On Tuesday morning, Dr. Chen sent a bloody photograph of the child received at the clinic and sent voice:
Q: This 1-year-old doll, who has been on high fever for 3 days, has no other symptoms, abnormal blood picture, and does not know whether it is caused by blood disease or virus infection, and has instructed parents to take their children to your follow-up clinic on Friday.
The child may have a toddler's acute rash, inform the parents in advance, and come to the clinic at any time if there is a problem.
Although the results of this blood routine are obviously abnormal, it is not excluded that there is a possibility of blood disease, but when diagnosing the disease, we should always follow the diagnostic principle of considering common diseases first and then considering rare diseases: 1 year old, high fever, no other symptoms, white blood cells and thrombocytopenia, the child still has to think of viral infections first, especially the possibility of acute rash in young children.
Referral
On Friday morning, the specialist clinic was attended by parents with their children. Although the child seemed to be in good shape, the four parents who came to the doctor together looked nervous.
I asked the parents, "Does the child still have a fever?" Have you had a rash in the past two days? ”
Parents told me: "The child has been very healthy before, this time I don't know what the reason is, the fever has been high for more than three days, the body temperature can reach 39.6 ° C, but after returning from the hospital on Tuesday, the child has a fever, and red rashes have appeared on the body since Wednesday." ”
Then I checked the child, and at present, in addition to the torso position, there are some rashes that have not faded, the others are normal, and the child's mental state is also very good.
I told the parents: "Don't be nervous, the first fever in the child's life is the toddler's rash, now go back to the blood routine." ”
Soon, the results of the blood routine came out: white blood cells 6.4×109/L, neutrophil absolute values of 1.3×109/L, hemoglobin 122g/L, platelets 98×109/L, close to normal.
I also introduced the knowledge of the child's acute rash to the parents of the child, and they left the clinic in a down-to-earth manner.
What are the abnormal changes in the blood routine that can cause a rash in young children?
Leukopenia and granulocytopenia
The most common blood picture abnormalities of acute rash in young children are leukopenia (the incidence of leukopenia is as high as 55.3% to 79.4%) and neutropenia (the incidence of literature reports is 16.63%), and with the progression of the disease, white blood cells and neutrophils have a gradual downward trend.
This is because viral infections can suppress the bone marrow to cause excessive granulocyte destruction or decreased production, or to ineffective bone marrow proliferation. Leukocyte therapy is generally not required, and the total number of white blood cells returns to normal on day 8 and the neutrophil count returns to normal on day 14.
Thrombocytopenia
Acute rash in young children can also cause thrombocytopenia (the incidence of literature reports is 4.85% to 16.98%), and platelets are mostly mild to moderate, and severe reduction (< 20×109/L) is rare. Thrombocytopenia is considered as a result of viral infection inhibiting the production of platelets by megakaryocytes and shortening the lifespan of platelets. Because the course of the disease is self-limited and the prognosis is good, platelets can gradually rise to normal after the fever has subsided.
Clinically, patients suspected of being diagnosed as acute rash in young children, such as thrombocytopenia, should avoid the use of drugs affecting platelets, mild to moderate reduction should not be treated specially; if severe reduction should be given early intervention, gamma globulin static therapy can be used, etc., to prevent bleeding from important organs, which is conducive to disease recovery.
What is a disease of acute rash in young children?
Infantile rash, also known as infant rose rash, is a common disease characterized by high fever and rash in infants and young children, and mostly occurs in spring and autumn.
cause of disease
The pathogen is mainly human herpesvirus type 6 (HHV-6), and the other pathogen is human herpesvirus type 7 (HHV-7), which accounts for 10% of the causes of acute rash in young children.
Clinical manifestations
Acute rash in young children occurs mainly in infants and young children under 3 years of age, especially in children aged 6 to 18 months. Babies often suddenly have high fever, body temperature at about 39 ~ 40 ° C, continue not to retreat, may have a slight cough or diarrhea, good mental appetite, 3 to 5 days after the body temperature declines, fever relief 12 to 24 hours after the skin appears reddish maculopapular rash, seen in the head and neck and trunk, quickly spread to the whole body, generally 2 to 3 days after the subsidence.
Seeing "fever and rash out" can diagnose acute rash in young children, and this feature can also help us identify other pediatric rash diseases.
In addition, only 40% of children with primary HHV-6 infection present as a rash in young children, and the rest do not have typical symptoms of acute rash in young children, but only have fever as a clinical manifestation.
differential diagnosis
Acute rash in young children is difficult to diagnose in the early stages because the initial symptoms and signs of the disease are similar to those common in children.
Fever is easily misdiagnosed as acute upper respiratory tract infection for a short time, and during a long fever time, it is easy to be misdiagnosed as Kawasaki disease and human herpes virus (Epstein-Barr virus) infection;
When the rash occurs, it is easy to be misdiagnosed as rubella, measles and other rash diseases.
complication
In addition to hyperthermia, the clinical manifestations of acute rash in young children are generally mild, but benign intracranial hypertension, febrile seizures, myocardial damage, liver function damage, neutropenia, and thrombocytopenia can be complicated by benign intracranial hypertension. Between 10% and 20% of febrile seizures are caused by primary HHV-6 infection.
treat
Acute rash in young children is a self-limiting disease with no specific drugs.
When the child has a fever, physical cooling can be used, such as applying a cold towel to the forehead or groin, and when the body temperature exceeds 38.5 ° C, the antipyretic medicine can be given orally in time to prevent the child from having febrile seizures. Give your child plenty of water and give your baby some nutritious and digestible foods. Seeing the child's red rash, parents do not have to be nervous, the rash will not scar after subsidation, there will be no peeling and darker color.
Clinical experience
If the child is under 2 years old, in addition to high fever, there is no obvious respiratory system, digestive system, ear infection, urinary tract infection, streptococcal infection and other manifestations, blood routine examination is white blood cell reduction, and there has been no rash before, the doctor will focus on the child's rash.
At this time, it is recommended that parents take their children home to observe and wait, only give timely antipyretic and actively replenish water and other symptomatic treatment, to see if the child will defer fever after 3 to 5 days, and there will be a rash unique to the acute rash of young children, and if there is a change in the condition, come to the hospital for follow-up.
Source: Pediatrics Channel of the Medical Professions
Edited by: Yeah Reviewer: Xiao Ran