Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Rashes associated with life-threatening diseases are uncommon, and your child will usually appear quite ill. If you suspect your child may have such a condition, you should go to your hospital's emergency department immediately.
Fever and Petechiae
Petechiae are small red or purplish flat 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 flat 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 but may rapidly become very ill.
Treatment
Petechiae resolve completely in seven to 10 days 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.
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 of age, 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. Petechiae are broken capillaries in the skin that cause flat, red dots that do not blanche with pressure applied to the skin. The petechial rash can rapidly evolve to appear as large bruises over the entire body.
Headache, congestion, nausea,
vomiting, and muscle aches may occur. Some children may appear to be delirious and may rapidly develop seizures or become unresponsive and comatose.
The rash may start out as small
bumps or raised blisters but develop into petechiae.
Treatment
A child with the symptoms of meningococcemia should be brought to your hospital's
emergency department immediately.
Blood tests, including blood cultures, will be needed, as may X-rays and a spinal tap (lumbar puncture), 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.
Vaccines exist to protect children against severe disease caused by N. meningitis,
H. influenzae, and Streptococcus pneumoniae. These vaccines are part of those routinely recommended by your child's pediatrician.
Rocky Mountain Spotted Fever
Rocky Mountain spotted fever
(RMSF) is a disease spread by tick bites. The disease occurs because the tick harbors the bacteria that cause the disease in its salivary glands. When the tick attaches to the skin, it feeds on the victim's blood and enables the transmission of the bacteria into the patient's blood. Often the child and parent may not remember any tick bite. RMSF is more common in the
southeastern U.S. 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
The first symptoms are not specific for RMSF and may occur in many illnesses: sudden onset of high fever (102
F-103 F), chills, moderate headache, nausea and vomiting, abdominal pain, and fatigue. These symptoms generally occur
two to 14 days after the tick bite.
On the second to fifth day of the illness, a characteristic rash develops on 85%-90% of patients.
The rash begins as red spots on the wrists and ankles and spreads centrally toward the trunk. The rash begins as flat, red marks that blanch with pressure. Later on, the rash will become raised and may have a non-blanching red center. Nine to twelve percent 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.
In addition to this rash, generalized muscle aches and pains, diarrhea, and restlessness occasionally developing into delirium may develop.
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 before confirmatory blood test results are available since they 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.
Complications of RMSF are generally rare but can include meningitis, brain damage, generalized organ failure, shock, and death.
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-sleeve shirts 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 Picaridin are long lasting and provide protection. Picaridin has low skin absorption and does not stain fabrics.
Never use a concentration of DEET (N, N-diethyltoluamide) higher than 30%,
and never apply DEET directly 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.
RMSF may be contracted more than once. Continue to follow the precautions listed above.
Once a tick has attached itself to you or your child, it should be promptly
removed. The longer the tick remains attached, the higher the likelihood of transmission of the causative bacteria.
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 mouthparts still attached. (The mouthparts may contain the salivary glands that are the reservoir for the causative bacteria.
Hold this gentle tension until the tick releases. This may take several
minutes. Save the tick in a plastic sandwich bag since your doctor may need to use it to determine which type of bacteria is causing your child's illness.
Cleanse the bite area with alcohol, and call your doctor immediately. Wash your hands immediately after tick removal.
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 mouthparts
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.
An organism spread by deer tick bites also causes Lyme disease. It is the most common tick spread illness in North America and Europe. Lyme disease has been reported in the Northeast, Mid-Atlantic, North Central, and Pacific coastal regions of the United States. About half of all cases are clustered in New York and Connecticut. (The disease was first described in a patient from Lyme, Connecticut.)
Symptoms
Lyme disease may be difficult to diagnose since patients may not have all of the potential signs and symptoms.
Lyme disease starts with a flu-like illness consisting of moderate fever (102 F), chills, body aches, and headache. A characteristic rash occurs in 70%-80% of patients several days to a few weeks following a tick bite. The rash often starts as a small, red tender nodule. The nodule decreases in size but an enlarging red ring spreads outward. This characteristic rash is called
erythema migrans and can vary in size from fingertip to up to 12 inches in diameter.
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 an asymmetric facial expression when smiling or frowning).
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 most commonly affecting the knees), and the
neurological system (brain
swelling that causes learning difficulties, confusion, or
coma).
Treatment
Lyme disease should be treated promptly.
Your doctor will treat early Lyme disease with oral antibiotics. When treated early, nearly all people with Lyme disease experience rapid improvement and minimal complications. If therapy is delayed, the response to antibiotics will be slower with a higher prevalence of complications.
A vaccine has been approved for people older than 15 years of age to prevent Lyme
disease (LYMErix), but it is given only to people with significant occupational
exposures to Lyme disease.
Prevention
See the Prevention section in the preceding section on Rocky Mountain spotted
fever for suggestions for prevention of tick-borne illnesses.
Kawasaki disease (also called
mucocutaneous lymph node syndrome or MCLNS) has no proven cause, although it is suspected to be caused by a bacteria or virus. Kawasaki disease usually affects children between 4 and 9 years of age. 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 child typically appears quite ill.
There are no definitive tests to establish a diagnosis of MCLNS; however, four of the following six criteria are considered necessary to establish a case of typical Kawasaki disease.
The disease is defined by the following diagnostic criteria:
Fever for five days straight -- generally 102 F or higher
Redness of the eyes -- but no discharge is present
Red throat, tongue, or lips
-- the lips are often cracked and fissured
Redness or swelling of the fingers and toes that may be associated with
peeling of the skin of the fingertips
Rash with flat red lesions, raised red lesions, blisters, or any combination
of these -- the rash is most impressive in the region of the hands and feet.
Less frequent symptoms include inflammation of the lining of the sac surrounding the heart (pericarditis), the large and small joints (arthritis), the tissue covering the brain (meningitis), and the gall bladder (cholecystitis) or urinary bladder (cystitis).
Treatment
No test is available to diagnose this disease. The diagnosis is made by evaluating for the presence of established diagnostic criteria. Children with this disease may have an elevated platelet count and erythrocyte sedimentation rate (a test that measures the extent of inflammation). Approximately 20% of patients with Kawasaki disease will develop saclike dilatations of the coronary arteries called aneurysms. All children suspected of having Kawasaki disease should have an echocardiogram and electrocardiogram (EKG).
Children with Kawasaki disease are admitted to the hospital and given IV
gamma globulin and high-dose aspirin.
Toxic Shock Syndrome
Toxic shock syndrome (TSS) is a life-threatening disease in which many body systems are acutely affected. Early in the course
of TSS, 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 is known for a sudden onset of high fever, chills, sore throat, body aches and may include vomiting or
diarrhea.
These signs and symptoms can rapidly progress to low blood pressure (shock), with multiple types of organ failure that may lead to disorientation. Death occurs in about 5% of all cases.
A characteristic rash is often present from the onset of symptoms. This rash looks like a mild sunburn but will be found in areas normally covered by clothes when outdoors. Peeling of the skin of the palms and soles may also occur.
Children with this disease appear very ill, and the disease can progress rapidly to a life-threatening situation.
Cause
Staph and Strep bacterial commonly are present in the skin as well as the nasal and vaginal cavities of healthy individuals. Women who take extended time between changes of tampons or intravaginal contraceptive devices or people with prolonged nasal packing following surgery are at risk for developing TSS or STSS. These situations promote retention of the bacteria and provide an opportunity for release of their toxin into the circulation.
Treatment
The source of the infection must be found and adequately treated with antibiotics. The mainstay of therapy involves supporting the circulation and thus major organs (for
example, kidneys).
Children with this disease are often admitted to the hospital for close
observation and therapy in an intensive-care setting.
A prototypical example of irritant contact dermatitis, diaper dermatitis is caused by overhydration of the skin, maceration, prolonged contact with urine and feces, retained diaper soaps, and topical preparations.
