A Very Sick 3-Year-Old: Fever, Cough, Congestion & Rash

Your nurse tells you the child is quite sick, advises wearing mask and gown and puts the patient in a room meant for isolation in the clinic.

The 3-year-old is a regular in your practice; her mother has refused to have her vaccinated so she has not had any immunizations.

Pertinent history: No immunizations; multiple well-child check-ups-parental refusal of immunization at each. No significant illnesses until the last 4-5 days.

Acute onset of illness 4-5 days ago; fever of 102o – 104oF; no known sick exposures; cough, coryza, congestion.

3- year-old with macular reddish-brown lesions began on head 3-4 days ago, spread downward; many have become confluent.

Noted are non-pruritic macular lesions on her legs.

Rash appeared on child's head ~2 days after fever was noted, then spread down the back and chest and then to the extremities; macular, reddish-brown without petechiae.

Differential diagnosis

of unvaccinated 3-year-old with fever cough, coryza, and conjunctivitis: roseola, rubella, rubeola, erythema infectiosum, a herpes hominus virus.

Diagnosis: Rubeola (measles)

Rubeola:

Acute viral respiratory illness; prodrome fever may be as high as 105FPathognomonic exanthema (Koplik spots) followed by maculopapular rash.

Measles virus declared eliminated in 2000; small local outbreaks continue, mostly in areas where immunization rates are low.

Treatment:

Symptomatic to include antipyretics, hydration, rest, vitamin A supplementation

Vitamin A supplementation is recommended by the

World Health Organization

and by the

American Academy of Pediatrics.