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Medical Author:

John Mersch, MD, FAAP

John Mersch, MD, FAAP

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.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

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.

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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.

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.

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.

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.

Lyme Disease

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).

Kawasaki Disease

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
• Swollen lymph nodes in the neck
• 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).

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.

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