With the recent deaths of 25 children in Lagos State attributable to Febrile Rash Illnesses (FRIs), the Wellbeing Foundation Africa – a leading maternal and child health NGO, is creating awareness of childhood febrile rash illnesses and associated diseases, in order to curb the spread of the diseases and aid in the prevention of needless deaths of children in Nigeria.
Diseases that occur with fever alongside rashes amongst children include Meningitis; Parvovirus B19 disease; Hand, Foot and Mouth Disease; Chickenpox; Measles; and Rubella. Due to the myriad of diseases that present with fever and rashes – which vary in size, intensity and location, it is necessary to be cognizant of other determining symptoms as well as the modes of transmission of the varying diseases. For example, while Hand, Foot and Mouth Disease display symptoms including fever, poor appetite, malaise and sore throat 1-2 days before mouth sores develop, symptoms of Chickenpox include headache, general body ache, backache and malaise. However, both diseases are classified as febrile rash illnesses, yet, knowing the difference while seeking treatment could be the difference between life and death.
Meningitis is another disease that presents with fever and rashes and should not be overlooked when evaluating cases of childhood febrile rash illnesses. Typically, viral meningitis is less severe than bacterial meningitis, with symptoms of bacterial meningitis commencing suddenly and escalating quickly. In addition, those most at risk for developing bacterial meningitis include infants and children under the age of five years. While symptoms may not be applicable to all, the usual symptoms of bacterial meningitis in young children include high fever, vomiting, drowsiness, convulsions or seizures and a distinctive rash. It should be noted that bacterial meningitis can result in blood poisoning or septicaemia – which can be fatal. Viral meningitis on the other hand, mirrors flu-like symptoms including headaches, fever and diarrhoea, in more severe cases. Nonetheless, all suspected cases of meningitis should be treated with urgent medical attention.
To prevent the outbreak of transmittable diseases such as those categorized under childhood febrile rash illnesses, the Wellbeing Foundation Africa, led by Wife of Nigeria Senate President, H.E. Mrs. Toyin Saraki, recommends that all children undergo routine immunization and receive immediate treatment once disease symptoms are observed. The Foundation also wishes to notify the rest of Nigeria to be alert, and pay strict vigilance, to avoid the spread of these febrile rash illnesses to other parts of southwest Nigeria.
| Disease
(Etiology) |
Rash Description | Associated signs/symptoms | How transmitted
(infectious period) |
| Meningitis | The rash isn’t always present, and even harder to visualize in dark skinned Africans (except in light areas like the palms, eyelids, and the inside of the mouth). When present, the rash presents as tiny pinpricks (initially), and only gets larger as the disease becomes severe. Importantly, ‘the glass test’ is used to identify a rash of meningitis; in this test, the rash does not fade away, when one applies pressure. Therefore, when a clear drinking glass is pressed against the skin rash, the rash will still be visible through the glass; this is highly suggestive of septicaemia from meningitis. | Early symptoms include fever, headaches, nausea, vomiting, increased sensitivity to light (photophobia), neck stiffness (especially in infants and young children), and a general feeling of illness (especially shown through lack of alertness or poor feeding).
There could also be bulging fontanelle, in infants. In severe cases, especially of bacterial meningitis, there could be seizures and coma. |
Transmission from droplets
Emitted from an infected person’s nose/mouth when they sneeze/cough, especially when there is close or long contact with a sick or infected person. Infants and children in day-care and schools are particularly prone to this. |
| Parvovirus B19
aka Fifth Disease (Human parvovirus B19) |
Facial rash can be intensely red with
a “slapped cheek” appearance; Symmetrical red, bumpy, lace-like, itchy rash starts on torso and moves out towards arms, buttocks, and thighs |
Mild early symptoms may
include fever, malaise, muscle pain, headache occurs 7-10 days before rash onset |
Transmission from droplets
emitted from an infected person’s nose/mouth when they sneeze/cough, by direct contact with blood/blood products, and transmission from mother to fetus (contagious during the early part of the illness, before the rash appears) |
| Hand, Foot and
Mouth Disease (various enteroviruses) |
Mouth sores begin as small red spots
that blister and may become ulcers; skin rash develops over 1-2 days with flat or raised red spots, sometimes with blisters; usually on the palms of the hands and soles of the feet; rash may also appear on the knees, elbows, buttocks or genital area |
Early symptoms include fever,
poor appetite, malaise and sore throat 1-2 days before mouth sores develop; |
Transmission from droplets
emitted from an infected person’s nose/mouth when they sneeze/cough and by fecal-oral transmission (respiratory tract shedding < 1-2 weeks; fecal viral shedding for weeks or more)
|
| Chickenpox aka
Varicella (Varicella-zoster virus) |
Small bumps (papules) with evolve
into fluid-filled blisters (vesicles); these become pus-filled (purulent) and eventually crust/scab over; rash can start on face or body and move outward |
Early symptoms can be absent
in children but can include headache, general body ache, backache and malaise; may have all forms of lesions at the same time |
Transmission from droplets
emitted from an infected person’s nose/mouth when they sneeze/cough, by direct contact, and by aerosolization of virus from skin lesions (2 days before – 5 days after rash onset or until lesions have crusted) |
| Measles aka
Rubeola (Measles virus) |
Flat red rash where individual
macules may run together, may contain small solid bumps (papules); begins on face, neck and shoulders and spreads down the body and out towards the extremities; fades in 4-6 days |
Early symptoms may consist of
upper respiratory tract infection symptoms, runny nose, bark-like cough, malaise, light sensitivity, fever, and Koplik’s spots inside the mouth; rash generally develops on 4th day of fever |
Transmission from droplets
emitted from an infected person’s nose/mouth when they sneeze/cough; can also pick up virus from contact with contaminated surfaces (4 days before – 4 day after rash onset) |
| Rubella aka
German Measles (Rubella virus) |
Flat pink rash where macules and
papules develop on forhead and spread down/out within one day; rash fades in reverse order by third day; similar to measles rash, but less red |
Early symptoms uncommon,
especially in children though they may experience Forschheimer’s spots (small red spots aka petechiae) on the soft palate; adults may experience anorexia, malaise, conjunctivitis, headache, and mild upper respiratory symptoms before rash onset |
Transmission from droplets
emitted from an infected person’s nose/mouth when they sneeze/cough; can also pick up virus from contact with contaminated surfaces (7 days before – 7 days after rash onset) |
[The Wellbeing Foundation Africa]
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