I’m a microbiologist by training, and I have developed a pretty strong interest in pathogenesis. But I am NOT a clinician. So when a rash appeared on Monkey’s forehead and torso yesterday afternoon, a couple of days after his fever and cold had begun to clear up, I completely. Freaked. OUT.
Thank God I work with doctors, and infectious disease specialists at that. These people have become my sanity check when it comes to stuffy noses, fevers, diarrhea – and now rashes. After a lengthy discussion with one of my favorite pediatricians, we pseudo-diagnosed Monkey, putting my mind at ease and saving Hubby and I another trip to the pediatrician. Before I share the diagnosis, however, I thought I’d impart my recently acquired knowledge on viral exanthems (a fancy-schmancy doctor word for rashes).
First, a disclaimer: please, oh please, keep in mind I am not a pediatrician. My doctorate is a PhD, not an MD. Do not use this post as a diagnostic tool; it is merely intended to help you along in a conversation with your family doctor, or provide you with some interesting trivia for your next dinner party (‘cuz who doesn’t like a nice dinnertime discussion on rashes?)
Alright, disclaimer aside, I’m going to tell you a little bit about three of the most common infections associated with rashes in children around Monkey’s age or older. Each of these infections is caused by a virus (another reason I shouldn’t be considered an expert in this area), so they cannot be treated with antibiotics. In each case, the rashes appear as the fever breaks and are caused by the immune reaction to the virus, so the child is most contagious prior to the appearance of the rash.
1. Fifth disease.Caused by human parvovirus, fifth disease is most common in school-age children during late winter and spring time. Symptoms include a mild fever (<102 °F), sore throat, and rash. As the fever subsides, the rash begins on the face, with bright red cheeks as if the face has been slapped, then spreads to the trunk, arms and legs, forming a lacey pattern. The rash may or may not itch. Additional note for pregnant mothers: fifth disease can cause problems for babies in utero, so if your child exhibits these symptoms and you’re pregnant, get yourself to the OB right away to check on your immune status.
Fifth disease rash. Click image for source.
2. Roseola: Caused by one of two human herpesviruses (HHV-6 and HHV-7), infection occurs throughout the year in infants and toddlers. Symptoms include irritability, swelling of the eyes, and a very high, sudden fever (>102 °F), followed by the development of pink non-itchy rash with raised or flat lesions on the trunk, arms and legs. Because of the high fever, febrile seizures can occur but are not common.
Roseola rash. Click image for source.
3. Hand, foot, and mouth disease (HFMD). Not to be confused with foot and mouth disease, which occurs in livestock, HFMD can be caused by one of many different enteroviruses, most commonly Coxsackie A and Enterovirus-71. Symptoms are variable due to diversity among the enteroviruses, but can include moderate fever, malaise, vomiting, sore throat, general cold-like symptoms, diarrhea, loss of appetite, and raised lesions on the hands, feet and mouth (hence the name). As the fever reduces, a pink non-itchy rash may also appear on the body and head. Perhaps the most notable trademark of HFMD is its prevalence in daycares and early school-age children during the summer and early fall. The viruses that cause HFMD can also cause cold-like symptoms and aseptic meningitis (with very bad headaches) in adults.
Raised lesions on the mouth from HFMD. Click image for source
Raised lesions on the hands from HFMD. Click image for source.
Body rash proceeding fever with HFMD. Click image for source.
So here’s a case study for all you wannabe clinicians. Monkey began experiencing a runny nose and mild cough last week, and became especially fussy as the weekend inched closer. By Saturday evening, he had a very mild fever (~100 °F), was VERY fussy, constantly wanted to be held by mama or dada, and would lay his head on the floor of his nursery while trying to play (seriously pathetic to watch). Motrin helped his fussiness some, mainly by helping him fall asleep. By late Sunday night, Monkey’s fever had risen to ~102 °F, and he had snot constantly pouring out of his nose. He had a few lose stools on Sunday and Monday, but only one that I would have characterized as diarrhea.
Monday was Monkey’s 9-month check-up, so we got a complete look-over from the pediatrician. His weight was lower than expected, but it was assumed this was possibly due to him recently starting table foods (only a small portion of food actually makes it to his mouth right now, but his coordination is slowly improving) and mama’s milk supply taking a hit due to travel and stress from job interviews. Monkey’s ears were clear, but he had a very red throat. I was starting to come down with a stuffy nose and slight cough, very common after I travel, so we all assumed this was just a little cold virus making its way through the Dr. O family. By Monday evening, Monkey’s fever was all but gone, and Tuesday morning, Hubby and I woke up to a perfectly happy baby boy. He returned to daycare Wednesday, fever free. Wednesday afternoon, I noticed a rash all over his head and body when I picked him up from daycare. I proceeded to freak out, microbiologist mama style, and called the help line at our local children’s hospital.
Today I’m feeling much better, as is Monkey, although he still has a rash lingering on his legs, arms and cheeks this morning. So what do you think Monkey had/has? Leave your probing questions and diagnoses in the comments!
Our diagnosis is here. Let me know if you think we’re way off base. 😉
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