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.
Diagnosis, Treatment, and Prevention of Life-Threatening Rashes
Fever and Petechiae
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.
Occasionally, a child also requires a
(spinal tap) to be sure
meningitis is not the cause.
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
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.
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
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
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.
See the Prevention section in the preceding section on Rocky Mountain spotted
fever for suggestions for prevention of tick-borne illnesses.
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
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
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.