Together, three types of bacteria account for over 90 percent of bacterial meningitis: H. influenza type b, meningococcus, and pneumococcus.
These bacteria are transmitted by person-to-person contact through respiratory secretions. Many people carry these bacteria with no serious consequence. (Pneumococcus, for instance, is the most common cause of ear infections.) A few people get very sick. Pneumococcus causes meningitis in about 3 per 100,000 people. (Textbook of Pediatric Infectious Disease, Saunders 1998)
Sudden onset meningitis features shock, internal bleeding, purple spots, and reduced consciousness at the very outset, with a rapidly progressive course often resulting in death within 24 hours.
More commonly, meningitis begins with several days of upper respiratory symptoms or gastrointestinal symptoms. Most children have high fevers, severe headaches, and poor feeding. They may also have muscle aches, nasal congestion, vomiting, neck stiffness, and seizures.
Children with meningitis become increasingly irritable and/or lethargic. The presence of petechiae (purple spots that indicate internal bleeding) is a sign that the infection may be raging out of control.
Pneumococcal meningitis is a devastating disease. Of all causes of meningitis, it is the most likely to have a negative outcome (Pediatric Infectious Disease Journal, May 1993). The overuse of antibiotics is resulting in increasingly resistant strains of pneumococcus every month.
In 1991, a vaccine against the H. influenzae Type b (HIB) bacteria was incorporated into the routine immunization schedule beginning at 2 months of age. The amount of meningitis plummeted. Arkansas Children's Hospital had about 27 cases of HIB meningitis per year in the 1980's before the vaccine was used. By 1993, the number had dropped to only 1.7 per year (Southern Medical Journal, Jan 1994). During the same period the number of cases dropped by 95 percent in the United States as a whole (Textbook of Pediatric Infectious Diseases, Saunders 1998).
The new pneumococcal vaccine for infants is now FDA approved and recommended by the American Academy of Pediatrics for all children less than 2 years of age. Vaccination of children between 2 and 5 years of age may also be considered on an individual basis. In large clinical studies, the vaccine has been shown to decrease the risk of invasive pneumococcal infection (i.e. meningitis and blood infections) by more than 93%. It has also been shown to decrease the risk of pneumonia and otitis media (ear infections). More information about the vaccine can be found at www.cdc.gov/.
By far the most common form of vaginal obstruction in little girls is fusion of the labia minora as a result of labial adhesions. These are typically diagnosed in girls from 6 months to 6 years of age. Diaper rash, infections, irritants, or mechanical trauma commonly cause chronic inflammation of the labia. Occasionally the inflammation is the result of chronic sexual abuse. Whatever the cause, as the labia try to heal, fibrous tissue adheres the labia to each other. Some girls are prone to forming adhesions no matter how careful the parents are. The adhesions result in a smooth membrane over the vulvar opening with a thin, pale line at the center. This surface membrane usually starts forming at the rear of the opening, and 'zippers' closed toward the front. Usually, a sufficient opening at the front remains to permit urine and vaginal secretions to exit.
The adhesions will often resolve spontaneously when girls are out of diapers or pull-ups both day and night. When labial adhesions persist, the estrogen surge at puberty will correct the problem. If there are no complications, such as infections or obstruction, the adhesions do not need to be treated. If treatment is needed or preferred, the natural process can be accelerated with the application of topical estrogen. A hormone cream, such as Premarin, should be applied twice daily for two weeks, and then nightly for an additional week, if necessary.
Most of the treatments for poison ivy, oak and sumac are aimed at reducing the itching, until the self-limited rash runs its course, which takes about two weeks. Click here for Dr. Greene’s tips on treating these allergic reactions.
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