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/.
Poison ivy, poison oak, and poison sumac together produce more cases of allergic contact dermatitis than all other allergens combined. The resulting rash can range from mildly unpleasant to a true emergency with intense swelling, blistering, and oozing. With even a moderate case, the itching can seem unbearable. Most of the treatments are aimed at reducing the itching, until the self-limited rash runs its course, which takes about two weeks.
Here are some tips for treating poison ivy, oak, and sumac rashes:
Try using a towel or washcloth soaked in either plain tap water or Burow's Solution (an astringent solution -- you can make it yourself using Domeboro tablets or powder packets available over-the-counter). This can help relieve the intense itching and remove dry crust that has formed as a result of the rash.
A fan blowing over the cool compress will diminish some of the heat of the itching and help to dry up some of the ooze coming from the rash. As the skin is cooling, the blood vessels compress and that cuts down on the itching and the new ooze.
Some dermatologists recommend rubbing an ice cube gently over the rash several times a day, then letting the skin air-dry.
Soaking in a tub, particularly using an oatmeal bath such as Aveeno, can also be very soothing to the itch. Be sure the bath is cool or lukewarm -- but not hot -- as heat tends to make the rash even more inflamed.
After the cooling treatment (using any of the forms mentioned above), coat the rash with a shake lotion such as calamine. This continues to relieve the itching and helps to dry up the blisters.
Be sure to check the expiration date on an old calamine bottle in your medicine cabinet, since it may not be effective after the expiration date. Be sure the shake lotion does not contain benzocaine, zirconium, or a topical antihistamine, such as Benadryl. These can actually make the rash worse by producing their own allergic reactions when applied to already sensitive skin.
Taking an oral antihistamine, such as Benadryl, can help with the itching quite a bit, although it does not speed up resolution of the rash. Taking Benadryl at nighttime will make most people drowsy and help them sleep through the night without itching.
Don't use Benadryl cream or spray topically, because this can cause its own reaction.
In severe cases of poison ivy, poison oak, or poison sumac, it is a good idea to see a doctor. Sometimes large blisters need to be drained, and sometimes an oral steroid such as prednisone may be useful. Occasionally, even a steroid injection is needed.
Systemic steroids produce rapid resolution of both the itching and the rash. If they are needed, a gradually tapering dosage over about 12 days should be given. The dosage needs to be tapered to avoid side effects after discontinuing use, and the entire course should be taken since stopping earlier may result in a rebound rash as bad as the original.
When a toddler or preschooler is still using a bottle to go to sleep, this choice has become a deeply ingrained habit. Weaning her from the bottle will require either finding an effective substitute, or using tremendous force to break the patterns. Click here for Dr. Greene’s tips for weaning a child from a bedtime bottle.
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