Diphtheria

Diphtheria is a bacterial infection that spreads easily and occurs quickly. It mainly affects the nose and throat. Children under 5 and adults over 60 years old are particularly at risk for contracting the infection. People living in crowded or unclean conditions, those who aren't well nourished, and children and adults who don't have up-to-date immunizations are also at risk.

Diphtheria is rare in the United States and Europe, where health officials have been immunizing children against it for decades. However, it's still common in developing countries where immunizations aren't given routinely. In 1993 and 1994, more than 50,000 cases were reported during a serious outbreak of diphtheria in countries of the former Soviet Union.

Signs and Symptoms

In its early stages, diphtheria can be mistaken for a bad sore throat. A low-grade fever and swollen neck glands are the other early symptoms.

The toxin, or poison, caused by the bacteria can lead to a thick coating in the nose, throat, or airway. This coating is usually fuzzy gray or black and can cause breathing problems and difficulty in swallowing. The formation of this coating (or membrane) in the nose, throat, or airway makes a diphtheria infection different from other more common infections (such as strep throat) that cause sore throat.

As the infection progresses, the person may:

• have difficulty breathing or swallowing
• complain of double vision
• have slurred speech
• even show signs of going into shock (skin that's pale and cold, rapid heartbeat, sweating, and an anxious appearance)

In cases that progress beyond a throat infection, diphtheria toxin spreads through the bloodstream and can lead to potentially life-threatening complications that affect other organs of the body, such as the heart and kidneys. The toxin can cause damage to the heart that affects its ability to pump blood or the kidneys' ability to clear wastes. It can also cause nerve damage, eventually leading to paralysis. Up to 40% to 50% of those who don't get treated can die.

Prevention

Preventing diphtheria depends almost completely on immunizing children with the diphtheria/tetanus/pertussis (DTP or DTaP) vaccine and non-immunized adults with the diphtheria/tetanus vaccine (DT). Most cases of diphtheria occur in people who haven't received the vaccine at all or haven't received the entire course.

The immunization schedule calls for:

• DTaP vaccines at 2, 4, and 6 months of age
• booster dose given at 12 to 18 months
• booster dose given again at 4 to 6 years
• booster shots given every 10 years after that to maintain protection

Although most children tolerate it well, the vaccine sometimes causes mild side effects such as redness or tenderness at the injection site, a low-grade fever, or general fussiness or crankiness. Severe complications, such as an allergic reaction, are rare.

Contagiousness

Diphtheria is highly contagious. It's easily passed from the infected person to others through sneezing, coughing, or even laughing. It can also be spread to others who pick up tissues or drinking glasses that have been used by the infected person.

People who have been infected by the diphtheria bacteria can infect others for up to 4 weeks, even if they don't have any symptoms. The incubation period (the time it takes for a person to become infected after being exposed) for diphtheria is 2 to 4 days, although it can range from 1 to 6 days.

Treatment

Children and adults with diphtheria are treated in a hospital. After a doctor confirms the diagnosis through a throat culture, the infected person receives a special anti-toxin, given through injections or through an IV, to neutralize the diphtheria toxin already circulating in the body, as well as antibiotics to kill the remaining diphtheria bacteria.

If the infection is advanced, people with diphtheria may need a ventilator to help them breathe. In cases in which the toxins may have spread to the heart, kidneys, or central nervous system, patients may need intravenous fluids, oxygen, or heart medications.

A person with diphtheria must also be isolated. Family members (as well as others who spend a lot of time with the person with diphtheria) who haven't been immunized, or who are very young or elderly, must be protected from contact with the patient.

When someone is diagnosed with diphtheria, the doctor will notify the local health department and will take steps to treat everyone in the household who may have been exposed to the bacteria. This will include assessment of immune status, throat cultures, and booster doses of the diphtheria vaccine. They will also receive antibiotics as a precaution.

Immediate hospitalization and early intervention allow most patients to recover from diphtheria. After the antibiotics and anti-toxin have taken effect, someone with diphtheria will need bed rest for a while (4 to 6 weeks, or until full recovery). Bed rest is particularly important if the person's heart has been affected by the disease. Myocarditis, or inflammation of the heart muscle, can be a complication of diphtheria.

Those who have recovered should still receive a full course of the diphtheria vaccine to prevent a recurrence because contracting the disease doesn't guarantee lifetime immunity.

When to Call the Doctor

Call your doctor immediately if you or your child has symptoms of diphtheria, if you observe symptoms in someone else, if anyone in your family is exposed to diphtheria, or if you think that you or a family member is at risk. It's important to remember, though, that most throat infections are not diphtheria, especially in countries that have routine immunizations against it.

If you're not sure if your child has been vaccinated against diphtheria, make an appointment. Also make sure your own booster immunizations are current. International studies have shown that a significant percentage of adults over 40 years of age aren't adequately protected against diphtheria and tetanus.

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Coxsackievirus Infections

Coxsackieviruses are part of the enterovirus family of viruses (which also includes polioviruses and hepatitis A virus) that live in the human digestive tract. They can spread from person to person, usually on unwashed hands and surfaces contaminated by feces, where they can live for several days.

In cooler climates, outbreaks of coxsackievirus infections most often occur in the summer and fall, though they cause infections year-round in tropical parts of the world.

In most cases, coxsackieviruses cause mild flu-like symptoms and go away without treatment. But in some cases, they can lead to more serious infections.

Signs and Symptoms

Coxsackievirus can produce a wide variety of symptoms. About half of all kids infected with coxsackievirus have no symptoms. Others suddenly develop high fever, headache, and muscle aches, and some also develop a sore throat, abdominal discomfort, or nausea. A child with a coxsackievirus infection may simply feel hot but have no other symptoms. In most kids, the fever lasts about 3 days, then disappears.

Coxsackieviruses can also cause several different symptoms that affect different body parts, including:

• Hand, foot, and mouth disease, a type of coxsackievirus syndrome, causes painful red blisters in the throat and on the tongue, gums, hard palate, inside of the cheeks, and the palms of hands and soles of the feet.
• Herpangina, an infection of the throat which causes red-ringed blisters and ulcers on the tonsils and soft palate, the fleshy back portion of the roof of the mouth.
• Hemorrhagic conjunctivitis, an infection that affects the whites of the eyes. Hemorrhagic conjunctivitis usually begins as eye pain, followed quickly by red, watery eyes with swelling, light sensitivity, and blurred vision.

Occasionally, coxsackieviruses can cause more serious infections that may need to be treated in a hospital, including:

• viral meningitis, an infection of the meninges (the three membranes that envelop the brain and spinal cord)
• encephalitis, a brain infection
• myocarditis, an infection of the heart muscle

Newborns can be infected from their mothers during or shortly after birth and are more at risk for developing serious infection, including myocarditis, hepatitis, and meningoencephalitis (an inflammation of the brain and meninges). In newborns, symptoms can develop within 2 weeks after birth.

Contagiousness

Coxsackieviruses are very contagious. They can be passed from person to person on unwashed hands and surfaces contaminated by feces. They can also be spread through droplets of fluid sprayed into the air when someone sneezes or coughs.

When an outbreak affects a community, risk for coxsackievirus infection is highest among infants and children younger than 5. The virus spreads easily in group settings like schools, child-care centers, or summer camps. People who are infected with a coxsackievirus are most contagious the first week they're sick.

Prevention

There is no vaccine to prevent coxsackievirus infection. Hand washing is the best protection. Remind everyone in your family to wash their hands frequently, particularly after using the toilet (especially those in public places), after changing a diaper, before meals, and before preparing food. Shared toys in child-care centers should be routinely cleaned with a disinfectant because the virus can live on these objects for days.

Kids who are sick with a coxsackievirus infection should be kept out of school or child care for a few days to avoid spreading the infection.

The duration of an infection varies widely. For coxsackie fever without other symptoms, a child's temperature may return to normal within 24 hours, although the average fever lasts 3 to 4 days. Hand, foot, and mouth disease usually lasts for 2 or 3 days, while viral meningitis can take 3 to 7 days to clear up.

Treating Coxsackievirus Infections

Depending on the type of infection and symptoms, the doctor may prescribe medications to make your child feel more comfortable. However, because antibiotics only work against bacteria, they can't be used to fight a coxsackievirus infection.

Acetaminophen may be given to relieve any minor aches and pains. If the fever lasts for more than 24 hours or if your child has any symptoms of a more serious coxsackievirus infection, call your doctor.

Most children with a simple coxsackievirus infection recover completely after a few days without needing any treatment. A child who has a fever without any other symptoms should rest in bed or play quietly indoors. Offer plenty of fluids to prevent dehydration.

When to Call the Doctor

Call the doctor immediately if your child develops any of the following symptoms:

• fever higher than 100.4° Fahrenheit (38° Celsius) for infants younger than 6 months and higher than 102° Fahrenheit (38.8° Celsius) for older kids
• poor appetite
• trouble feeding
• vomiting
• diarrhea
• difficulty breathing
• convulsions
• unusual sleepiness
• pain in the chest or abdomen
• sores on the skin or inside the mouth
• severe sore throat
• severe headache, especially with vomiting, confusion, unusual sleepiness, or convulsions
• neck stiffness
• red, swollen, and watery eyes
• pain in one or both testicles

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Common Cold

Bringing sniffles and sneezes and perhaps a sore throat and annoying cough, the common cold catches all of us from time to time.

With kids getting as many as eight colds per year or more, this contagious viral infection of the upper respiratory tract is the most common infectious disease in the United States and the No. 1 reason kids visit the doctor and stay home from school.

Causes

Most colds are caused by rhinoviruses that are in invisible droplets in the air we breathe or on things we touch. More than 100 different rhinoviruses can infiltrate the protective lining of the nose and throat, triggering an immune system reaction that can cause a throat sore and headache, and make it hard to breathe through the nose.

Air that's dry — indoors or out — can lower resistance to infection by the viruses that cause colds. And so can being a smoker or being around someone who's smoking. People who smoke are more likely to catch a cold than people who don't — and their symptoms will probably be worse, last longer, and are more likely to lead to bronchitis or even pneumonia.

But despite what old wives' tales may have you believe, not wearing a jacket or sweater when it's chilly, sitting or sleeping in a draft, and going outside while your hair's wet do not cause colds.

Signs and Symptoms

The first symptoms of a cold are often a tickle in the throat, a runny or stuffy nose, and sneezing. Kids with colds may also have a sore throat, cough, headache, mild fever, fatigue, muscle aches, and loss of appetite. Nasal discharge may change from watery to thick yellow or green.

Contagiousness

Colds are most contagious during the first 2 to 4 days after symptoms appear, and may be contagious for up to 3 weeks. Your can catch a cold from person-to-person contact or by breathing in virus particles spread through the air by sneezing or coughing. Touching the mouth or nose after touching skin or another surface contaminated with a rhinovirus can also spread a cold.

Prevention

Because so many viruses cause them, there isn't a vaccine that can protect against catching colds. But to help prevent them, kids should:

• try to steer clear of anyone who smokes or who has a cold. Virus particles can travel up to 12 feet through the air when someone with a cold coughs or sneezes, and secondhand smoke can make your child more likely to get sick.
• wash their hands thoroughly and frequently, especially after blowing their noses
• cover their noses and mouths when coughing or sneezing (have them sneeze or cough into a shirtsleeve, though, not their hands — this helps prevent the spread of germs)
• not use the same towels or eating utensils as someone who has a cold. They also shouldn't drink from the same glass, can, or bottle as anyone else — you never know who might be about to come down with a cold and is already spreading the virus.
• not pick up other people's used tissues

Researchers aren't sure whether taking extra zinc or vitamin C can limit how long cold symptoms last or how severe they become, but large doses taken every day can cause negative side effects.

The results of most studies on the value of herbal remedies, such as echinacea, are either negative or inconclusive, and few properly designed scientific studies of these treatments have been done in kids.

Talk to your doctor before you decide to give your child any herbal remedy or more than the recommended daily allowance (RDA) of any vitamin or supplement.

Duration

Cold symptoms usually appear 2 or 3 days after exposure to a source of infection. Most colds clear up within 1 week, but some last for as long as 2 weeks.

Treatment

"Time cures all." That may not always be true, but in the case of the common cold, it's pretty close. Medicine can't cure the common cold, but it can be used to relieve such symptoms as muscle aches, headache, and fever. You can give your child acetaminophen or ibuprofen based on the package recommendations for age or weight.

However, aspirin should never be given to children younger than 12, and all kids and teens under age 19 shouldn't take aspirin during viral illnesses, because such use may increase the risk of developing Reye syndrome, a rare but serious condition that can be fatal.

Although you may be tempted to give your child over-the-counter (OTC) decongestants and antihistamines to try to ease the cold symptoms, there's little or no evidence to support that they actually work. In fact, decongestants can cause hallucinations, irritability, and irregular heartbeats in infants and shouldn't be used in children younger than 2 without first consulting a doctor.

Some ways you can help ease cold discomfort include:

• saltwater drops in the nostrils to relieve nasal congestion (you can buy these — also called saline nose drops — at any pharmacy)
• a cool-mist humidifier to increase air moisture
• petroleum jelly on the skin under the nose to soothe rawness
• hard candy or cough drops to relieve sore throat (for kids older than 3 years)
• a warm bath or heating pad to soothe aches and pains
• steam from a hot shower to help your child breathe more easily

But what about chicken soup? There's no real proof that eating it can cure a cold, but sick people have been swearing by it for more than 800 years. Why? Chicken soup contains a mucus-thinning amino acid called cysteine, and some research shows that chicken soup helps control congestion-causing white cells, called neutrophils.

The best plan, though, is not to worry about whether to "feed a cold" or "starve a fever." Just make sure your child eats when hungry and drinks plenty of fluids like water or juice to help replace the fluids lost during fever or mucus production. Avoid serving caffeinated beverages, though, which can cause frequent urination and, therefore, increase the risk of dehydration.

When to Call the Doctor

Your doctor won't be able to identify the specific virus causing cold symptoms, but can examine your child's throat and ears and take a throat culture to make sure the symptoms aren't from another condition that may need specific treatment. (If your child's symptoms get worse instead of better after 3 days or so, the problem could be strep throat, sinusitis, pneumonia, or bronchitis, especially if your child or teen smokes.)

Taking a throat culture is a simple, painless procedure that involves brushing the inside of the throat with a long cotton swab. Examining the germs that stick to the swab will help the doctor determine whether your child has strep throat and needs treatment with antibiotics.

If symptoms last for more than a week, appear at the same time every year, or occur when your child is exposed to pollen, dust, animals, or another substance, your child could have an allergy. A child who has trouble breathing or wheezes when he or she catches a cold could have asthma.

Also see your doctor if you think your child might have more than a cold or is getting worse instead of better.

Also call the doctor if your child has any of these symptoms:

• coughing up a lot of mucus
• shortness of breath
• unusual lethargy/tiredness
• inability to keep food or liquids down or poor fluid intake
• increasing headache or facial or throat pain
• severely painful sore throat that interferes with swallowing
• fever of 103 degrees Fahrenheit (39.3° Celsius) or higher, or a fever of 101° Fahrenheit (38.0° Celsius) or higher that lasts for more than a day
• chest or stomach pain
• swollen glands (lymph nodes) in the neck
• earache

Like most virus infections, colds just have to run their course. Getting plenty of rest, avoiding vigorous activity, and drinking lots of fluids — juice, water, and noncaffeinated beverages — all may help your child feel better while on the mend.

Keeping up regular activities like going to school probably won't make a cold any worse. But it will increase the likelihood that the cold will spread to classmates or friends. So you might want to put some daily routines aside until your child is feeling better.

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Chlamydia

Chlamydia is a sexually transmitted disease (STD) caused by the bacteria Chlamydia trachomatis. When transmitted through sexual contact, the bacteria can infect the urinary and reproductive organs.

The term chlamydia typically refers to Chlamydia trachomatis, the STD. But two other types of this bacteria also can lead to illness: Chlamydia pneumoniae, which can be spread through coughing and sneezing, and Chlamydia psittaci, which birds can pass to humans.

Chlamydia can be treated with antibiotics. But in many cases, it causes no symptoms, so people can be infected without even knowing it. If chlamydial infections go untreated, they can lead to more serious health problems, such as infertility. So it's important to take the precautions to prevent chlamydia, and if it's suspected, to seek treatment as soon as possible.

Symptoms

In many cases, chlamydia causes only mild symptoms or no symptoms at all. So an infection can last for weeks or months before it is discovered.

In females, chlamydia symptoms can include:

• vaginal irritation
• vaginal discharge
• lower abdominal pain
• burning feeling with urination

If chlamydia infections go untreated in females, they can lead to such serious health problems as scarring of the fallopian tubes and chronic pelvic pain, both of which can affect fertility.

Untreated chlamydia also can lead to pelvic inflammatory disease (PID), which can affect the vagina, cervix, uterus, fallopian tubes, and ovaries. In some cases PID has no symptoms, but often causes abdominal or lower back pain, painful urination, pain during intercourse, bleeding between menstrual periods, nausea, vomiting, fatigue, or fever.

In males, chlamydia symptoms can include discharge from the tip of the penis and a burning feeling during urination. Untreated infections can lead to epididymitis, an inflammation of the coiled tubes in the back of the testicles. This can result in testicular swelling, pain, and even infertility.

Contagiousness

Chlamydia is contagious. It can be transmitted through sexual contact, in semen and vaginal secretions. If it comes into contact with the eyes, it can cause conjunctivitis.

Chlamydia does not spread through casual contact such as shaking hands or using the same toilet as someone who is infected. If someone is diagnosed with chlamydia, all of that person's sexual partners need to be notified and treated with antibiotics, even if they don't have any symptoms, so that they don't develop any long-term complications or spread the infection to others.

Treatment

If detected early on, chlamydia can easily be treated with antibiotics and the symptoms alleviated within 7 to 10 days. If untreated, chlamydia can lead to serious complications that can appear months or even years after the person is infected.

Because the symptoms of genital chlamydia are similar to those of gonorrhea, and someone can have both infections, people with chlamydia are sometimes treated for both diseases.

Like other STDs, chlamydia may seem to get better even when it's still present. The fact that the symptoms disappear after a few days with no treatment does not mean that the infection has gone away.

The sexual partners of anyone who has or is suspected of having chlamydia or any other STD should be examined and treated. Those diagnosed with any STD should inform their partners as soon as possible so that they can be examined and treated, prevent complications, and avoid spreading the infections to others.

Prevention

Because chlamydia is spread through sexual contact, the best way to prevent it is to abstain from having sex. Sexual contact with more than one partner or with someone who has more than one partner increases the risk of contracting any STD.

When properly and consistently used, condoms decrease the risk of STDs. Latex condoms provide greater protection than natural-membrane condoms. The female condom, made of polyurethane, is also considered effective against STDs.

Although birth control pills offer no protection against STDs, they may provide some protection against PID by causing the body to create thicker cervical mucus, making it more difficult for bacteria to reach the upper genital tract.

Using douche can actually increase a female's risk of contracting STDs because it can change the natural flora of the vagina and may flush bacteria higher into the genital tract.

A teen who is being treated for chlamydia also should be tested for other STDs, and should have time alone with the doctor to openly discuss issues like sexual activity. Not all teens will be comfortable talking with parents about these issues. But it's important to encourage them to talk to a trusted adult who can provide the facts.

Getting Help

If your teen is thinking of becoming sexually active or already has started having sex, it's important to talk with him or her about it. Make sure your teen knows how STDs can be spread (during anal, oral, or vaginal sex) and that these infections often don't have symptoms, so a partner might have an STD without knowing it.

It can be difficult to talk about STDs, but just as with any other medical issue, teens need this information to stay safe and healthy. Provide the facts, and let your child know where you stand.

It's also important that all teens have regular full physical exams — which can include screening for STDs. Your teen may want to see a gynecologist or a specialist in adolescent medicine to talk about sexual health issues. Community health organizations and sexual counseling centers in your local area also may be able to offer some guidance.

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Cellulitis

Cellulitis is an infection of the skin and underlying tissues that can affect any area of the body. It often begins in an area of broken skin, like a cut or scratch, when bacteria invade and spread, causing inflammation, pain, swelling, warmth, and redness.

Causes

Conditions that create breaks in the skin and allow bacteria to enter, such as eczema and severe acne, will put a child at risk for cellulitis. Chickenpox, scratched insect bites, animal bites, and puncture wounds are other causes.

Cellulitis also can form in areas of intact skin, especially in people who have diabetes or who are taking medicines that suppress the immune system.

Cellulitis requires particularly close monitoring when it infects the eyelid and tissues surrounding the eye. It can be the result of minor trauma to the area around the eye (such as an insect bite or a scratch), or it may be an extension of another infection, such as sinusitis. This kind of cellulitis is treated with antibiotics and close follow-up. If untreated, it can progress to a more serious infection that affects vision.

Symptoms

Cellulitis typically begins as a small, inflamed area of pain, swelling, warmth, and redness on a child's skin. As this red area begins to spread, the child may begin to feel sick and develop a fever, sometimes with chills and sweats. Swollen lymph nodes (commonly called swollen glands) are sometimes found near the area of infected skin. Cellulitis is not contagious.

Prevention

You can prevent cellulitis by protecting your child's skin from cuts, bruises, and scrapes. This may not be easy, especially if you have an active child who loves to explore or play sports. Protective equipment worn to prevent other injuries during active play can also protect skin: elbow and knee pads while skating, a bike helmet during bike riding, shin guards during soccer, long pants and long-sleeved shirts while hiking in the woods, sandals (not bare feet) on the beach, and seatbelts while riding in a motor vehicle.

If your child does get a scrape, wash the wound well with soap and water. Apply an antibiotic ointment and cover the wound with an adhesive bandage or gauze. Check in with your doctor if your child has a large cut, deep puncture wound, or bite (animal or human).

Diagnosis

The incubation period for cellulitis varies, depending on the type of bacteria causing it. Your doctor can diagnose cellulitis by asking a few questions and examining the area of affected skin. Sometimes, especially in younger kids, a blood culture may be done to check for bacteria growth. A positive blood culture means that bacteria from the skin infection have spread into the bloodstream, a condition known as bacteremia. This can potentially lead to septicemia, an infection affecting many systems of the body.

Treatment

A child with severe cellulitis may be treated in the hospital using intravenous (IV) antibiotics. Kids with milder cellulitis can be treated at home with antibiotics. The doctor may also suggest that the affected part of the body be immobilized and elevated to reduce swelling and pain. Pain relievers such as acetaminophen or ibuprofen can help reduce discomfort.

After 1 or 2 days on antibiotics at home, a child may return to see the doctor, who'll check that the area of cellulitis has improved and that the antibiotics are working to heal the infection.

When to Call the Doctor

Call the doctor whenever any area of your child's skin becomes red, warm, and painful — with or without fever and chills. This is especially important if the affected skin is on the face or if your child has a chronic illness (like diabetes) or a condition that suppresses the immune system.

Because cellulitis can happen very quickly after an animal bite, call the doctor whenever your child is bitten by an animal, especially if the puncture wound is deep. Human bites also can cause skin infections and should be seen by a doctor. If red streaks develop from the infected area or symptoms worsen despite antibiotic treatment, your child should be reexamined.

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