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/.
Once bitten, the mainstays of treatment are cool compresses, antihistamines, anti-itching compounds, and anti-inflammatory medicines.
For a cool compress, apply an ice pack wrapped in a towel or soak a washcloth in cold water and press it on the bite.
Ask your pharmacist to help you select an appropriate antihistamine for your child. Some are available by prescription only. You might have to balance strength versus drowsy side effects. Zyrtec, a newer antihistamine for children, usually works very well while not being very sedating.
The simplest anti-itching compound is a paste made of baking soda and water. Use just enough water to make a sticky paste, and spread it on.
Calamine lotion works in a similar way, and usually the effect lasts longer. Other children prefer a menthol lotion such as Sarna.
A topical anesthetic containing pramoxine (such as the prescription PrameGel or the over-the-counter Caladryl) can take away the pain and itching.
Topical steroid creams of various strengths can also be useful. Occasionally reactions to mosquito bites can be severe enough to warrant systemic steroids.
Studies suggest that some natural anti-inflammatory remedies are very effective in some people: oral evening primrose oil (Lancet, 2:1120, 1982) and papaverine (Journal of the American Academy of Dermatology, 13:806, 1985). You might find both of these in a health food store.
The best way to avoid bee stings is prevention. Effective prevention means not attracting bees and not frightening them if they are present. Click here for Dr. Greene’s tips on avoiding bees.
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