Synonyms
Exanthema subitum, Roseola infantum, Sixth DiseaseSixth Disease
Definition
The three-day fever describes a viral disease. After about three days of fever, a large-area skin rash, a so-called exanthema, usually appears on the trunk and neck.
Therapy
The therapy of three-day fever in children is divided into the following points:
- Fever
- Deflection
- Febrile convulsions
- Antiviral therapy
- Digestive disorders (diarrhea, vomiting)
In case of a three-day fever, a symptomatic therapy of the fever, i.e. a fever reduction, can be carried out first in the first days. This can first be attempted with the usual home remedies, such as plenty of bed rest, warmth, plenty of fluids and warm clothing. Likewise, moist lukewarm calf compresses can be applied, which support the heat release through evaporation.
In this case, cloths are soaked in lukewarm water, wrung out and placed around the child’s lower legs. It is important that the water is really lukewarm, because too cold calf compresses cause the vessels in the legs to contract and reduce the body’s heat output. Dry cloths can be placed under and over the wet wraps so that the bed does not get wet.
The moisture from the calf compresses is driven by the increased body heat to evaporate, cooling the skin. The calf compresses should be changed as soon as they are warmed. 2-3 passes can be made.
Since calf compresses may be more difficult to apply in children under one year of age, the body can also be washed with lukewarm water. It is important that calf compresses are only used on children whose circulation is fine and whose extremities (arms and hands as well as legs and feet) are warm. A sufficient fluid intake is just as essential in the case of fever, as the body loses a lot of fluid in the case of fever.
Water, juices or tea are recommended. It is also best to encourage the child to drink every half hour. If these measures are not sufficient, the fever can also be reduced with medication.
Paracetamol or non-steroidal anti-inflammatory drugs such as ibuprofen are suitable for this. Depending on the doctor’s instructions, such drugs can either be swallowed as drops or tablets or used as suppositories. Under no circumstances should children be given acetylsalicylic acid (ASA) as it can lead to the so-called Reye syndrome in children.
Reye syndrome is a serious disease of the liver and brain, resulting in severe liver dysfunction and subsequent impairment of brain function. This can lead to loss of consciousness and seizures. It can eventually even lead to coma and respiratory arrest and can be fatal.
There is no causal therapy to treat the typical rash on the trunk and neck that develops during the course of the three-day fever. Depending on the symptoms, symptomatic therapy may also be sufficient. Normally, the rash is not accompanied by itching.
However, some patients complain of itching of the raised blisters, pustules or wheals. To prevent scarring, the affected areas should not be scratched if possible. This is especially true in the case of a rash on the face, as this is where scarring is particularly common in wounds, which are later perceived as particularly disturbing.
Certain creams and tinctures can help against itching. It is advisable to consult your doctor before using these creams and tinctures. There are also herbal and homeopathic remedies against itching, the effectiveness of which is usually not proven, but in individual cases can lead to an improvement in symptoms.
Since the rash in the context of the three-day fever is only of very short duration, the itching usually disappears after a short time. In rare cases, febrile convulsions may occur during an increase in fever in the three-day fever. These can be treated with medication and sedatives.
Diazepam or clonazepam can be used as medication. Both drugs belong to the benzodiazepines and have anticonvulsant, anxiety-relieving and sedative effects. They can be used as a prophylaxis to prevent febrile seizures.
It is important that the side effects are taken into account and that administration is not continued for more than 72 hours.In an acute seizure, care should also be taken to ensure that objects, especially those with which the child could be injured (sharp or pointed objects), are not within reach. Furthermore, breathing should be observed. A reduced number of breaths and a blue discoloration of the skin may well occur.
Normally an acute seizure ends on its own. However, if it exceeds 10-15 minutes, a seizure interruption with diazepam should be performed. It is recommended that a child be admitted to hospital after a seizure.
A reduction in fever can prevent a further seizure, as fever is a cause of febrile seizures. Three-day fever is a disease caused by viruses. Therefore antibiotics are ineffective in this case, as they only work in bacterial diseases.
However, there is no sufficiently proven antiviral therapy available. In rare cases, reactivation of the disease can lead to complications such as encephalitis. In this case, it is discussed whether a therapy with the drugs ganciclovir or cidofovir (two antivirals) is appropriate.
However, the effect and sensible application have not yet been fully clarified. Also under discussion is the antiviral drug foscarnet, which shows an effect against the human herpes virus 6 (HH-6) in the test tube. The human herpes viruses 6 and 7 are considered to be the trigger for the exanthema, which occurs in the course of the three-day fever. If other accompanying symptoms such as diarrhea or vomiting occur, these should also be treated symptomatically. In case of diarrhoea, a sufficient fluid intake is also important.
