Pneumocystis Pneumonia

Pneumocystis carinii pneumonia (PCP) is an infection caused by Pneumocystis carinii, a microscopic fungus that lives in the lungs of many people. The infection usually causes no symptoms in healthy people, but can cause pneumonia in infants who have AIDS, cancer, or other conditions that affect the immune system.

In kids who are already seriously ill, symptoms of this form of pneumocystis pneumonia begin suddenly with a fever, a cough, and difficulty breathing.

Pneumocystis pneumonia is the most common pediatric illness associated with AIDS, especially in babies younger than 6 months, and its prevention is very important in AIDS care.

Infants who are weak or sick also can develop pneumocystis pneumonia. Usually the infant is 3 to 6 months old and has no fever, but gradually begins to breathe faster than normal. As the lung infection gets worse, breathing becomes more difficult, and the baby's chest muscles may begin to retract (pull in abnormally) with each breath. The child's lips, fingernails, and skin also may turn blue or gray.

Diagnosing PCP

A doctor can sometimes diagnose pneumocystis pneumonia by X-ray or by finding the organism in lung fluids that have been examined in the laboratory. The doctor may need to use a bronchoscope to take a tissue sample from inside the lungs. This sample will be sent to a laboratory where special chemical stains can identify the pneumocystis organism.

Even if your child has no other medical problems, call your doctor immediately if your child has unusually rapid breathing or difficulty breathing, is coughing, or has a blue or gray color to his or her nails, lips, or skin.

Treating PCP

Antibiotics, either alone or in special combinations, are usually used to treat pneumocystis pneumonia. They may be given by mouth or intravenously (into the veins) for at least 2 weeks. If the child has AIDS, antibiotic treatment will probably last about 3 weeks. Depending on the severity of the PCP infection, the doctor may add a steroid medication.

If your child has any condition that severely weakens the immune system, check with your doctor about the need for giving your child antibiotics to prevent pneumocystis infection.

All infants born to HIV-infected mothers should begin treatment to prevent PCP at 1 month of age until it's known for sure whether they have the HIV infection.

Transmission of PCP

Research is ongoing about how pneumocystis is spread. Scientists believe that it's transmitted through the air, but cannot yet point to sources in the environment. Although animals may carry pneumocystis, they do not seem to be able to pass it to humans. Human-to-human spread may be possible, since there have been hospital outbreaks among sick infants and children with weakened immune systems.

Because of the seriousness of this infection, most kids who have symptoms of pneumocystis infection are treated in the hospital. Some of the different antibiotics that may be used to treat pneumocystis can have side effects, which are easier to monitor in a hospital.

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Tinea (Ringworm, Jock Itch, Athlete's Foot)

If your kids are active, locker-room showers and heaps of sweaty clothes probably are part of their everyday lives — and so is the risk of getting fungal skin infections.

Jock itch, athlete's foot, and ringworm are all types of fungal skin infections known collectively as tinea. They're caused by fungi called dermatophytes that live on skin, hair, and nails and thrive in warm, moist areas.

Symptoms of these infections can vary depending on where they appear on the body. The source of the fungus might be soil, an animal (most often a cat, dog, or rodent), or in most cases, another person. Minor trauma to the skin (such as scratches) and poor skin hygiene increase the potential for infection.

It's important to teach kids to take precautions to prevent fungal skin infections, which can be itchy and uncomfortable. If they do get one, most can be treated with over-the-counter medication, though some might require treatment by a doctor.

Ringworm

Ringworm isn't a worm, but a fungal infection of the scalp or skin that got its name from the ring or series of rings that it can produce.

Symptoms of Ringworm

Ringworm of the scalp may start as a small sore that resembles a pimple before becoming patchy, flaky, or scaly. These flakes may be confused with dandruff. It can cause some hair to fall out or break into stubbles. It can also cause the scalp to become swollen, tender, and red.

Sometimes, there may be a swollen, inflamed mass known as a kerion, which oozes fluid. These symptoms can be confused with impetigo or cellulitis. The distinctive features of ringworm are itching, redness on the skin, and a circular patchy lesion that spreads along its borders and clears at the center.

Ringworm of the nails may affect one or more nails on the hands or feet. The nails may become thick, white or yellowish, and brittle.

If you suspect that your child has ringworm, call your doctor.

Treating Ringworm

Ringworm is fairly easy to diagnose and treat. Most of the time, the doctor can diagnose it by looking at it or by scraping off a small sample of the flaky infected skin to test for the fungus. The doctor may recommend an antifungal ointment for ringworm of the skin or an oral medication for ringworm of the scalp and nails.

Preventing Ringworm

A child usually gets ringworm from another infected person, so it's important to encourage kids to avoid sharing combs, brushes, pillows, and hats with others.

Jock Itch

Jock itch, an infection of the groin and upper thighs, got its name because cases are commonly seen in active kids who sweat a lot while playing sports. But the fungus that causes the jock itch infection can thrive on the skin of any kids who spend time in hot and humid weather, wear tight clothing like bathing suits that cause friction, share towels and clothing, and don't completely dry off their skin. It can last for weeks or months if it goes untreated.

Symptoms of Jock Itch

Symptoms of jock itch may include:

• itching, chafing, or burning in the groin, thigh, or anal area
• skin redness in the groin, thigh, or anal area
• flaking, peeling, or cracking skin

Treating Jock Itch

Jock itch can usually be treated with over-the-counter antifungal creams and sprays. When using one of these, kids should:

• Wash and then dry the area with a clean towel.
• Apply the antifungal cream, powder, or spray as directed on the label.
• Change clothing, especially the underwear, every day.
• Continue this treatment for 2 weeks, even if symptoms disappear, to prevent the infection from recurring.

If the ointment or spray is not effective, call your doctor, who can prescribe other treatment.

Preventing Jock Itch

Jock itch can be prevented by keeping the groin area clean and dry, particularly after showering, swimming, and sweaty activities.

Athlete's Foot

Athlete's foot typically affects the soles of the feet, the areas between the toes, and sometimes the toenails. It can also spread to the palms of the hands, the groin, or the underarms if your child touches the affected foot and then touches another body part. It got its name because it affects people whose feet tend to be damp and sweaty, which is often the case with athletes.

Symptoms of Athlete's Foot

The symptoms of athlete's foot may include itching, burning, redness, and stinging on the soles of the feet. The skin may flake, peel, blister, or crack.

Treating Athlete's Foot

A doctor can often diagnose athlete's foot simply by examining the foot or by taking a small scraping of the affected skin to detect the presence of the fungus that causes athlete's foot.

Over-the-counter antifungal creams and sprays may effectively treat mild cases of athlete's foot within a few weeks. Athlete's foot can recur or be more serious. If that's the case, ask your doctor about trying a stronger treatment.

Preventing Athlete's Foot

Because the fungus that causes athlete's foot thrives in warm, moist areas, infections can be prevented by keeping feet and the space between the toes clean and dry.

Athlete's foot is contagious and can be spread in damp areas, such as public showers or pool areas, so it's wise to take extra precautions. Encourage kids to:

• wear waterproof shoes or flip-flops in public showers, like those in locker rooms
• alternate shoes or sneakers to prevent moisture buildup and fungus growth
• avoid socks that trap moisture or make the feet sweat and instead choose cotton or wool socks or socks made of fabric that wicks away the moisture
• choose sneakers that are well ventilated with small holes to keep the feet dry

By taking the proper precautions and teaching them to your kids, you can prevent these uncomfortable skin infections from putting a crimp in your family's lifestyle.

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Diaper Rash

Diaper rash is a very common infection that can cause a baby's skin to become sore, red, scaly, and tender. In most cases, the rash occurs because the skin is irritated by diapers that are too tight; soiled diapers that are left on for too long; or certain brands of detergent, diapers, and baby wipes.

Diaper rash usually can be cleared up by checking your baby's diaper often, and changing it as soon as it's wet or soiled, and by using a zinc oxide cream or ointment to soothe skin and protect it from moisture.

When a diaper rash lasts for more than 3 days, even with changes to the diapering routine, it's usually caused by candida, a yeast-like fungus. This form of the rash is usually red, slightly raised, and has small red dots extending beyond the main part of the rash. It typically starts in the creases of skin and can spread to skin on the front and back of the baby. It usually goes away after treatment with antifungal creams, which can be prescribed by your doctor.

Preventing Diaper Rash

The best way to prevent diaper rash is by keeping your baby's skin as dry and clean as possible and changing diapers often so that feces and urine won't irritate the skin. The plastic that prevents diapers from leaking also prevents air circulation, thus creating a warm, moist environment where rashes and fungi can thrive.

To prevent diaper rash:

• change your baby's soiled or wet diapers as soon as possible
• occasionally soak your baby's bottom between diaper changes with warm water
• allow your baby's skin to dry completely before you put on another diaper

If you use cloth diapers, rinse them several times after washing to remove any traces of soap or detergent that can irritate your baby's skin. Avoid using fabric softeners — even these can irritate the skin.

Some experts suggest allowing your baby to go without diapers for several hours each day to give irritated skin a chance to dry and "breathe." This is easiest if you place your baby in a crib with waterproof sheets.

Treating Diaper Rash

Diaper rash usually goes away within 2 to 3 days with home care. If it persists, or if sores start to appear on your baby's skin, talk to your doctor.

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