Whooping Cough (Pertussis)

Whooping cough — or pertussis — is an infection of the respiratory system caused by the bacterium Bordetella pertussis (or B. pertussis). It's characterized by severe coughing spells that end in a "whooping" sound when the person breathes in. Before a vaccine was available, pertussis killed 5,000 to 10,000 people in the United States each year. Now, the pertussis vaccine has reduced the annual number of deaths to less than 30.

But in recent years, the number of cases has started to rise. By 2004, the number of whooping cough cases spiked past 25,000, the highest level it's been since the 1950s. It's mainly affected infants younger than 6 months old before they're adequately protected by immunizations, and kids 11 to 18 years old whose immunity has faded.

Signs and Symptoms

The first symptoms of whooping cough are similar to those of a common cold:

• runny nose
• sneezing
• mild cough
• low-grade fever

After about 1 to 2 weeks, the dry, irritating cough evolves into coughing spells. During a coughing spell, which can last for more than a minute, the child may turn red or purple. At the end of a spell, the child may make a characteristic whooping sound when breathing in or may vomit. Between spells, the child usually feels well.

Although it's likely that infants and younger children who become infected with B. pertussis will develop the characteristic coughing episodes with their accompanying whoop, not everyone will. However, sometimes infants don't cough or whoop as older kids do. They may look as if they're gasping for air with a reddened face and may actually stop breathing for a few seconds during particularly bad spells.

Adults and adolescents with whooping cough may have milder or atypical symptoms, such as a prolonged cough without the coughing spells or the whoop.

Contagiousness

Pertussis is highly contagious. The bacteria spread from person to person through tiny drops of fluid from an infected person's nose or mouth. These may become airborne when the person sneezes, coughs, or laughs. Others then can become infected by inhaling the drops or getting the drops on their hands and then touching their mouths or noses.

Infected people are most contagious during the earliest stages of the illness up to about 2 weeks after the cough begins. Antibiotics shorten the period of contagiousness to 5 days following the start of antibiotic treatment.

Prevention

Whooping cough can be prevented with the pertussis vaccine, which is part of the DTaP (diphtheria, tetanus, acellular pertussis) immunization. DTaP immunizations are routinely given in five doses before a child's sixth birthday. To give additional protection in case immunity fades, the AAP now recommends that kids ages 11-18 get a booster shot of the new combination vaccine (called Tdap), ideally when they're 11 or 12 years old, instead of the Td booster routinely given at this age. As is the case with all immunization schedules, there are important exceptions and special circumstances. Your doctor will have the most current information.

Experts believe that up to 80% of nonimmunized family members will develop whooping cough if they live in the same house as someone who has the infection. For this reason, anyone who comes into close contact with someone who has pertussis should receive antibiotics to prevent spread of the disease. Young kids who have not received all five doses of the vaccine may require a booster dose if exposed to an infected family member.

Incubation

The incubation period (the time between infection and the onset of symptoms) for whooping cough is usually 7 to 10 days, but can be as long as 21 days.

Duration

Pertussis can cause prolonged symptoms. The child usually has 1 to 2 weeks of common cold symptoms, followed by approximately 2 to 4 weeks of severe coughing, though the coughing spells can sometimes last even longer. The last stage consists of another several weeks of recovery with gradual resolution of symptoms. In some children, the recovery period may last for months.

Professional Treatment

Call the doctor if you suspect that your child has whooping cough. To make a diagnosis, the doctor will take a medical history, do a thorough physical exam, and take nose and throat mucus samples that will be examined and cultured for B. pertussis bacteria. Blood tests and a chest X-ray may also be done.

If your child has whooping cough, it will be treated with antibiotics, usually for 2 weeks. Many experts believe that the medication is most effective in shortening the infection when it's given in the first stage of the illness, before coughing spells begin. But even if antibiotics are started later, they're still important because they can stop the spread of the pertussis infection to others. Ask your doctor whether preventive antibiotics or vaccine boosters for other family members are needed.

Some kids with whooping cough need to be treated in a hospital. Infants and younger children are more likely to be hospitalized because they're at greater risk for complications such as pneumonia, which occurs in about 1 in 5 children under the age of 1 year who have pertussis. Up to 75% of infants younger than 6 months old with whooping cough will receive hospital treatment. In infants younger than 6 months of age, whooping cough can even be life-threatening.

While in the hospital, a child may need suctioning of thick respiratory secretions. Breathing will be monitored and oxygen given, if needed. Intravenous (IV) fluids might be required if the child shows signs of dehydration or has difficulty eating. Precautions will be taken to prevent the infection from spreading to other patients, hospital staff, and visitors.

Home Treatment

If your child is being treated for pertussis at home, follow the schedule for giving antibiotics exactly as your doctor prescribed. Giving cough medicine probably will not help, as even the strongest usually can't relieve the coughing spells of whooping cough.

During recovery, let your child rest in bed and use a cool-mist vaporizer to help loosen respiratory secretions and soothe irritated lungs and breathing passages. (Be sure to follow directions for keeping it clean and mold-free.) In addition, keep your home free of irritants that can trigger coughing spells, such as aerosol sprays, tobacco smoke, and smoke from cooking, fireplaces, and wood-burning stoves.

Kids with whooping cough may vomit or not eat or drink much because of frequent coughing. So offer smaller, more frequent meals and encourage your child to drink lots of fluids. Watch for signs of dehydration, too, including thirst, irritability, restlessness, lethargy, sunken eyes, a dry mouth and tongue, dry skin, crying without tears, and fewer trips to the bathroom to urinate (or in infants, fewer wet diapers).

When to Call the Doctor

Call the doctor if you suspect that your child has whooping cough or has been exposed to someone with whooping cough, even if your child has already received all scheduled pertussis immunizations.

Your child should be examined by a doctor if he or she has prolonged coughing spells, especially if these spells:

• make your child turn red or purple
• are followed by vomiting
• are accompanied by a whooping sound when your child breathes in after coughing

If your child has been diagnosed with whooping cough and is being treated at home, seek immediate medical care if he or she has difficulty breathing or shows signs of dehydration.

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Amebiasis

Amebiasis is an intestinal illness that's typically transmitted when someone eats or drinks something that's contaminated with a microscopic parasite called Entamoeba histolytica (E. histolytica). The parasite is an amoeba, a single-celled organism. That's how the illness got its name — amebiasis.

In many cases, the parasite lives in a person's large intestine without causing any symptoms. But sometimes, it invades the lining of the large intestine, causing bloody diarrhea, stomach pains, cramping, nausea, loss of appetite, or fever. In rare cases, it can spread into other organs such as the liver, lungs, and brain.

Amebiasis typically occurs in areas where living conditions are crowded and where there is a lack of adequate sanitation. The illness is very prevalent in parts of the developing world, including Africa, Latin America, India, and Southeast Asia. It is rare in the United States, occurring mostly in immigrants, recent travelers to high-risk countries, and people with HIV/AIDS.

Signs and Symptoms

Most kids who get amebiasis have minimal or no symptoms. When children do become ill, they experience abdominal pain that begins gradually, along with frequent loose or watery bowel movements, cramps, nausea, and a loss of appetite. In some cases they develop a fever and, possibly, bloody stools.

For some people, symptoms of amebiasis can begin within days to weeks of swallowing food or water contaminated by amoebas. For other people, symptoms of amebiasis either take months to appear or never appear at all.

Contagiousness

Amebiasis is contagious. Wherever living conditions are unsanitary and hygiene is poor, the chances are higher that the infection will pass from person to person.

Someone carrying amoebas in his or her intestines can pass the infection to others through the stool. When infected stool contaminates food or water supplies, amebiasis can spread quickly to many people at once. This is especially true in developing countries where drinking water may be contaminated.

Amebiasis can also be spread between people through inadequate hand washing, by using the same objects, and by sexual contact.

Prevention

There is no vaccine to prevent amebiasis.

Because amoebas may contaminate food and water, you can help prevent the illness by being cautious about what you eat and drink, especially in developing countries, where a good rule regarding food is to cook it, boil it, peel it, or forget it.

Treatment

If your doctor suspects that your child has amebiasis, you may be asked to collect stool samples. After diagnosis, treatment will usually require consultation with appropriate experts such as those at the Centers for Disease Control and Prevention (CDC) or other infectious disease specialists.

When to Call the Doctor

Call your doctor if your child has signs or symptoms of amebiasis, including:

• diarrhea with blood or mucus
• abdominal pain
• fever
• distended abdomen
• pain or tenderness in the area of the liver (below the ribs on the right side)

This is especially important if you have recently traveled to a part of the world where amebiasis is common. Your child should also be examined if he or she has persistent diarrhea without any other symptoms.

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Wart

Many of us have had a wart somewhere on our bodies at some time. Other than being a nuisance, most warts are harmless and go away on their own.

More common in kids than in adults, warts are skin infections caused by viruses of the human papillomavirus (HPV) family. They can affect any area of the body, but tend to invade warm, moist places, like small cuts or scratches on the fingers, hands, and feet. Warts are usually painless unless they're on the soles of the feet or another part of the body that gets bumped or touched all the time.

Kids can pick up HPV — and get warts — from touching anything someone with a wart has used, like towels and surfaces. Kids who bite their fingernails or pick at hangnails tend to get warts more often than kids who don't because they can expose less-protected skin and create open areas for a virus to enter and cause the wart.

Types of warts include:

• common warts. Usually found on fingers, hands, knees, and elbows, a common wart is a small, hard bump that's dome-shaped and usually grayish-brown. It has a rough surface that may look like the head of a cauliflower, with black dots inside.
• flat warts. These are about the size of a pinhead, are smoother than other kinds of warts, and have flat tops. Flat warts may be pink, light brown, or yellow. Most kids who get flat warts have them on their faces, but they can also grow on arms, knees, or hands and can appear in clusters.
• plantar warts. Found on the bottom of the foot, plantar warts can be very uncomfortable — like walking on a small stone.
• filiform warts. These have a finger-like shape, are usually flesh-colored, and often grow on or around the mouth, eyes, or nose.

Sometimes warts are sexually transmitted and appear in the genital area, but most warts appear on the fingers, hands, and feet.

Are Warts Contagious?

Simply touching a wart on someone doesn't guarantee that you'll get one, too. But the viruses that cause warts are passed from person to person by close physical contact or from a surface that a person with a wart touches, like a bathmat or a shower floor. (You can't, however, get a wart from holding a frog or toad, as your child might have wondered!)

A tiny cut or scratch can make any area of skin more vulnerable to warts. Also, picking at a wart can spread warts to other parts of the body.

The length of time between when someone is exposed to the virus that causes warts and when a wart appears varies. Warts can grow very slowly and may take weeks or longer, in some cases, to develop.

Preventing Warts

Although there's no way to prevent warts, it's always a good idea to encourage kids to wash their hands and skin regularly and well. If your child has a cut or scratch, use soap and water to clean the area because open wounds are more susceptible to warts and other infections.

It's also wise to have kids wear waterproof sandals or flip-flops in public showers, locker rooms, and around public pools (this can help protect against plantar warts and other infections, like athlete's foot).

Treating Warts

Warts don't generally cause any problems, so it's not always necessary to have them removed. Without treatment, it can take anywhere from 6 months to 2 years for a wart to go away. A doctor might decide to remove a wart if it's painful or interferes with activities because of the discomfort.

Doctors have different ways of removing warts, including:

• using over-the-counter or prescription medications to put on the wart
• burning the wart off using a light electrical current)
• freezing the wart with liquid nitrogen (called cryosurgery)
• using laser treatment (with recalcitrant warts)

Within a few days after the doctor's treatment, the wart may fall off, but several treatments might be necessary. Doctors don't usually cut off a wart because it can cause scarring and the wart may return.

If an older child has a simple wart on the finger, ask the doctor about using an over-the-counter wart remedy that can help remove the wart. This treatment can take several weeks or months before you see results, but eventually the wart should crumble away from the healthy skin. Wart medicines contain strong chemicals and should be used with care because they can also damage the areas of healthy skin. Talk with your doctor before using any over-the-counter wart medicine on the face or genitals.

Also make sure that your child:

• soaks the wart in warm water and removes dead skin on the surface of the wart with an emery board (that's never going to be used for nails) before applying the medicine. Be careful not to file into it.
• keeps the area of the wart covered while the medicine works
• knows not to rub, scratch, or pick at it to avoid spreading the virus to another part of the body or causing the wart to become infected

You might also have heard that you can use duct tape to remove a wart. Talk to your doctor about whether this type of home treatment is OK for your child.

When to Call the Doctor

Before you try to remove a wart with a store-bought remedy, call your doctor if:

• you have a young child or infant with a wart anywhere on the body
• your child (of any age) has a wart on the face, genitals, or rectum

Also call the doctor if a wart or surrounding skin is:

• painful
• red
• bleeding
• swollen
• oozing pus

Although they can be a nuisance, warts are common in childhood and unlikely to cause serious problems.

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Male Problems

Things That Can Go Wrong With the Male Reproductive System

Boys may sometimes experience reproductive system problems, including:

Disorders of the Scrotum, Testicles, or Epididymis
Conditions affecting the scrotal contents may involve the testicles, epididymis, or the scrotum itself.

• Testicular trauma. Even a mild injury to the testicles can cause severe pain, bruising, or swelling. Most testicular injuries occur when the testicles are struck, hit, kicked, or crushed, usually during sports or due to other trauma. Testicular torsion, when one of the testicles twists around, cutting off its blood supply, is also a problem that some teen males experience, although it's not common. Surgery is needed to untwist the cord and save the testicle.
• Varicocele. This is a varicose vein (an abnormally swollen vein) in the network of veins that run from the testicles. Varicoceles commonly develop while a boy is going through puberty. A varicocele is usually not harmful, although it can damage the testicle or decrease sperm production. Take your son to see his doctor if he is concerned about changes in his testicles.
• Testicular cancer. This is one of the most common cancers in men younger than 40. It occurs when cells in the testicle divide abnormally and form a tumor. Testicular cancer can spread to other parts of the body, but if it's detected early, the cure rate is excellent. Teen boys should be encouraged to learn to perform testicular self-examinations.
• Epididymitis is inflammation of the epididymis, the coiled tubes that connect the testes with the vas deferens. It is usually caused by an infection, such as the sexually transmitted disease chlamydia, and results in pain and swelling next to one of the testicles.
• Hydrocele. A hydrocele occurs when fluid collects in the membranes surrounding the testes. Hydroceles may cause swelling in the scrotum around the testicle but are generally painless. In some cases, surgery may be needed to correct the condition.
• Inguinal hernia. When a portion of the intestines pushes through an abnormal opening or weakening of the abdominal wall and into the groin or scrotum, it is known as an inguinal hernia. The hernia may look like a bulge or swelling in the groin area. It can be corrected with surgery.

Disorders of the Penis

Disorders affecting the penis include:

• Inflammation of the penis. Symptoms of penile inflammation include redness, itching, swelling, and pain. Balanitis occurs when the glans (the head of the penis) becomes inflamed. Posthitis is foreskin inflammation, which is usually due to a yeast or bacterial infection.
• Hypospadias. This is a disorder in which the urethra opens on the underside of the penis, not at the tip.
• Phimosis. This is a tightness of the foreskin of the penis and is common in newborns and young children. It usually resolves itself without treatment. If it interferes with urination, circumcision (removal of the foreskin) may be recommended.
• Paraphimosis. This may develop when a boy's uncircumcised penis is retracted but doesn't return to the unretracted position. As a result, blood flow to the head of the penis may be impaired, and your son may experience pain and swelling. A doctor may use lubricant to make a small incision so the foreskin can be pulled forward. If that doesn't work, circumcision may be recommended.
• Ambiguous genitalia. This occurs when a child is born with genitals that aren't clearly male or female. In most boys born with this disorder, the penis may be very small or nonexistent, but testicular tissue is present. In a small number of cases, the child may have both testicular and ovarian tissue.
• Micropenis. This is a disorder in which the penis, although normally formed, is well below the average size, as determined by standard measurements.

If your son has symptoms of a problem with his reproductive system or he has questions about growth and sexual development, talk with your doctor — many problems with the male reproductive system can be treated.

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Female Problems

Problems of the Female Reproductive System

Your daughter may sometimes experience reproductive system problems. Below are some examples of disorders that affect the female reproductive system.

Problems of the Vulva and Vagina

• Vulvovaginitis is an inflammation of the vulva and vagina. It may be caused by irritating substances (such as laundry soaps or bubble baths). Poor personal hygiene (such as wiping from back to front after a bowel movement) may also cause this problem. Symptoms include redness and itching in the vaginal and vulvar areas and sometimes vaginal discharge. Vulvovaginitis can also be caused by an overgrowth of Candida, a fungus normally present in the vagina.
• Nonmenstrual vaginal bleeding is most commonly due to the presence of a vaginal foreign body, often wadded-up toilet paper. It may also be due to urethral prolapse, a condition in which the mucous membranes of the urethra protrude into the vagina and form a tiny, doughnut-shaped mass of tissue that bleeds easily. It can also be due to a straddle injury (such as when falling onto a beam or bicycle frame) or vaginal trauma from sexual abuse.
• Labial adhesions, the sticking together or adherence of the labia in the midline, usually appear in infants and young girls. Although there are usually no symptoms associated with this condition, labial adhesions can lead to an increased risk of urinary tract infection. Sometimes topical estrogen cream is used to help separate the labia.

Problems of the Ovaries and Fallopian Tubes

• Ectopic pregnancy occurs when a fertilized egg, or zygote, doesn't travel into the uterus, but instead grows rapidly in the fallopian tube. A woman with this condition can develop severe abdominal pain and should see a doctor because surgery may be necessary.
• Endometriosis occurs when tissue normally found only in the uterus starts to grow outside the uterus — in the ovaries, fallopian tubes, or other parts of the pelvic cavity. It can cause abnormal bleeding, painful periods, and general pelvic pain.
• Ovarian tumors, although they're rare, can occur. Girls with ovarian tumors may have abdominal pain and masses that can be felt in the abdomen. Surgery may be needed to remove the tumor.
• Ovarian cysts are noncancerous sacs filled with fluid or semisolid material. Although they are common and generally harmless, they can become a problem if they grow very large. Large cysts may push on surrounding organs, causing abdominal pain. In most cases, cysts will disappear on their own and treatment is unnecessary. If the cysts are painful, a doctor may prescribe birth control pills to alter their growth, or they may be removed by a surgeon.
• Polycystic ovary syndrome is a hormone disorder in which too many male hormones (androgens) are produced by the ovaries. This condition causes the ovaries to become enlarged and develop many fluid-filled sacs, or cysts. It often first appears during the teen years. Depending on the type and severity of the condition, it may be treated with drugs to regulate hormone balance and menstruation.
• Ovarian torsion, or the twisting of the ovary, can occur when an ovary becomes twisted because of a disease or a developmental abnormality. The torsion blocks blood from flowing through the blood vessels that supply and nourish the ovaries. The most common symptom is lower abdominal pain. Surgery is usually necessary to correct it.

Menstrual Problems

A variety of menstrual problems can affect girls, including:

• Dysmenorrhea is when a girl has painful periods.
• Menorrhagia is when a girl has a very heavy periods with excess bleeding.
• Oligomenorrhea is when a girl misses or has infrequent periods, even though she's been menstruating for a while and isn't pregnant.
• Amenorrhea is when a girl has not started her period by the time she is 16 years old or 3 years after starting puberty, has not developed signs of puberty by age 14, or has had normal periods but has stopped menstruating for some reason other than pregnancy.

Infections of the Female Reproductive System

• Sexually transmitted diseases (STDs). These include infections and diseases such as pelvic inflammatory disease (PID), human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), human papillomavirus (HPV, or genital warts), syphilis, chlamydia, gonorrhea, and genital herpes. Most are spread from one person to another by sexual contact.
• Toxic shock syndrome. This uncommon illness is caused by toxins released into the body during a type of bacterial infection that is more likely to develop if a tampon is left in too long. It can produce high fever, diarrhea, vomiting, and shock.

If you think your daughter may have symptoms of a problem with her reproductive system or if you have questions about her growth and development, talk to your doctor — many problems with the female reproductive system can be treated.

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Lymphatic System Problems

Problems of the Lymphatic System

Certain diseases can affect the lymph nodes, the spleen, or the collections of lymphoid tissue in certain areas of the body.

• Lymphadenopathy. This is a condition where the lymph nodes become swollen or enlarged, usually because of a nearby infection. Swollen lymph glands in the neck, for example, can be caused by a throat infection. Once the infection is treated, the swelling usually goes away. If several lymph node groups throughout the body are swollen, that can indicate a more serious disease that needs further investigation by a doctor.
• Lymphadenitis. Also called adenitis, this inflammation of the lymph node is caused by an infection of the tissue in the node. The infection can cause the skin overlying the lymph node to swell, redden, and feel warm and tender to the touch. This infection usually affects the lymph nodes in the neck, and it's usually caused by a bacterial infection that can be easily treated with an antibiotic.
• Lymphomas. These cancers start in the lymph nodes when lymphocytes undergo changes and start to multiply out of control. The lymph nodes swell, and the cancer cells crowd out healthy cells and may cause tumors (solid growths) in other parts of the body.
• Splenomegaly (enlarged spleen). In someone who is healthy, the spleen is usually small enough that it can't be felt when you press on the abdomen. But certain diseases can cause the spleen to swell to several times its normal size. Most commonly, this is due to a viral infection, such as mononucleosis. But in some cases, more serious diseases such as cancer can cause the spleen to expand. Doctors usually tell someone with an enlarged spleen to avoid contact sports like football for a while, because a swollen spleen is vulnerable to rupturing (bursting). And if it ruptures, it can cause a huge amount of blood loss.
• Tonsillitis. Tonsillitis is caused by an infection of the tonsils, the lymphoid tissues in the back of the mouth at the top of the throat that normally help to filter out bacteria. When the tonsils are infected, they become swollen and inflamed, and can cause a sore throat, fever, and difficulty swallowing. The infection can also spread to the throat and surrounding areas, causing pain and inflammation. A child with repeated tonsil infections may need to have them removed in a procedure called a tonsillectomy.

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