ticks.



• When outdoors, dress in light colors that make it easier to see ticks if they attach themselves.



• Wear long sleeves and long pants, tucking the pant legs into the socks.



• Check for ticks on your body periodically, paying special attention to the scalp, underarms, and genital areas.



• Use an insect repellent that is effective against ticks. Both DEET and Picardin are long lasting and provide protection. Picardin has low skin absorption and does not stain fabrics.



• Never use a concentration of DEET (N, N-diethyltoluamide) higher than 30%, and never apply it to the skin. Do not use DEET on children less than 4 months of age. Do not apply to broken skin. Avoid getting DEET into the eyes, nose, or mouth. DEET can damage synthetic fibers, so be careful applying this to clothing.



• Apply the insect repellent to the shirt collar, sleeves, and pants. There are permethrin products that can be applied only to clothing which are long-lasting and effective in helping to prevent tick bites.



• Once a tick has attached itself to you or your child, it should be promptly removed.



• Gently grab the tick with tweezers close to the skin (to include the head) and apply a gentle tug. Do not crush the tick, as this usually results in leaving the microscopic mouth parts still attached.



• Hold this gentle tension until the tick releases. This may take several minutes.



• Cleanse the bite area with alcohol, and call your doctor immediately.



• Avoid the old home remedies of applying lighter fluid, petroleum jelly, gasoline, or a lit match to kill a tick. Once the tick is dead, the mouth parts may stay in the wound and greatly increase the risk of disease.



• Ticks can also be brought into your home by your pets, so be sure to have your veterinarian check your pet regularly and ask about products to reduce the risk.

Lyme disease

Lyme disease is also caused by an organism spread by deer tick bites. Avoiding tick bites is the best defense. The disease has been reported in the Northeast, Mid-Atlantic, North Central, and Pacific coastal regions of the United States and in Europe. It is most prevalent in the northeastern states of the United States, with about half of all cases clustered in New York and Connecticut.

• Symptoms



• Lyme disease starts with a flu-like illness or a characteristic target-like rash several days to a few weeks following a tick bite.



• The illness consists of a fever, which can range from 100 F-104 F, headache, muscle and joint aches, a mild sore throat, a cough, stomach upset, neck pain and stiffness, and Bell's palsy (a paralysis of the facial nerve that causes your face muscles to be uneven).



• The rash is red and grows in size daily.



• The U.S. Centers for Disease Control and Prevention (CDC) defines the rash to be a minimum of 3.5 cm (1.5 inches) across to distinguish it from a tick bite, which usually is about the size of a dime or smaller.



• The rash occurs at the site of the tick bite and can grow from the size of a silver dollar to the size of a football.



• Its shape can be circular or oval.



• As it grows, the rash can remain red throughout, although it often can develop a clear area and may take on the appearance of a target with concentric circles of red next to clear areas.



• The early symptoms are not as threatening as what occurs later if the infection is not treated. The organs affected later include the following: the heart (heart rhythm complications), the musculoskeletal system (a chronic arthritis), and the neurological system (brain swelling that causes learning difficulties, confusion, or coma).



• Treatment



• Lyme disease should be treated promptly.



• Your doctor treats early Lyme disease with oral antibiotics. When treated early, nearly all people with Lyme disease experience rapid improvement and minimal complications from the disease.



• A vaccine has been approved for people older than 15 years to prevent Lyme disease (LYMErix), but it is given only to people with significant occupational exposures to Lyme disease.

Kawasaki disease

Kawasaki disease (also called mucocutaneous lymph node syndrome) is of unknown cause, although it is suspected to be caused by a bacteria or virus. It usually affects children younger than 9 years. It can have serious effects on your child's heart if not diagnosed and treated correctly. With treatment, only 2% of children die from this disease. Call your doctor or go to the hospital's emergency department immediately if you suspect your child may have Kawasaki disease.

• Symptoms



• The disease is defined by the following diagnostic criteria:



• Fever for five days straight



• Redness of the eyes



• Swollen lymph nodes in the neck



• Red throat, tongue, or lips



• Redness or swelling of the fingers and toes



• Rash with flat red lesions, raised red lesions, blisters, or any combination of these



• The child typically appears quite ill and unhappy.



• Treatment



• No test diagnoses this disease. The diagnosis is made by evaluating for the diagnostic criteria. Children with this disease may also have an elevated platelet count. The saclike dilatations of the coronary arteries called aneurysms also may be noted.



• Children with Kawasaki disease are admitted to the hospital and given IV gamma globulin and high-dose aspirin.

Toxic shock syndrome

Toxic shock syndrome is a life-threatening disease in which many body systems are acutely affected. Early in the course the disease may resemble RMSF, measles, and several other diseases. This disease is caused by a toxin produced by Staph aureus or Streptococcus. When the causative organism is Streptococcus, the disease is called streptococcal toxic shock syndrome (STSS). This disease can be fatal even with the maximum intensive treatment. If you suspect that your child may have TSS or STSS, go to your hospital's emergency department immediately.

• Symptoms



• Toxic shock syndrome (TSS) is very serious and begins with a high fever, sore throat, and body aches and may include vomiting or diarrhea.



• The CDC definition of TSS involves fever, low blood pressure, and multiple types of organ failure that may lead to disorientation, or liver failure and kidney failure.



• The rash looks like a mild sunburn but will be found in areas normally covered by clothes when outdoors. The rash eventually peels off in two to three weeks if the child survives.



• Children with this disease appear very ill, and the disease can progress rapidly to a life-threatening situation.



• Treatment



• The source of the infection must be found and adequately treated, but the mainstay of therapy involves supporting the circulation.



• Children with this disease are often admitted to the hospital for close observation and therapy in an intensive care setting.