WEDNESDAY, Feb. 20, 2002 (HealthDayNews) -- Health officials are scratching their heads over a mysterious rash that has affected hundreds of school children in at least seven states.
The rash was first reported in late January in the Quakertown Community School District, located outside of Philadelphia. Since then, the rash has been confirmed in almost 170 students in all nine of the district's schools and forced the closure of some schools while environmental tests were conducted.
Similar rashes have since been reported at schools in New York, West Virginia, Virginia, Ohio, Oregon and Washington.
The symptoms include a bright red rash on the cheeks, neck, arms, legs or thighs, and sometimes a lacy rash on the trunk. Intriguingly, many students have reported the rash disappears when they leave the school building and returns when they come back.
Otherwise, the main link between all of the cases is the fact that experts are baffled as to a cause.
"This is indeed a mystery," says Dr. Norman Sykes, a Philadelphia dermatologist who has treated dozens of students from the Quakertown Community School District.
"It's actually sort of fascinating from a medical point of view, but we really want to find out what the cause is, because there are a lot of worried parents who are understandably very anxious about this," he says.
In searching for clues, officials have considered both medical and environmental factors.
At one school, in Gig Harbor, Washington's Peninsula School District, an overactive ventilation system that took too much moisture out of the air was suspected of causing the rashes of at least 50 students.
However, a top-to-bottom environmental inspection of schools in the Quakertown district, which included examining everything from cafeteria foods to the ventilation system to the wood chips used in playgrounds, turned up nothing.
Acting on a hunch the rashes might be the result of a condition called fifth disease, named that because it was once regarded as one of the five main illnesses afflicting children, Sykes performed blood tests on some patients.
Fifth disease is characterized by a similar rash, or a "slapped face" appearance, but also usually produces a low-grade fever and cold-like symptoms. Although evidence of the virus was indeed found in one patient, a 3-year-old sibling of a student, tests on at least nine other students have turned up negative.
Still, the presence of the one case has led Sykes to speculate that the culprit may be an undiscovered form of the same virus, called Parvovirus B19, that causes fifth disease.
"The evidence has led us to suspect there might be either some mutated form of the Parvovirus that's causing this, or it could be a completely different virus that is yet to be discovered," Sykes says.
With recent elevated concerns of bioterrorism, Sykes adds causes such as anthrax were also looked at, but have been ruled out.
While such bioterrorism concerns may have brought a bit more alarm to the situation than normal, Sykes says it's not that unusual to see unexplained symptoms mysteriously pop up in groups of people.
"Fifth disease, itself, was actually a medical mystery until as recently as 1975, when it was discovered that Parvovirus B19 was the cause," he explains. "So it's true that every now and then we stumble on something that we just don't recognize."
However, others say some clues in the cases don't add up to a virus.
"While some viral infections can have a waxing and waning of symptoms, it's suspicious that children would report getting worse in the building and better when they leave," says Andy Mullins, an Epidemic Intelligence Service officer with the Centers for Disease Control and Prevention (CDC).
"It almost sounds more like something new introduced into the school, like a varnish or a chemical or something that all of a sudden might cause a contact dermatitis reaction," he adds.
While some parents and siblings of patients in Pennsylvania have reported similar symptoms, Sykes says he hasn't been able to confirm the rashes are the same. He suspects some may simply have dry skin that was scratched too much, causing a rash that was then associated with the relative's rash.
There have also been a few Quakertown cases that might best be described as "opportunist-itis" - - cases in which students apparently rubbed themselves with sand paper in a failed attempt to justify closing the school, according to reports.
For the legitimate rashes, Sykes says that, with the exception of one or two cases, most have appeared to either clear up on their own or respond well to standard treatments such as oral antihistamines or topical cortisone creams.
CDC spokeswoman Rhonda Smith says the federal agency is aware of the cases, but has not found it necessary to become officially involved yet.
"We've been asked to review some information for a few states, but so far, the rashes have appeared to have gone away on their own, the schools reopened and we haven't heard of any negative repercussions from the initial onset. So, we have not become involved, " she says.
What To Do
If your child develops a rash with symptoms matching those listed above, you may want to consider Sykes' original speculation of fifth disease. Here's more information on fifth disease from the CDC.
You can also read more updates on the Pennsylvania outbreak at the Quakertown Community School District.
