Roseola

Roseola (also known as sixth disease, exanthem subitum, and roseola infantum) is a viral illness in young children, most commonly affecting those between the ages of 6 months and 2 years. It is typically marked by several days of high fever, followed by a distinctive rash just as the fever breaks.

Two common and closely related viruses can cause roseola: human herpesvirus (HHV) type 6 and possibly type 7. These two viruses belong to the same family as the better-known herpes simplex viruses (HSV), but HHV-6 and HHV-7 do not cause the cold sores and genital herpes infections that HSV can cause.

Signs and Symptoms

A child with roseola typically develops a mild upper respiratory illness, followed by a high fever (often over 103° Fahrenheit, or 39.5° Celsius) for up to a week. During this time, the child may appear fussy or irritable and may have a decreased appetite and swollen lymph nodes (glands) in the neck.

The high fever often ends abruptly, and at about the same time a pinkish-red flat or raised rash appears on the child's trunk and spreads over the body. The rash's spots blanch (turn white) when you touch them, and individual spots may have a lighter "halo" around them. The rash usually spreads to the neck, face, arms, and legs.

The fast-rising fever that comes with roseola triggers febrile seizures (convulsions caused by high fevers) in about 10% to 15% of young children. Signs of a febrile seizure include:

• unconsciousness
• 2 to 3 minutes of jerking or twitching in the arms, legs, or face
• loss of control of the bladder or bowels

Contagiousness

Roseola is contagious and spreads through tiny drops of fluid from the nose and throat of infected people. These drops are expelled when the infected person talks, laughs, sneezes, or coughs. Then if other people breathe the drops in or touch them and then touch their own noses or mouths, they can become infected as well.

The viruses that cause roseola do not appear to be spread by kids while they are exhibiting symptoms of the illness. Instead, someone who has not yet developed symptoms often spreads the infection.

Prevention

There is no known way to prevent the spread of roseola. Because the infection usually affects young children but rarely adults, it is thought that a bout of roseola in childhood may provide some lasting immunity to the illness. Repeat cases of roseola may occur, but they are not common.

Duration

The fever of roseola lasts from 3 to 7 days, followed by a rash lasting from hours to a few days.

Professional Treatment

To make a diagnosis, your doctor first will take a history and do a thorough physical examination. A diagnosis of roseola is often uncertain until the fever drops and the rash appears, so the doctor may order tests to make sure that the fever is not caused by another type of infection.

The illness typically does not require professional treatment, and when it does, most treatment is aimed at reducing the high fever. Antibiotics cannot treat roseola because a virus, not a bacterium, causes it.

Home Treatment

Until the fever drops, you can help keep your child cool using a sponge or towel soaked in lukewarm water. Do not use ice, cold water, alcohol rubs, fans, or cold baths. Acetaminophen (such as Tylenol) or ibuprofen (such as Advil or Motrin) can help to reduce your child's fever. Avoid giving aspirin to a child who has a viral illness because the use of aspirin in such cases has been associated with the development of Reye syndrome, which can lead to liver failure and death.

To prevent dehydration from the fever, encourage your child to drink clear fluids such as water with ice chips, children's electrolyte solutions, flat sodas like ginger ale or lemon-lime (stir room-temperature soda until the fizz disappears), or clear broth. If you are still breastfeeding, breast milk can help prevent dehydration as well.

When to Call the Doctor

Call the doctor if your child is lethargic or not drinking or if you cannot keep the fever down. If your child has a seizure, seek emergency care immediately.

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Rocky Mountain Spotted Fever

Rocky Mountain spotted fever (RMSF) is a bacterial infection that's transmitted to people by tick bites. It occurs most often in the spring and summer, during months when ticks are active — between April and early September.

Although RMSF is most common in the southeastern part of the United States (Virginia, Georgia, and the Carolinas), it occurs in other states as well. It's relatively rare (about 250–2,000 cases per year in the United States), but can be a serious disease if not treated properly.

The bacteria Rickettsia rickettsii that causes RMSF is transmitted by the dog tick (Dermacentor variabilis) in the eastern United States and by the wood tick (Dermacentor andersoni) in the Rocky Mountain states. On the West Coast, the lone star tick (Amblyomma americanum) also can transmit the bacteria.

RMSF gets its name from the trademark rash it causes — small red spots and blotches that begin on the wrists, ankles, palms, and soles. In addition to the rash, the infection can cause fever, chills, muscle aches, vomiting, and nausea. Typically, RMSF is treated with antibiotics and patients recover without any complications. But with late or no treatment, RMSF can cause serious health problems. If your child has fever, achiness, stiff neck, or rash and has or may have been bitten by a tick, it's important to talk with your doctor.

Signs and Symptoms

The symptoms of RMSF typically develop within 1 week of a tick bite but can take up to 2 weeks to appear. In many cases, the person doesn't even remember being bitten by a tick.

Symptoms of RMSF usually begin suddenly. There is a high fever — often 103° Fahrenheit (39° Celsius) to 105° Fahrenheit (40° Celsius) — with chills, muscle aches, and a severe headache. Eyes can become red, muscles may feel tender, and there may be abdominal pain, nausea, vomiting, poor appetite, and fatigue.

The trademark rash of this infection can begin anytime up to 10 days after the fever and headache start, but it most often appears on the third to fifth day. The rash looks like small red spots or blotches that begin on the wrists, ankles, palms, and soles. It spreads up the arms and legs toward the trunk. As the RMSF infection progresses, the original red spots might start to look more like bruises or bloody dots or patches under the skin.

Treating Rocky Mountain Spotted Fever

Doctors usually diagnose Rocky Mountain spotted fever based on enough symptoms to indicate infection. Test results for RMSF can take a while to be sent to the doctor, so treatment often starts before the results are available.

RMSF is typically treated with oral or IV antibiotics, depending on the severity of the infection. Complications may require prolonged treatment.

Untreated, RMSF can lead to serious health problems, so it's important to call your doctor promptly if you notice any symptoms of RMSF, such as:

• high fever
• headache
• chills
• muscle aches
• red eyes
• rash

Without antibiotic treatment, RMSF can lead to health problems that involve the heart, lungs, and brain. In the most severe case, it can be fatal.

If your child is recovering from RMSF at home, follow the doctor's instructions for giving antibiotics. Allow your child to rest in bed until the fever and other symptoms are gone.

Prevention

RMSF can be prevented by avoiding tick-infested areas, like woods and tall grasses, brush, shrubs, and low tree branches, and by taking precautions when spending time outdoors.

When they're playing outdoors, have kids wear light-colored clothing that makes ticks more visible if they get onto them and, if it's practical, long-sleeved shirts and long pants. Use an insect repellant that fends off ticks, being careful to follow the label instructions. Be sure to use a repellent that contains 10% to 30% concentration of DEET (look for N,N-diethyl-meta-toluamide).

Not all ticks carry the RMSF bacteria, but it's a good idea to remove any immediately. The longer a tick stays attached to the skin, the greater the chance of infection. It usually takes several hours for a tick to transmit the bacteria that cause RMSF once it has become attached to the skin.

To remove a dog tick, use tweezers to grasp it by the head (not just the body) as close to the skin as possible. Pull steadily until the tick dislodges. Without touching the tick, preserve it in a jar or plastic bag until you can show it to your doctor. Disinfect the bite area with alcohol, wash your hands, and call your doctor.

Since pets can also bring ticks into your home, check their skin and fur for ticks whenever they have been playing in tick-infested areas. Follow your veterinarian's advice about collars and other products that can be used to keep your pet tick-free.

If you have any concerns, talk with your doctor.

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Reye Syndrome

Reye syndrome, an extremely rare but serious illness that can affect the brain and liver, occurs most commonly in kids recovering from a viral infection.

Named after Australian pathologist R. Douglas Reye, who first reported it as a distinct syndrome in 1963, Reye syndrome is still not well understood. Studies have linked the use of aspirin or aspirin-containing medications during viral disease to development of Reye syndrome.

Cases have dropped dramatically since the finding of a link between the illness and aspirin use in children.

About Reye Syndrome

Reye syndrome predominantly affects kids between 4 and 14 years old, and occurs most frequently when viral diseases are epidemic, such as during the winter months or following an outbreak of chickenpox or influenza B.

Duration varies with the severity of the disease, which can range from mild and self-limiting to, rarely, death within hours. Although severity varies, Reye syndrome is a potentially life threatening disorder that should be treated as a medical emergency. Early detection and treatment are critical — the chances for a successful recovery increase greatly when Reye syndrome is treated in its earliest stages.

Signs and Symptoms

The signs and symptoms of Reye syndrome are almost always preceded by a viral illness, such as an upper respiratory tract infection (a cold, the flu, etc.), a diarrheal illness, or chickenpox. Many cases are mild and may even go undetected; others can be severe, requiring aggressive care.

Reye syndrome can occur from 1 day to 2 weeks after a viral infection. The viral illnesses that lead to it are contagious, but the syndrome itself is not.

Symptoms include:

• persistent vomiting
• lethargy or sleepiness
• in infants, diarrhea and rapid breathing

In the later stages, a child may exhibit irrational behavior, confusion, severe weakness, seizures, and loss of consciousness. There is usually no fever.

Reye syndrome is now very rare: only a few cases a year are reported in the United States. It should be considered, however, in a child with frequent vomiting or a change in mental status — particularly after a recent viral illness.

Prevention

Aspirin and other drugs from the salicylate family should never be used in the treatment of chickenpox, influenza, and other viral diseases.

In general, aspirin should not be used for kids or teenagers except on the advice of a doctor for certain conditions.

Treatment

Children with Reye syndrome are usually treated in a hospital; if seriously ill, in a hospital intensive care unit (ICU).

Treatment is supportive as there is no cure for the illness. The clinical care team focuses on making sure a child with Reye syndrome maintains proper fluid and electrolyte balance, nutritional, and cardiorespiratory status. Chances of recovery are greatest when these systems are as balanced as possible.

Mechanical ventilation (a breathing machine or respirator) may be necessary if breathing becomes too sluggish. Intracranial pressure (pressure of the fluid within the brain) and blood pressure may be monitored. Small quantities of insulin may be given to increase glucose metabolism, corticosteroids to reduce brain swelling, and diuretics to increase fluid loss.

The prognosis for children with Reye syndrome has improved. Earlier diagnosis and better treatment have increased the survival rate to about 80%. The earlier the syndrome is detected, the better the chances for survival. Children who progress to the late stages of the syndrome may suffer brain damage and disability.

When to Call the Doctor

If your child has vomiting, behavioral changes, or extreme sleepiness, especially after a viral illness such as the flu or a cold, contact your doctor immediately. Of course, many kids with viruses will have some of these symptoms, and most will not have Reye syndrome. Nevertheless, early detection is the key to successful treatment of Reye syndrome.

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Respiratory Syncytial Virus

Respiratory syncytial virus (RSV) is a major cause of respiratory illness in young children. RSV causes infection of the lungs and breathing passages. In adults, it may only produce symptoms of a common cold, such as a stuffy or runny nose, sore throat, mild headache, cough, fever, and a general feeling of being ill. But RSV infections can lead to other more serious illnesses in premature babies and kids with diseases that affect the lungs, heart, or immune system.

RSV is highly contagious, and can be spread through droplets containing the virus when a person coughs or sneezes. The virus can also live on surfaces such as countertops or doorknobs, and on hands and clothing. RSV can be easily spread when a person touches an object or surface contaminated with the virus. The infection can spread rapidly through schools and child-care centers. Infants often get it when older kids carry the virus home from school and pass it to them. Almost all kids are infected with RSV at least once by the time they are 2 years old.

RSV infections often occur in epidemics that last from late fall through early spring. Respiratory illness caused by RSV — such as bronchiolitis or pneumonia — usually lasts about a week, but some cases may last several weeks. Doctors typically diagnose RSV by taking a medical history and doing a physical exam. Generally, in healthy kids, it's not necessary to distinguish RSV from a common cold. But in cases where a child has other health conditions, a doctor might want to make a specific diagnosis. RSV is typically identified in nasal secretions, which can be collected either with a cotton swab or by suction through a bulb syringe.

Preventing RSV

Because RSV can be easily spread by touching people or surfaces that are infected, frequent handwashing can go a long way toward preventing the virus from spreading around a household. It's best to wash your hands after having any contact with someone who has any cold symptoms. And keep your school-age child with a cold away from younger siblings — particularly infants — until the symptoms pass.

To prevent serious RSV-related respiratory disease, at-risk kids can be given a monthly injection of a medication consisting of RSV antibodies during peak RSV season (roughly November to April). Because its protection is short-lived, it has to be given in subsequent years until the child is no longer at high risk for severe RSV infection. Ask the doctor if your child is considered high risk.

Treating RSV

Fortunately, most cases of RSV are mild and require no specific treatment from doctors. Antibiotics aren't used because RSV is a virus and antibiotics are only effective against bacteria. Medication may sometimes be given to help open airways.

In an infant, however, an RSV infection can be more serious and may require hospitalization so that the baby can be watched closely, receive fluids, and, if necessary, be treated for breathing problems.

At home, make a child with an RSV infection as comfortable as possible, allow time for recovery, and provide plenty of fluids. The last part can be tricky, however, because babies may not feel like drinking. In that case, offer fluids in small amounts at more frequent intervals than usual.

To help your child breathe easier, use a cool-mist vaporizer during the winter months to keep the air moist — winter air can dry out airways and make the mucus stickier. Avoid hot-water and steam humidifiers, which can be hazardous and can cause scalding. If you use a cool-mist humidifier, clean it daily with household bleach to discourage mold.

If your child is uncomfortable and too young to blow his or her own nose, use a nasal aspirator (or bulb syringe) to remove sticky nasal fluids.

Treat fever using a nonaspirin fever medicine like acetaminophen. Aspirin should NOT be used in children with viral illnesses since its use in such cases has been associated with Reye syndrome, a life-threatening illness.

When to Call the Doctor

Call the doctor if your child has any of these symptoms:

• high fever with ill appearance
• thick nasal discharge that is yellow, green, or gray
• worsening cough or cough that produces yellow, green, or gray mucus

Call also if you think your child might be dehydrated.

In infants, besides the symptoms already mentioned, call the doctor if your baby is unusually irritable or inactive, or refuses to breastfeed or bottle-feed.

Seek immediate medical help if you feel your child is having difficulty breathing or is breathing very rapidly, is lethargic, or if his or her lips or fingernails appear blue.

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Recurrent Urinary Tract Infections

Urinary tract infections (UTIs) are common in kids. By age 5, about 8% of girls and 1%-2% of boys have had at least one UTI. They occur when the kidneys, ureters, bladder, or urethra

become infected.

Symptoms of a UTI can include:

• pain when urinating
• changes in frequency, appearance, or smell of urine
• fever
• chills
• loss of appetite
• nausea
• vomiting
• lower abdominal pain
• lower back pain or discomfort

UTIs can also cause bedwetting in kids who were previously dry at night. Infants and young children may only show nonspecific signs such as fever, vomiting, or decreased appetite or activity.

Some kids experience UTIs again and again — these are called recurrent UTIs. If left untreated, recurrent UTIs can cause kidney damage, especially in kids younger than 6. So it's important to know how to recognize the signs of these infections and get help for your child.

Types of UTIs

Common types of UTIs include:

• cystitis, the most common type of UTI, is a bladder infection that can occur when bacteria move up the urethra (the tube-like structure that allows urine to exit the body from the bladder) and into the bladder
• urethritis, when bacteria infect the urethra
• pyelonephritis, a kidney infection that can occur when infected urine flows backward from the bladder to the kidneys, or when an infection in the bloodstream reaches the kidneys

Related Conditions Associated With Recurrent UTIs

Recurrent UTIs are sometimes seen in conjunction with other conditions, such as:

• vesico-ureteral reflux (VUR), which is found in 30%-50% of kids diagnosed with a UTI and is a congenital (present at birth) condition in which urine flows backward from the bladder to the ureters (the thin, tube-like structures that carry urine from the kidney to the bladder) and sometimes reaches the kidneys. If the urine in the bladder is infected with bacteria, VUR can lead to pyelonephritis.
• hydronephrosis, which is an enlargement of one or both kidneys due to backup or blockage of urine flow and is usually caused by severe VUR or a blocked ureter. Kids with hydronephrosis are sometimes at risk of recurrent UTIs and may need to take daily low doses of antibiotics to prevent them.

But not all cases of recurrent UTIs can be traced back to these body structure-related abnormalities. For example, dysfunctional voiding — when a child doesn't urinate frequently enough or doesn't relax his or her muscles properly while urinating — is a common cause of UTIs.

Unrelated conditions that compromise the body's natural defenses, such as diseases of the immune system, can also lead to recurrent UTIs. In addition, using a nonsterile urinary catheter can introduce bacteria into the urinary tract and cause an infection.

Detecting Abnormalities

Although UTIs can be treated with antibiotics, it's important for your child's doctor to rule out any underlying abnormalities in the urinary system when these infections occur repeatedly.

Some abnormalities can be detected even before birth. Hydronephrosis, when it occurs as a congenital condition, can be detected in a fetus by ultrasound as early as 16 weeks of gestation. When hydronephrosis poses significant danger to the developing kidneys, surgery may be performed while the baby is in the womb; however, in most cases, doctors wait until after birth before treating the condition because almost half of all cases that are diagnosed prenatally disappear by birth.

Once a baby suspected to have hydronephrosis or another urinary system abnormality is born, the baby's blood pressure will be monitored carefully because some kidney abnormalities can cause high blood pressure. An ultrasound may be used again to get a closer look at the bladder and kidneys.

Diagnosis and Treatment

If your doctor suspects that your child may have an abnormality of the urinary tract, he or she may order tests to make an accurate diagnosis including:

Ultrasound

Using high-frequency sound waves to "echo," or bounce, off the body and create a picture of it, an ultrasound can detect some abnormalities in the kidneys, ureters, and bladder. It can also measure the size and shape of the kidneys. When an ultrasound suggests VUR, a voiding cystourethrogram (VCUG) or a renal scan (see below for descriptions of both) may be performed for further evaluation.

Renal scan (nuclear scan)

Radioactive material is injected into a vein and followed through the urinary tract. The material can show the shape of the kidneys, how well they function, if there is damaged kidney tissue, and the course of the urine. A small amount of radiation is received in the study and leaves the body in the urine.

Voiding cystourethrogram (VCUG or cystogram)

A catheter (a hollow, soft tube) is used to inject an opaque dye into the bladder. This X-ray test can diagnose VUR and identify problems with the bladder or urethra.

Cystoscopy

A cystoscope uses lenses and a light source within a tube inserted through the urethra to directly view the inside of the bladder. It's used when other tests or symptoms indicate a possible bladder abnormality.

Intravenous pyelogram

Opaque dye is injected into a vein and then X-rays are taken to follow the course of the dye through the urinary system. Although this test is still used sometimes, the renal ultrasound and renal scan have replaced intravenous pyelogram in most cases.

Because VUR can lead to kidney infection (pyelonephritis) and subsequent kidney damage, children with the condition must be monitored closely. Usually, surgery isn't necessary because many kids will outgrow the condition. Even in those who don't, surgery may be unnecessary because antibiotics are often successful in warding off UTIs.

The most common type of surgery to correct VUR is ureteral reimplantation, in which one or both ureters are reattached to the bladder to decrease backflow of urine from the bladder to the ureters and kidneys. Although the success of ureteral reimplantation is greater than 90%, only those who have recurrent UTIs while on antibiotic prophylaxis (preventive therapy) will be considered for surgery.

Blockages can interfere with normal urine flow, which serves to wash bacteria out of the urinary tract. Because severe blockages in the ureter or the urethra may ultimately lead to repeated kidney infections and kidney damage, they may require surgical intervention. Kidney stones are another source of blockage that may obstruct the path of urine.

When anatomical defects have been ruled out, antibiotics may be prescribed for months or even years to prevent recurrent infections.

The Future for Managing Recurrent UTIs

Doctors have started to use a less-invasive way to correct VUR than implantation. The procedure involves the injection of such materials as Teflon, Delflux, or collagen through a cystoscope. This procedure was considered experimental a few years ago, but is rapidly gaining wider acceptance.

Recent studies have found that women and children who get recurrent UTIs may lack certain immunoglobins (a group of proteins that fight infections). Some researchers are optimistic that a vaccine may be developed that could help boost production of antibodies that fight UTIs. A promising vaccine that would protect against E. coli (the most common bacterium that causes UTIs) is being tested.

Home Treatment

Additional things to consider to help prevent recurrent UTIs in kids:

Diet Modifications

Encourage kids to drink 8 to 10 glasses of water and other fluids per day. Cranberry juice is often suggested because it may prevent E. coli from attaching to the walls of the bladder. Always ask your doctor, though, if your child should drink cranberry juice because it can interfere with some medicines.

Multivitamins

Vitamin C acidifies the urine, making the environment less friendly to bacteria. Vitamins designed for kids are generally safe, but always ask your doctor before increasing the dose beyond the currently recommended daily allowance.

No Bubble Baths

Kids should avoid bubble baths and perfumed soaps because they can irritate the urethra.

Frequent Diaper Changes

Kids in diapers should be changed frequently to prevent stool from having prolonged contact with the genital area, which can increase the chance that bacteria will move up the urethra and into the bladder.

Proper Wiping Technique

In females, wiping from front to back after using the toilet will reduce exposure of the urethra to UTI-causing bacteria in the stool.

Cotton Underwear

Breathable cotton underwear is less likely to encourage bacterial growth near the urethra than nylon or other fabrics.

Frequent Bathroom Visits

Some kids may object to using the school bathroom or may become so engrossed in a project that they delay urination. Kids with UTIs should urinate at least every 3 to 4 hours to help flush bacteria from the urinary tract.

Follow-Up Visits

Your doctor may advise performing another urine culture after treatment of a UTI is completed to be sure that the infection has cleared.

When to Call the Doctor

As soon as you suspect a UTI in your child, it's important to contact your doctor.

If your child suffers from recurrent UTIs, consult a pediatric nephrologist or urologist who can perform a thorough evaluation and, if necessary, order tests for urinary system abnormalities. In the meantime, follow your doctor's instructions for treating a UTI.

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