Friday, February 23, 2018

The “Dangerous” Combo of Fever with Rash: What You Need to Know

A mother always worries when her child becomes ill, be it a strange rash or a worrisome fever. When these two symptoms occur together, a trip to the doctor seems like the best choice. Fortunately, the list of common childhood illnesses with these two symptoms contains mostly viral illness, many of which are preventable with vaccines.

Prior to the introduction of Chicken Pox vaccine in 1995 in this country, four million children suffered through its itching blisters every year. This virus now infects non-vaccinated children and adults, initially with fever, headache and sore throat. The telltale “pocks” show up on the second or third day, with symptoms lasting about ten days. Most children recover without incident, though adults have a much rougher course. Antibiotics won’t help; treatment consists of medication for fever and itching.

The triad of Measles, Mumps, and Rubella also have been nearly wiped out from this country by childhood vaccinations. Measles symptoms include fever, cough, runny nose, and red eyes, followed in a day or two by a diffuse red spotty rash. Fortunately rarely seen today, the extensiveness of the rash makes the disease easily recognizable. German Measles, also known as Rubella, presents similarly to regular measles, with symptoms and rash so much milder that the whole episode might be overlooked. Rash rarely shows up in Mumps, which is instead identified by swelling in the cheeks. None of these three illnesses will benefit from antibiotic treatments and usually resolve by themselves, though they can have significant complications, particularly in a pregnant woman.

Another viral illness, “Slapped Cheek Disease” starts with a low-grade fever, headache, and cold-like symptoms. A few days after these get better, the child develops the telltale bright red cheeks. Sometimes the rash will form a lacy pattern on the trunk and upper arms, and can last as long as several weeks. Again, this infection does not need antibiotics; unless the patient has specific risk factors, such as pregnancy, sickle-cell disease, or depressed immune systems, he or she almost never has complications.

Scarlet Fever comes from a bacterial infection and benefits from antibiotic treatment. Symptoms usually include the classic “strep throat,” with swollen tonsils and fever. The rash has been described as feeling like “sandpaper,” a rough red diffuse body rash found mostly on the trunk. Sometimes the strep gets into the skin, creating a raised “orange peel” look, often with high fever and chills. Again, being a bacterial infection, a trip to the doctor for antibiotics would be a good idea.

A rare but dangerous rash with fever combo is Toxic Shock Syndrome. A result of bacterial breakdown products of staph or strep, the fever can be dangerously high and the bright red diffuse rash frightening, with symptoms progressing rapidly. The rash has been described as looking like bad sunburn.

Tick fevers generally present a week or two after exposure, so keep them in mind if your child has been out hiking or camping. Generally presenting with muscle and joint pains, headaches, low-grade fever, and a spotted rash, the most dangerous of these is Rocky Mountain Spotted Fever. Here, prompt antibiotics can be lifesaving!

One final, extremely rare disease to mention is Meningococcal Meningitis, a bacterial infection showing up with headache and a rash of small spots of blood under the skin. The intensity of the headache of this illness and strange looking rash usually alert the parent for the need to bring the child to the emergency room promptly.

Red rash and fever signal a dangerous combination in a child. Proper immunizations will prevent some of the viral causes. Keep acetaminophen and ibuprofen available for fever and don’t hesitate to bring your child to the doctor if bacterial causes might be involved.


Philip L. Levin, M.D. is a Coast-based physician and writer. He is president of the Gulf Coast Writers Association and is the author of numerous award-winning stories and poems, many nonfiction articles, and eight published books, including two children’s books.

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