Fever in children: What you need to know

The article was professionally consulted by Specialist Doctor II Le Thanh Cam - Department of Pediatrics - Neonatology, Vinmec Da Nang International General Hospital.

Scarlet fever in children (ticker fever or jungle typhus), is an acute bacterial infection that spreads to humans. The disease usually occurs in the rainy season, in places with a lot of bushes and is quite dangerous if not treated properly.

In Vietnam, the parasitic hosts of red mite larvae, including mice and small mammals, are abundantly present and widely distributed in many places. In recent years, northern provincial hospitals have received many cases of tick fever and even death. Many children with fever were hospitalized in critical condition, with hemorrhage, systemic edema and toxic infection.
Other names: Bush fever, jungle fever, tick fever, bush typhus or jungle typhus. Location: Malaria is most prevalent in Asia and the Western Pacific, including Vietnam. Small outbreaks appear sporadically in areas with forests and shrubs, lawns along rivers and streams, on swidden fields or places with shade and moist soil. Time: tick fever occurs all year round but is common in the rainy season (from May to October) in which June and July are the peak. Target audience: All ages can be infected, but mainly children, especially those living in high mountain forests, near remote borders.

Pathogen is an obligate intracellular parasite, named Orientia tsutsugamushi, belonging to the family Rickettsia. They do not have a complete enzyme system, so they are forced to live in the cells of other animals.
Source of disease The larvae of ticks are infected with the bacterium O. tsutsugamushi.
Mode of transmission The larvae infected with O. tsutsugamushi will crawl up the grass and feed on human blood for 2-3 days. Humans are only infected through the saliva of the tick larvae, the disease is not capable of being transmitted from person to person.
Based on the living characteristics of the mites, people can be infected while working in the outbreak, for example: working in the fields, digging ore mining, passing through areas along rivers and streams, entering caves kicking, having a picnic, sitting, resting on the grass...

3.1. The characteristic sore of typhus After passing through the skin, O. tsutsugamushi bacteria will multiply locally and form nodules. From here, they progress to pea-sized blisters and scaly necrotic sores, specifically as follows:
Initially, blisters with turbid fluid around red papules. Occurs on soft, moist skin (genitals, groin, armpits, neck) or elsewhere, such as in the earlobes, navel or eyelids. The sores are usually painless but can sometimes be itchy. Unlike a rash or chickenpox, a person with typhoid fever usually has only one sore. About 4-5 days later, the blister breaks into a light or dark brown scaly spot. After the scab peels off, a shallow bottom ulcer is revealed. When the fever is gone, the sores will also heal gradually. Although typical, some patients with tick fever may not find this characteristic sore.
3.2. Lymph nodes and maculopapular rash From external sores, the causative agent of Orientia disease attacks the lymphatic system, causing local inflammation of the lymph nodes. After that, the disease progressed to systemic lymphadenitis, causing swelling and pain in the lymph nodes with some characteristics such as:
Within 2-3 days, the fever will appear in the area with the sores. If the patient does not have an ulcer, this swollen and painful lymph node is an indicator. Sometimes the lymph nodes will swell all over the body, but the degree of swelling and pain is milder. After 5-8 days from the onset of fever, most of the time, a maculopapular rash appears all over the body, except for the palms and soles. The duration of the rash is from a few hours up to a week. Erythema is not itchy, painless, but there are cases where the rash is purpura and then goes away on its own. 3.3. Multi-organ damage Orientia continues hematogenously, colonizing and growing in the endothelial cells of small blood vessels in several organs, including the lungs, liver, spleen, kidney, brain, and heart, and causes damage. multi-organ. Specific symptoms through each stage are:
First week of fever: The patient may cough a lot. Second end of week: Pneumonia often appears. Severe cases can damage multiple organs: Myocarditis, cardiovascular collapse, disseminated intravascular coagulation, severe pneumonia, respiratory failure... 3.4. Other clinical manifestations The incubation period of typhus in children lasts an average of 10 -12 days, can be shorter or longer to a maximum of 21 days. At this stage, only burning nodules and swollen lymph nodes are seen nearby. When tick fever progresses, the patient also has some symptoms as follows:
Chills for the first 1-2 days; Sudden onset of fever, initially low-grade fever, then continuously high ≥ 38 - 40°C but pulse is not rapid; Dizziness and severe headache; Dry lips, dirty tongue; Body aches and pains; Lethargy, delirium or agitation; Hypotension; Digestive disorders; Hemorrhage (vomiting, coughing, and bloody stools).

4.1. Differential diagnosis Recognizing and diagnosing typhus in children is often difficult because the initial symptoms of the disease are atypical, easily confused with malaria, typhus, dengue, and typhus. weld. In addition, most patients are admitted to the hospital when they are in the late stage, serious symptoms similar to spirochetes infection, acute viral infection, sepsis, meningococcal infection...
Therefore, to make a definitive diagnosis, the doctor must rely on the tick bite (if any) and conduct tests, including:
Find specific antibodies in the blood. Complete blood count shows normal or elevated white blood cell count, neutrophil predominance, and low platelet count. Liver enzymes are very high. Biochemical analysis of the positive ELISA reaction. 4.2. Treatment Early intervention and correct antibiotics will give positive results, patients usually have no fever after 3 days, can recover quickly. Conversely, when left untreated, fever can last for 2 weeks or more and then gradually subside. Usually, typhus in children clears up on their own after 6 weeks, but if the disease is severe and untreated, the mortality rate is quite high. The immunity of typhus is not stable, so there is a possibility of re-infection after being cured.
Your doctor may prescribe specific antibiotics such as chloramphenicol, tetracycline or doxycycline to treat tick fever. For children and pregnant women, azithromycin or chloramphenicol is usually indicated. In general, the antibiotic will be quite effective, the patient will quickly reduce the fever, and the symptoms will be markedly improved. It should be noted that you should not arbitrarily stop antibiotics too soon, especially in the first days of fever, which can cause the disease to recur.

Treatment of outbreaks: Clearing bushes around the house, spraying insecticides, killing rats seasonally. Personal protection: When working in the fields or in the forest, it is necessary to wear long-sleeved clothes, boots and hats to protect them carefully; Avoid sitting, lying, placing personal tools on the lawn, near the edge of the bush, tree stump. Prophylaxis with drugs: Use insecticides on clothes or use insect repellant skin creams. Scarlet fever in children is an acute infectious disease, caused by larvae of ticks infected with Orientia tsutsugamushi bacteria. If detected early and treated properly, tick fever will go away after 3-5 days. When having suspicious symptoms, the patient should immediately go to a medical facility, avoid arbitrarily taking fever-reducing drugs, which will make the disease worse. Moreover, this pathology is also difficult to distinguish and easy to misdiagnose, if not treated promptly, there is a risk of death.
Children need to provide enough elemental zinc/day for them to eat well, reach the correct height and weight and exceed the standard. Zinc plays a role in affecting most biological processes taking place in the body, especially the breakdown of nucleic acids, proteins... Organs in the body when zinc deficiency can lead to a There are a number of diseases such as neurological disorders, irritability, etc. Therefore, parents need to learn about the role of zinc and guide them to appropriate zinc supplements for their children.
In addition to zinc, parents also need to supplement their children with other important vitamins and minerals such as lysine, chromium, B vitamins,... errands.
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