Strep Throat

Strep throat is very common among kids and teens. Symptoms of strep throat include fever, stomach pain, and red, swollen tonsils.

Strep throat usually requires treatment with antibiotics. With the proper medical care — along with plenty of rest and fluids — your child should be back to school and play within a few days.

How Strep Throat Spreads

Anybody can get strep throat, but it's most common in school-age kids and teens. These infections occur most often during the school year when big groups of kids and teens are in close quarters.

The bacteria that cause strep throat (group A streptococcus) tend to hang out in the nose and throat, so normal activities like sneezing, coughing, or shaking hands can easily spread infection from one person to another.

That's why it's so important to teach kids the importance of hand washing — good hygiene can lessen their chances of getting contagious diseases like strep throat.

Strep Throat vs. Sore Throat

Not all sore throats are strep throats. Most episodes of sore throat — which can be accompanied by a runny nose, cough, hoarseness, and red eyes — are caused by viruses and usually clear up on their own without medical treatment.

A child with strep throat will start to develop other symptoms within about 3 days, such as:

• red and white patches in the throat
• difficulty swallowing
• tender or swollen glands (lymph nodes) in the neck
• red and enlarged tonsils
• headache
• lower stomach pain
• fever
• general discomfort, uneasiness, or ill feeling
• loss of appetite and nausea
• rash

Diagnosis

If your child has a sore throat and other strep throat symptoms, call your doctor. The doctor will likely do a rapid strep test in the office, using a cotton swab to take a sample of the fluids at the back of the throat. The test only takes about 5 minutes.

If it's positive, your child has strep throat. If it's negative, the doctor will send a sample to a lab for a throat culture. The results are usually available within a few days.

Treatment

In most cases, doctors prescribe about 10 days of antibiotic medication to treat strep throat. Within about 24 hours after starting on antibiotics, your child will probably no longer have a fever and won't be contagious. By the second or third day after taking antibiotics, the other symptoms should start to go away, too.

Even if your child feels better, he or she should finish the antibiotics as prescribed. If your child stops taking antibiotics too soon, bacteria can remain in the throat and the symptoms can return.

If your child is not treated for strep throat, he or she is most infectious when the symptoms are the most severe but could remain contagious for up to 21 days. Lack of treatment — or not finishing the prescribed course of antibiotics — also could put your child at risk for other health problems, such as rheumatic fever (which can cause permanent damage to the heart), scarlet fever, blood infections, or kidney disease.

To prevent your sick child from spreading strep throat to others in your home, keep his or her eating utensils, dishes, and drinking glasses separate from those that everyone else is using. Wash them in hot, soapy water after each use. Also, make sure your child doesn't share food, drinks, napkins, handkerchiefs, or towels with other family members.

Make sure your child covers his or her mouth and nose during a sneeze or a cough to prevent passing infectious fluid droplets to someone else. Also, throw out your child's toothbrush after the antibiotic treatment has been started and he or she is no longer contagious, and make sure your child uses a new one.

Caring for Your Child

You can help your child feel better while battling strep throat. Provide plenty of liquids to prevent dehydration, such as water or ginger ale, especially if he or she has had a fever. Avoid orange juice, grapefruit juice, lemonade, or other acidic beverages that can irritate a sore throat. Warm liquids like soups, sweetened tea, or hot chocolate can be soothing.

As recovery progresses, talk to your doctor about when your child can return to school and other routine activities.

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Malaria

Malaria is a common infection in hot, tropical areas but can also occur (rarely) in temperate climates. It is caused by any of four single-celled parasites of the Plasmodium species, which are carried by mosquitoes infected from biting someone who already has the disease. Malaria is then transmitted to other people when they are bitten by the infected mosquitoes. It is rarely passed from person to person (from mother to child in "congenital malaria," or through blood transfusion, organ donation, or shared needles).

Worldwide, 300-500 million people are infected with malaria each year. Most cases occur in sub-Saharan Africa, with approximately 2 million people dying there each year. Malaria is rare in the United States, with only about 1,300 cases reported each year over the last 10 years. Most of these cases occurred in travelers, military personnel, and immigrants who had become infected by malaria parasites outside the United States.

Signs and Symptoms

A child with early symptoms of malaria may be irritable and drowsy, with poor appetite and trouble sleeping. These symptoms are usually followed by chills, then a fever with rapid breathing. The fever may either gradually increase over 1 to 2 days or may rise very suddenly to 105° Fahrenheit (40.6° Celsius) or above. Then, as fever ends and body temperature quickly returns to normal, the child has an intense episode of sweating.

The same pattern of symptoms — chills, fever, sweating — may repeat at intervals of 2 or 3 days, depending on which particular species of malaria parasite is causing the infection. Because the initial symptoms are not specific and can be mistaken for other diseases, it can be difficult to diagnose. In countries where the disease is seen a lot, it's not uncommon for doctors to treat people for malaria who have fever of no obvious cause without getting laboratory confirmation.

Other symptoms of malaria include headache, nausea, aches and pains all over the body (especially the back and abdomen), and an abnormally large spleen. When malaria affects the brain, a child may have convulsions or lose consciousness. If malaria affects the kidneys, the amount of urine produced by the child may be abnormally low. In falciparum malaria, caused by the Plasmodium falciparum parasite, the episode of fever and chills is especially intense, and this variety may be fatal in about 20% of cases.

Once malaria parasites enter the bloodstream, they travel to the liver and multiply. Every few days, thousands of parasites are released from the liver into the blood, where they destroy red blood cells. Some parasites also remain in the liver and continue to multiply, releasing more parasites into the blood every few days.

The incubation period for malaria is the time between the mosquito bite and the release of parasites from the liver. This varies, depending on which malaria parasite is causing the disease. In general, it can range from 10 days to a month.

With treatment, malaria can usually be cured in about 2 weeks. Without treatment, it can be fatal, especially in children who are poorly nourished.

Prevention

Health authorities try to prevent malaria by using mosquito-control programs aimed at killing mosquitoes that carry the disease. If you travel to an area of the world with a high risk for malaria, you can install window screens, use insect repellents, and place mosquito netting over beds. Insecticide-impregnated bed netting has successfully reduced the number of malarial deaths among African children.

Check with your doctor before visiting any tropical or subtropical area at high risk for malaria. Your doctor can give your family anti-malarial drugs to prevent the disease. Several malaria vaccines are currently being developed and tested across the world, but because the malaria parasite has a complicated life cycle, it is a difficult vaccine to develop.

Diagnosis and Treatment

Doctors diagnose malaria by using special blood tests. A blood sample is sent to the laboratory and checked under a microscope for malaria parasites, which may be seen inside infected red blood cells.

Doctors treat malaria with anti-malarial drugs, such as chloroquine or quinine, given by mouth, by injection, or intravenously (into the veins). Depending on the type of parasite causing the malaria, a person can be treated as an outpatient over a few days or may require hospitalization with IV medication. Doctors also watch for signs of dehydration, convulsions, anemia, and other complications that can affect the brain, kidneys, or spleen. The patient may require fluids, blood transfusions, and breathing assistance.

Malaria is a leading cause of death worldwide. If diagnosed early and treated, it can be cured. However, many people who live in areas where malaria is common get repeated infections and never really recover between episodes of illness.

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Coxsackie Viruses

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 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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Campylobacter Infection

Campylobacter bacteria, usually transmitted in contaminated food or water, can infect the gastrointestinal tract and cause diarrhea, fever, and cramps. Practicing good hand-washing and food safety habits will help prevent Campylobacter infections (or campylobacteriosis), which usually clear up on their own but sometimes are treated with antibiotics.

Campylobacter infects over 2 million people each year, and it's a leading cause of diarrhea and food-borne illness. Babies under 1 year old, teens, and young adults are most commonly affected.

Causes

Campylobacter is found in the intestines of many wild and domestic animals. The bacteria are passed in their feces, which can lead to infection in humans via contaminated food, meats (especially chicken), water taken from contaminated sources (streams or rivers near where animals graze), and milk products that haven't been pasteurized.

Bacteria can be transmitted from person to person when someone comes into contact with fecal matter from an infected person, especially a child in diapers. Household pets can carry and transmit the bacteria to their owners.

Once inside the human digestive system, Campylobacter infects and attacks the lining of both the small and large intestines. The bacteria can also affect other parts of the body. In some cases — particularly in very young patients and those with chronic illnesses or a weak immune system — the bacteria can get into the bloodstream, causing bacteremia. In rare cases, campylobacteriosis can lead to Guillain-Barré syndrome, a rare autoimmune disorder.

Symptoms

Symptoms generally appear 1 to 7 days after ingestion of the bacteria. The main symptoms of campylobacteriosis are fever, abdominal cramps, and mild to severe diarrhea. Diarrhea can lead to dehydration, which should be closely monitored. Signs of dehydration include: thirst, irritability, restlessness, lethargy, sunken eyes, dry mouth and tongue, dry skin, fewer trips to the bathroom to urinate, and (in infants) a dry diaper for several hours.

In cases of campylobacteriosis, the diarrhea is initially watery, but it may later contain blood and mucus. Sometimes, the abdominal pain appears to be a more significant symptom than the diarrhea. When this happens, the infection may be mistaken for appendicitis or a problem with the pancreas.

Prevention

You can prevent campylobacteriosis by using drinking water that's been tested and approved for purity, especially in developing countries, and by drinking milk that's been pasteurized. While hiking and camping, avoid drinking water from streams and from sources that pass through land where animals graze.

Kill any bacteria in meats by cooking these foods thoroughly and eating while still warm. Whenever you prepare foods, wash your hands well before and after touching raw meats, especially poultry. Clean cutting boards, countertops, and utensils with soap and hot water after contact with raw meat.

As you care for a family member who has diarrhea, remember to wash your hands before touching other people in your household and before handling foods. Clean and disinfect toilets after they're used by the person with diarrhea. Also, if a pet dog or cat has diarrhea, wash your hands frequently and check with your veterinarian about treatment.

Diagnosis

Your doctor may send a stool sample to the lab to be tested for Campylobacter bacteria. Other lab tests may also be needed, especially if your child has blood in the stool.

Treatment

Most kids with campylobacteriosis will recover without medication. Occasionally, the doctor may prescribe an antibiotic, especially if the child is very young or the symptoms are severe or persistent. If your child receives an antibiotic, give it on schedule for as long as the doctor has ordered. Also, do not give nonprescription medicines for diarrhea without first checking with your doctor.

After being checked by a doctor, most kids with Campylobacter infections are treated at home, especially if they show no signs of being seriously dehydrated. They should drink plenty of fluids as long as the diarrhea lasts and be monitored for signs of dehydration.

Kids with mild diarrhea and no dehydration should continue to eat normally and increase their fluid intake — but fruit juices and soft drinks can worsen diarrhea and should be avoided. If your child is dehydrated, your doctor may recommend using an oral rehydration solution. Babies with campylobacteriosis who are breastfed should continue to be breastfed throughout the illness.

Diarrhea usually stops within 2 to 5 days. Full recovery usually takes about 1 week. In about 20% of cases, diarrhea can last longer or recur.

When to Call the Doctor

If your child has bloody or black, tar-like bowel movements or seems dehydrated, call your doctor immediately.

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Yersiniosis

Yersiniosis is a relatively uncommon infection contracted through the consumption of undercooked meat products, unpasteurized milk, or water contaminated by the bacteria.

Usually, a child with an infection caused by the yersinia bacteria recovers within a few days without medical treatment (in some cases, doctors prescribe antibiotics).

About Yersiniosis

Three main types of yersiniosis affect people. The form that most commonly causes infections in the United States is yersinia enterocolitica, which are bacteria that thrive in cooler temperatures. There is only 1 confirmed case per 100,000 people each year.

The bacteria can infect the digestive tracts of humans, cats, dogs, pigs, cattle, and goats. People can contract it by eating or handling contaminated foods such as raw or undercooked meat, or by drinking untreated water or unpasteurized milk that has been contaminated.

An infant can be infected if a parent or caretaker handles contaminated food without cleaning up adequately before handling the infant's toys, bottles, or pacifiers.

Signs and Symptoms

Symptoms of yersiniosis appear 4 to 7 days after exposure and can last up to 3 weeks. They include fever, stomach pain, nausea, vomiting, and bloody diarrhea. Sometimes, older kids also get pain in the lower right side of the abdomen, which can mimic appendicitis.

If your child has these symptoms, call your doctor. If your child is an infant, it's particularly important to call the doctor as soon as symptoms appear to prevent the infection from leading to other health problems.

In rare cases, the infection can cause a skin rash or joint pain that appears a month after the initial symptoms. But these symptoms go away without treatment.

Treatment

Diarrhea caused by yersiniosis generally goes away on its own, though in some cases antibiotics are prescribed. In infants, however — particularly those who are 3 months old or younger — it can develop into a more serious condition called bacteremia, an infection of the blood. Infants who contract yersiniosis are usually treated in a hospital.

Depending on the severity of the diarrhea, your doctor may suggest modifying your child's diet for 1 to 2 days and encouraging your child to drink more fluids (which may include drinks with electrolytes to replace body fluids quickly).

If your child is frequent bouts of diarrhea, watch for signs of dehydration, including:

• severe thirst
• dry mouth or tongue
• sunken eyes
• dry skin
• infrequent urination
• in infants, a dry diaper for several hours

Prevention

To reduce the risk of yersiniosis, take these precautions:

• Don't serve eat raw or undercoooked meat.
• Drink and serve only pasteurized milk or milk products.
• Wash hands with soap and water particularly before eating and preparing food; before touching infants or their toys, bottles, or pacifiers; and after contact with animals or handling raw meat.
• Use separate cutting boards for meat and other foods.
• Clean all cutting boards, countertops, and utensils with soap and hot water after preparing raw meat.
• Always cook meat thoroughly before you eat it, especially pork products.
• Dispose of animal feces and sanitize anything they have touched.
• Avoid drinking directly from natural water sources such as ponds and mountain streams, particularly if the water is near farmland where cattle, pigs, or goats are raised.
• As you care for a family member who has diarrhea, remember to wash your hands thoroughly before touching other people and before handling food.
• If your pet dog or cat has diarrhea, wash your hands frequently as you care for it, and check with your veterinarian about treatment and/or contagiousness.

When to Call the Doctor

Call your doctor if your child:

• has diarrhea streaked with blood
• has been vomiting
• shows any signs of dehydration

With some rest, kids with yersiniosis usually make a full recovery quickly.

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