Three-day fever is a sudden onset of high fever in infants. This often gives many parents cause for concern. Is this concern justified in three-day fever?? What is hidden behind this disease in detail and how can it be treated?? All these questions are answered in the following article.
What is the three-day fever?
Three-day fever (exanthema subitum/Roseola infantum) is a highly contagious, although harmless, viral disease. This viral infection is a special form of fever. Mostly infants are affected. Infants between the ages of 6 and 24 months. Since the infection is not seasonal, children can be infected year-round. If the infection takes a more severe course, it can develop into pneumonia, liver inflammation (hepatitis), or brain inflammation (encephalitis). However, this happens very rarely. Mostly in children with a defective immune system.
Three-day fever – adults
The disease is rather rare in adults, since it was usually already passed through in infancy. If infection occurs, it manifests itself with flu-like symptoms similar to mononucleosis (glandular fever). If the immune system is weak, chronic inflammation of the lungs may occur.
Three-day fever – baby
An infection with three-day fever before 3. The first outbreak in the first month of life is extremely rare. During birth, antibodies from the mother are passively transferred to the infant, protecting it initially.
Three-day fever – Causes
Triggers of the three-day fever in children in the 9. month of life is the human herpes virus type 6 (HHV 6). There are 2 serotypes. After the acute infection has subsided, the virus, like all herpes viruses, remains in the body for life (latent infection) and can be reactivated. Humans are the only reservoir of pathogens for HHV-6. HHV-7 is ubiquitous. Transmission takes place via saliva and possibly also via droplet infection (speaking, sneezing, coughing).
In rare cases, infection occurs through organ transplants or blood transfusions. Children can become infected through breast milk while breastfeeding. Infection is also possible during sexual intercourse. In children who are around 2. However, people who are infected with the herpes virus type 7 (HHV 7) before they reach the age of three have itchy skin. The incubation period can be up to 17 days.
Three-day fever – symptoms
The symptoms of three-day fever are very characteristic and are characterized on the one hand by very sudden, high fever and on the other hand by a skin rash that follows the fever. How these symptoms present themselves in detail, clarifies the next section.
Characterized by a sudden onset of high fever (39°C -41°C) that lasts between three to four days and then drops rapidly. The fever should be observed by taking it regularly. In addition, a typical skin rash sets in after the fever subsides.
After the fever has subsided, an initially limited, bright red, blotchy skin rash develops very quickly. These spots are usually flat, but can also be raised. Some of these spots may be surrounded by a white ring. Within a few hours, the rash spreads over a large area on the chest, abdomen, back, arms and legs.
Scalp and face are usually not affected. However, itching does not occur with the three-day fever rash. The rash disappears as suddenly as it appeared within a few days or even hours. Sometimes the rash may not appear at all or may be barely visible.
About 30 percent of cases are accompanied by a febrile convulsion. Even if such a febrile convulsion looks very alarming, it ends after only a few minutes and does not lead to any negative consequences. The convulsion is manifested by the child's loss of consciousness and rhythmic twitching of both arms and legs.
To be on the safe side, the pediatrician should still be consulted after a febrile seizure. Prophylactic administration of anticonvulsant drugs is generally not advisable. They are not very effective and are not necessary because of the positive prospect of cure.
In addition to these primary symptoms, there may also be swelling of the eyelids, reddened eardrums, vomiting/diarrhea, and swollen cervical lymph nodes. A bulging fontanel is typical in infants. Even after the symptoms of the disease have subsided, the children are still grouchy and querulous for a few days. Often the infection runs also in such weakened form, so that it remains completely unnoticed and in such a way by most children up to the completion of the third year of life was passed through.
In order not to confuse three-day fever with other diseases that are also accompanied by fever and rash, it is important to pay attention to the symptoms and the order in which they occur. Measles announces itself, for example, with a cough, cold and sensitivity to light before the characteristic skin rash and fever set in.
Three-day fever – Is it contagious?
The causative agent of three-day fever, the herpes virus, is mainly transmitted via saliva. Thus it is highly contagious. Droplet infection, transmission of the virus by coughing, sneezing, talking, must also be considered. Between the actual infection and the outbreak of the disease, between 5 and 15 days can pass. Once you have contracted three-day fever, you have a lifelong immunity to re-infection.
Three-day fever – Diagnosis
In the case of high fever in children, the family doctor or a pediatrician should be consulted immediately. In order to make a diagnosis of three-day fever, the physician must first take a detailed history of the disease. It includes important information about the onset, course and level of the fever, the appearance of the rash and any itching. In addition, a blood test supports the diagnosis.
During the fever phase, an increased number of white blood cells (leukocytes) can be observed, which decreases again after the fever phase. By certain tests, the IgM antibodies resp. If HHV IgG antibodies can be detected in the blood, the diagnosis is even more definite. A positive finding of the pathogen in the blood must always be associated with the existing symptoms. Traces of the herpes virus can also be detected in the blood of people who have already been infected.
Three-day fever several times
If the three-day fever has been passed through once, one usually does not get sick again. Through the initial infection one develops a lifelong immunity. Of course, here too the exception proves the rule. Under extreme conditions that place a great strain on the immune system or. A second infection can occur if the fever is transmitted downhill. This is the case, for example, when taking immunosuppressants that are used in a pending organ transplantation.
Three-day fever – treatment
The therapy of three-day fever is purely symptomatic. Ensuring adequate fluid intake plays a major role, as infants and young children in particular lose a lot of fluid due to the fever and are at risk of dehydration. Fever-reducing abdominal or calf compresses and fever-reducing medications such as paracetamol and suppositories are used. Further and more detailed information can be found in the article on: Fever-reducing measures.
Three-day fever – course of the disease
After the fever has subsided, children recover rapidly. Often the infection occurs without the typical symptoms. Remains even completely undetected. An occurring febrile convulsion does not have to be classified as threatening, since it does not belong to the epilepsies and therefore does not leave any permanent damage to the child.
By the age of two, almost all children – whether noticed or unnoticed – have passed through the three-day fever. Lifelong immunity is usually acquired. Secondary infection is possible in extreme situations such as organ transplantation, where the immune system is severely compromised due to immunosuppressants. Since there are no effective immunoglobulins for the three-day fever, vaccination is not possible.
Three-day fever – differentiation from similar diseases
The differential diagnosis of three-day fever to other (children's) diseases with similar symptoms is very simple. The symptom of sudden high fever without other accompanying symptoms is the determining factor. However, parents in particular may initially be unclear as to which infection is involved, as there are a variety of diseases in children that are also accompanied by a skin rash, for example.
Overview of diseases for differential diagnosis:
Morbilli (measles) symptoms
Typical two-phase course: in the first phase moderate fever, rhinitis, dry cough, pronounced photophobia and poor general condition set in. On 3. or 4. In the second day, an enanthema in the mouth and throat and the characteristic Koplik spots appear. These spots are characterized by a pale red, dot-like appearance and have a white center.
The second phase has the typical rash (exanthema) that begins behind the ears, spreads over the neck and face to the entire body within three days. The reddish skin spots often run together. After another three to four days, the rash fades in order of appearance. Typical is a brownish discoloration, which results in a bran-like scaling.
Rubella (German measles) symptoms
The course of the disease begins with cold-like symptoms. Rubella is characterized by a small-spotted bright red exanthema that begins on the face, spreads to the body and extremities, and disappears after several days. In contrast to measles, the individual spots do not run together.
Lymph node swellings in the area of the neck, back of the head and behind the ears are also characteristic. The body temperature is only moderately elevated or not elevated at all. After one to three days the rash subsides.
Scarlatina (scarlet fever) symptoms
The early symptom stage with fever, sore throat, enlarged throat lymph nodes (tonsillopharyngitis), coated tongue and possibly vomiting is followed after 12-48 hours by the typical skin rash with dense, bright red maculopapules, beginning at the triangle of the thighs. Then the rash spreads to the trunk. Extremities over. In addition, enanthema of the soft palate with typical redness of the cheek is seen.
The tongue coating is shed after a few days, and the characteristic raspberry or strawberry tongue is formed by the emergence of the red, swollen papillae. In the 2.- 4. In the first week of the disease, scaling of the skin occurs, first in the area of the face, trunk and extremities, and finally on the hands and feet.
Varicella (chickenpox) symptoms
Before the onset of the disease, symptoms such as fever, fatigue and general malaise appear one to two days earlier. The main symptom of varicella is a very itchy skin rash, which first appears on the trunk and face, and then spreads to other parts of the body in a short time. The palms of the hands and soles of the feet are not affected. Small spots develop within a short time into papules, then into vesicles with initially clear, then cloudy contents and, after drying, finally into crusts.
In the first week new blisters appear again and again. Not every efflorescence shows all stages. Due to the occurrence of several spurts of efflorescences, the picture of the so-called "starry sky" (different stages next to each other) is formed. As a rule, chickenpox is characterized by this typical picture, so that a specific diagnosis is only necessary in individual cases. Direct detection of the varicella-zoster virus (VZV) is possible by nucleic acid detection using the polymerase chain reaction. The virus can cause two different types of disease: Varicella (chickenpox) in exogenous initial infection and herpes zoster (shingles) in endogenous reactivation.