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, but with early use of antibiotics, this is much less common today.

• Symptoms
  • About 2-14 days after the tick bite, the child develops a sudden high temperature (103°F or more), headache, muscle aches, and rash.
  • The rash usually appears on the second or third day of the illness.
  • The rash begins as red spots on the wrists and ankles and spreads inward to the trunk.
  • It 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 with red dots or even small bruises.
• Treatment
  • Go to the hospital if you suspect your child has RMSF or with any tick bite.
  • RMSF treatment must be started early, even before the blood tests become available. It may take several days to confirm the diagnosis.
  • 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.
    • Never use a concentration of DEET (N, N-diethyltoluamide) higher than 10%, and never apply it to the skin.
    • Apply the insect repellent to the shirt collar, sleeves, and pants.
  • Once a tick has attached itself to you or your child, it should be promptly removed.
    • Gently grab the tick close to the skin (to include the head) and apply a gentle tug.
    • 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 red rash several days to a few weeks following a tick bite.
  • The illness consists of a fever, which can range from 100–104°F, headache, muscle and joint aches, a mild sore throat, a cough, stomach upset, neck pain and stiffness, and Bell 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 Centers for Disease Control and Prevention 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 then clear.
  • 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. If you cannot see your doctor quickly, go to a hospital's emergency department immediately.
  • Your doctor treats early Lyme disease with a long course of 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 is of unknown cause, although it is suspected to be caused by a bacteria or virus. It usually affects children younger than 5 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 5 diagnostic criteria:
    • Fever for more than 5 days
    • Redness of the eyes (painless conjunctivitis)
    • Swollen lymph nodes in the neck
    • Red throat, tongue, or cracked lips
    • Redness or swelling of the hands and feet
    • Rash with flat red lesions, raised red lesions, blisters, or any combination of these.
  • The child appears quite ill and may also have vomiting, diarrhea, cough, and arthritis.
• Treatment
  • No test diagnoses this disease. The diagnosis is made by looking for all of the diagnostic criteria. Children with this disease may also have an elevated platelet count. Saclike dilatation 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. It can be similar to RMSF, measles, and several other diseases. This disease is caused by a toxin produced by S aureus or a streptococcal bacteria. 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 very serious and begins with a high fever, sore throat, and body aches and may include vomiting or diarrhea.
  • Your child may also have a low blood pressure, disorientation, or liver and kidney failure.
  • The rash looks like a mild sunburn but will be found in areas normally covered by clothes when outdoors.
  • Children with this disease appear very ill, and the disease can progress rapidly to life threatening.
• 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.