Ask Emily

30 11 2011

Can you have mono more than once?

Mononucleosis, known as the “kissing disease” in my youth, is a viral disease that has engendered many a myth. The idea that you can have the nonspecific group of symptoms we call “mono” only once is just one of them.

Unless specified by the virus that causes it, the term mononucleosis is a general name for a suite of symptoms of viral illness. These symptoms include swollen glands, fever, sore throat, and fatigue. The spleen will swell along with the lymph nodes, and even after the acute fever and sore throat depart, the fatigue and a feeling of unwellness may last several weeks.

The virus that is most associated with mono is the Epstein-Barr virus, or EBV. EBV often infects people who show no symptoms, but in some cases, the infection is more serious.

In rare cases, the virus can remain active over the long-term without showing symptoms, and may be associated with several autoimmune diseases. Another possible outcome of long-term EBV activity can even more rarely be certain kinds of lymphoma.

This virus is so common that in the United States, up to 95% of adults in their thirties and forties may have been infected at some point in their lives. In younger folk—teens and children—exposure results in symptoms in up to half of cases.

But EBV is not the only agent that can produce the illness we generally call mononucleosis. Other viruses, including cytomegalovirus or adenovirus, can cause mono, as can an infection with the protozoan that causes toxoplasmosis.

The symptoms can be very similar, and the only way to be sure that the cause was EBV is to undergo tests to confirm it.

Usually, if you’ve had a specific virus once, your body develops immunity to it, and you’ll avoid getting sick the next time you’re exposed. But given the tendency of EBV to sometimes linger in the body, some people may experience its reactivation, which may or may not cause symptoms. During reactivation, symptoms or not, a person can pass EBV to someone else, primarily through exposure to saliva or other very close contact.

Also, if you had what you thought was mononucleosis but it was caused by a different virus, such as cytomegalovirus, then you can obviously have “mono” again if you pick up EBV and experience symptoms. Thus, the final answer to the question is, Yes, you can have mononucleosis more than once.

By Emily Willingham

Image courtesy of mugley





Patsy Stinchfield Talks Measles

28 11 2011

Patsy Stinchfield, RN, MS, CPNP,  Director of Infectious Diseases at Children’s Hospitals and Clinics, talks measles.

Listen now!

Right-click here to download podcast





Patsy Stinchfield Talks HPV Vaccine

21 11 2011

Patsy Stinchfield, RN, MS, CPNP,  Director of Infectious Diseases at Children’s Hospitals and Clinics, talks HPV vaccine.

Listen Now!

Right-click here to download podcast.





Antibiotics – Not Always Invited

17 11 2011

George Armelagos is an anthropologist (kind of like Apolo Ohno is a skater).

A few years ago, one of George’s students detected an antibiotic called tetracycline in the bone of an ancient Nubian. Both the student and George thought this was odd, since tetracycline had not come into common use until the 1950s.

George and his student, along with some of their colleagues, got busy and discovered that lots of Nubians, Egyptians, and others from the early years of the second period of the Gregorian calendar had detectable tetracycline in their bones.

Turns out, the antibiotic was consumed in the beer of the day.

George wrote up this find in Natural History Magazine. As for the beer . . .

The beer produced in ancient times, according to Barry Kemp, author of Ancient Egypt: Anatomy of a Civilization, was quite different from the modern commercial product: “It was probably an opaque liquid looking like a gruel or soup, not necessarily very alcoholic but highly nutritious. Its prominence in the Egyptian diet reflects its food value as much as the mildly pleasurable sensation that went with drinking it.”

Spores that produce tetracycline were inadvertently captured during the beer-brewing process and before they knew it, the ancients were slinging back antibiotics with their brewskies.

The old-timers might not have known how their beer came to be medicinal, but know it they did. George went on to write:

Given that the ancient Nubians and Egyptians were getting doses of tetracycline, another question is whether this afforded them any medical benefits. In Food: The Girl of Osiris, William J. Darby and coauthors provide archaeological, historical, and ethnographic accounts of beer’s use as a mouthwash to treat the gums, as an enema, as a vaginal douche, as a dressing for wounds, and as a fumigant to treat diseases of the anus (the dried remains of grains used in brewing are burned to produce a therapeutic smoke). This shows that even in the distant past, Egyptians and their neighbors appreciated beer’s medicinal qualities.

This sounds like a classic case of antibiotic overuse to me, and who knows? Maybe it was.

Overuse or misuse is certainly a concern these days. CDC is in the middle of Get Smart About Antibiotics Week, which is an international collaboration with the European Antibiotic Awareness Day and Canada′s Antibiotic Awareness Week.

Antibiotics are effective “against bacterial infections, certain fungal infections and some kinds of parasites.” They don’t do squat against viruses.

Misuse of antibiotics is a pervasive problem. For instance, if I take an antibiotic against a bacterial infection but I don’t take it long enough, the bacteria that survive become resistant to the antibiotic and can infect other people. The bacteria also reproduce and their offspring or clones are resistant.

When someone is infected with the resistant bacteria and he or she takes the same antibiotic I took (but didn’t finish), it may not work.

If this happens often enough, and it has, then we end up with a plethora of germs against which we have little or no defense.

It’s not a theory. It’s reality. It’s happening right now.

What can be done?

Healthcare professionals can stop giving antibiotics against viral infections and in other circumstances where the drug is not helpful.

We can stop asking for antibiotics. The healthcare professionals will know when we need them and when we don’t. Also, we must comply with the dosing instructions. We need to take the drug as directed and for as long as directed.

That’s about it. Pretty simple. But here’s hoping it’s not too late for scientists to come up with a new class of antibiotics that will allow us to have a do-over.

By Trish Parnell

Image courtesy of National Health Service





RSV – Not Always Simple

14 11 2011

Almost all kids in the United States are infected with RSV by the time they’re two years of age. In adults and older kids and teens, the symptoms resemble your basic cold, and for most babies and toddlers, it’s not a serious infection, but it’s capable of great nastiness.

Respiratory syncytial (sin-SISH-ul) virus, or RSV, was identified in 1956 and is the usual suspect in “lung and airway infections in infants and young children.”

It’s a contagious virus — spreads easily through droplets that infected people cough or sneeze into the air. Those droplets that aren’t inhaled by others land on surfaces, which are then touched by unsuspecting individuals. The germ gets on people’s hands and infects them when they touch their noses or mouths.

The virus is no lightweight. It can survive for at least 30 minutes on one’s hands, nearly five hours on surfaces, and even longer on contaminated tissues.

Symptoms are similar to cold symptoms, and may include:

  • Wheezing
  • Difficulty breathing
  • Cough
  • Stuffy or runny nose
  • Fever

There is a simple and quick test for RSV that clinics can run. Because it’s a virus, antibiotics don’t work against it, and most of the time, there is no treatment because the symptoms will be no worse than those of a mild cold.

But, more severe infections can lead to pneumonia, bronchiolitis, lung failure, and a host of related problems. If a baby or toddler (or anyone, really) has difficulty breathing, get them to a hospital. There they will be treated for their symptoms and treatment may include oxygen, IV, or even a ventilator.

To stop transmission of RSV, pertussis (whooping cough), colds, flu and many other infections, cover your coughs and sneezes, wash hands frequently and thoroughly, don’t swap spit with others, and don’t share forks, cups, straws, or anything else that’s been in your mouth.

There’s no vaccine for RSV, but there is a drug that can be given monthly to those kids at high risk of severe illness. Check with your provider about this preventive option, and if your young one has any symptoms that would lead you to suspect RSV or any other infection, it never hurts to take him in for a visit.

By Trish Parnell

Video courtesy of  TheDoctorsVideos





Vaccinate Against Pneumonia – Please!

10 11 2011

I’m a pediatrician, an infectious disease pediatrician at that.  We’re supposed to know what to do when a baby has pneumonia—apparently that’s not always true.  I’ve treated hundreds of such cases, but this time was different.

When it’s your own infant, none of that experience matters.  Jack looked at me with what seemed like panic in his eyes.  Coughing, crying, breathing fast, sleeping in fits and spurts.  Babies aren’t supposed to breath that fast.  He lay beside me in bed. It was the day before Christmas and I just kept telling myself that we’d be better soon—apparently that’s not true either.

We both had influenza, I’m sure of that.  If you’ve had it, you’ll know what I mean. I felt like hell, exhausted, muscle aches, every time I coughed it felt like sandpaper scraping over my trachea.  But since I’m an infectious disease doc, of course we were vaccinated! Well, apparently that wasn’t true this year.  I had every intention of getting that done weeks earlier, but life got in the way.

The middle of the night always makes things worse, or at least things seem worse.  So, we became ‘that family,’ calling our neighbors in the middle of the night to care for our two-year-old while we drove to the hospital with Jack.  So many times I was that doctor we were about to meet in the emergency room, scratching my head wondering, “Why did they wait the whole day at home and decide to finally come in at 2:00 in the morning?”

Well, now I knew.  Sometimes it doesn’t get better.  He had pneumonia on the chest x-ray and needed antibiotics.

Every day, of every year, millions of children get pneumonia and struggle to breath; more than a million of them don’t get the treatment they need and die.  Every day of every year, something unimaginable to the mothers we are happens to mothers we don’t know—over 90% of them living in poor countries in Africa and Asia—their child dies in front of their eyes from pneumonia.  It’s senseless.  It’s inhuman.

Vaccines against the biggest pneumonia-causing bacteria, Hib and pneumococcus, along with other simple strategies, can prevent these deaths.  So, this year on World Pneumonia Day, look at your kids and remember to get them vaccinated, remember to get yourself vaccinated, and remember that not every mother is so lucky . . . yet.

The GAVI Alliance is helping give those mothers the same opportunity for their kids, faster than ever before for any vaccine.  At a time when the world seems to be more complicated than ever, this seems like a pretty sensible thing to do.

By Dr. Kate O’Brien, pediatrician, epidemiologist, Deputy Director of the International Vaccine Access Center (IVAC), Johns Hopkins Bloomberg School of Public Health, USA,
Winner of the 2011 US Presidential Early Career Award for Scientists and Engineers





Holiday Poisoning (oops) Cooking

7 11 2011

Do you cook? Most people do, and some people cook every day. I know of only one person who doesn’t cook—ever. The rest of us crank the oven on or prepare salads or treats at some point during the year, even if it’s just for the holidays.

We also manage to poison each other when we handle food with unclean hands, undercook the bird, or let hot foods get cool and cold foods get warm.

CDC says that “each year roughly one out of six Americans (or 48 million people) get sick, 128,000 are hospitalized, and 3,000 die from foodborne diseases.”

Hence this rather long (but we hope useful) post on how not to poison Grandma this year.

Foodsafety.gov says to follow these four steps (edited a little for length):

CLEAN hands and surfaces often—wash your hands for 20 seconds with soap and running water. Here’s a visual that shows how.

And when to do it:

  • Before eating food.
  • Before, during, and after preparing food.
  • Before and after treating a cut or wound.
  • Before and after caring for someone who is sick.
  • After handling uncooked eggs, or raw meat, poultry, seafood, or their juices.
  • After blowing your nose, coughing, or sneezing.
  • After touching an animal or animal waste.
  • After touching garbage.
  • After using the toilet.

Wash surfaces and utensils after each use:

  • Use paper towels or clean cloths to wipe up kitchen surfaces or spills, then toss or wash.
  • Wash cutting boards, dishes, utensils, and counter tops with hot, soapy water after preparing each food item and before you go on to the next item.
  • As an extra precaution, you can use a solution of 1 tablespoon of unscented, liquid chlorine bleach in 1 gallon of water to sanitize washed surfaces and utensils.

Wash fruits and veggies:

  1. Cut away any damaged or bruised areas.
  2. Rinse produce under running water. Don’t use soap, detergent, bleach, or commercial produce washes.
  3. Scrub firm produce—like melons or cucumbers—with a clean produce brush.
  4. Dry produce with a paper towel or clean cloth towel and you’re done.
  5. Bagged produce marked “pre-washed” is safe to use without further washing.

Don’t wash meat, poultry, and eggs. Washing raw meat and poultry can actually help bacteria spread, because their juices may splash onto (and contaminate!) your sink and countertops. All commercial eggs are washed before sale. Any extra handling of the eggs, such as washing, may actually increase the risk of cross-contamination, especially if the shell becomes cracked.

SEPARATE Don’t cross-contaminate

Even after you’ve cleaned hands and surfaces, raw meat, poultry, seafood, and eggs can still spread illness-causing bacteria to ready-to-eat foods—unless you keep them separate. Use separate cutting boards and plates for produce and for meat, poultry, seafood, and eggs.

  • Use one cutting board for fresh produce, and one for raw meat, poultry, or seafood.
  • Use separate plates and utensils for cooked and raw foods.
  • Before using them again, thoroughly wash plates, utensils, and cutting boards that held raw meat, poultry, seafood, or eggs.
  • Once a cutting board gets excessively worn or develops hard-to-clean grooves, consider replacing it.

Keep meat, poultry, seafood, and eggs separate from all other foods at the grocery.

  • Separate raw meat, poultry, seafood, and eggs from other foods in your shopping cart.
  • At the checkout, place raw meat, poultry, and seafood in plastic bags to keep their juices from dripping on other foods.

Keep meat, poultry, seafood, and eggs separate from all other foods in the fridge.

  • Place raw meat, poultry, and seafood in containers or sealed plastic bags to prevent their juices from dripping or leaking onto other foods. If you’re not planning to use these foods within a few days, freeze them instead.
  • Keep eggs in their original carton and store them in the main compartment of the refrigerator—not in the door.

COOK

Did you know that the bacteria that cause food poisoning multiply quickest in the “Danger Zone” between 40˚ and 140˚ Fahrenheit? Cooked food is safe only after it’s been heated to a high enough temperature to kill harmful bacteria. Color and texture alone won’t tell you whether your food is done. Instead, use a food thermometer to be sure.

  • If you don’t already have one, consider buying a food thermometer.
  • When you think your food is done, place the food thermometer in the thickest part of the food, making sure not to touch bone, fat, or gristle.
  • Wait the amount of time recommended for your type of thermometer.
  • Compare your thermometer reading to our Minimum Cooking Temperatures Chart to be sure it’s reached a safe temperature.
  • Some foods need 3 minutes of rest time after cooking to make sure that harmful germs are killed. Check the Minimum Cooking Temperatures Chart for details.
  • Clean your food thermometer with hot, soapy water after each use.

Keep food hot after cooking (at 140 ˚F or above). The possibility of bacterial growth actually increases as food cools after cooking because the drop in temperature allows bacteria to thrive. But you can keep your food above the safe temperature of 140˚F by using a heat source like a chafing dish, warming tray, or slow cooker.

Microwave food thoroughly (to 165 ˚F). To make sure harmful bacteria have been killed in your foods, it’s important to microwave them to 165˚ or higher. Here’s how:

  • When you microwave, stir your food in the middle of heating.
  • If the food label says, “Let stand for x minutes after cooking,” don’t skimp on the standing time. Letting your microwaved food sit for a few minutes actually helps your food cook more completely by allowing colder areas of food time to absorb heat from hotter areas of food. That extra minute or two could mean the difference between a delicious meal and food poisoning.
  • After waiting a few minutes, check the food with a food thermometer to make sure it is 165˚F or above.

CHILL

Did you know that illness-causing bacteria can grow in perishable foods within two hours unless you refrigerate them? (And if the temperature is 90 ˚F or higher during the summer, cut that time down to one hour!) But by refrigerating foods promptly and properly, you can help keep your family safe from food poisoning at home.

Cold temperatures slow the growth of illness-causing bacteria. So it’s important to chill food promptly and properly. Here’s how:

  • Make sure your fridge and freezer are cooled to the right temperature. Your fridge should be between 40 ˚F and 32 ˚F, and your freezer should be 0 ˚F or below.
  • Pack your refrigerator with care. To properly chill food (and slow bacteria growth), cold air must be allowed to circulate in your fridge. For this reason, it’s important not to over-stuff your fridge.
  • Get perishable foods into the fridge or freezer within two hours. In the summer months, cut this time down to one hour.
  • Remember to store leftovers within two hours as well. By dividing leftovers into several clean, shallow containers, you’ll allow them to chill faster.

Never thaw or marinate foods on the counter. Many people are surprised at this tip. But since bacteria can multiply rapidly at room temperature, thawing or marinating foods on the counter is one of the riskiest things you can do when preparing food for your family. To thaw food safely, choose one of these options:

  • Thaw in the refrigerator. This is the safest way to thaw meat, poultry, and seafood. Simply take the food out of the freezer and place it on a plate or pan that can catch any juices that may leak. Normally, it should be ready to use the next day.
  • Thaw in cold water. For faster thawing, you can put the frozen package in a watertight plastic bag and submerge it in cold water. Be sure to change the water every 30 minutes. Note: If you thaw this way, be sure to cook the food immediately.
  • Thaw in the microwave. Faster thawing can also be accomplished in the microwave. Simply follow instructions in your owner’s manual for thawing. As with thawing in cold water, food thawed in the microwave should be cooked immediately.
  • Cook without thawing. If you don’t have enough time to thaw food, just remember, it is safe to cook foods from a frozen state—but your cooking time will be approximately 50% longer than fully thawed meat or poultry.

To marinate food safely, always marinate it in the refrigerator.

Know when to throw food out. You can’t tell just by looking or smelling whether harmful bacteria has started growing in your leftovers or refrigerated foods. Be sure you throw food out before harmful bacteria grow by checking our Safe Storage Times chart.

And finally, CDC has some reminders for Turkey Day:

Food safety is especially important as you prepare a holiday meal. Within the last couple of years, CDC has investigated outbreaks of foodborne illness that were caused by bacteria in jalapeños, spinach, peanut butter, frozen pizza, frozen pot pies, and frozen beef patties. Many consumers are now more aware of the ongoing importance of food safety.

CDC is a food safety partner with the United States Department of Agriculture (USDA), Food Safety and Inspection Service (FSIS), which is responsible for the safety of meat and poultry. The FSIS has assembled preparation tips intended to serve as safety reminders to those who are already familiar with meat and poultry preparation safety and as guidelines for the first-time chef.

Turkey Basics: Safely Thaw, Prepare, Stuff, and Cook

When preparing a turkey, be aware of the four main safety issues: thawing, preparing, stuffing, and cooking to adequate temperature.

Safe Thawing
Thawing turkeys must be kept at a safe temperature. The “danger zone” is between 40 and 140°F — the temperature range where foodborne bacteria multiply rapidly. While frozen, a turkey is safe indefinitely, but as soon as it begins to thaw, bacteria that may have been present before freezing can begin to grow again, if it is in the “danger zone.”
There are three safe ways to thaw food: in the refrigerator, in cold water, and in a microwave oven. Instructions are also available in Spanish .

Safe Preparation
Bacteria present on raw poultry can contaminate your hands, utensils, and work surfaces as you prepare the turkey. If these areas are not cleaned thoroughly before working with other foods, bacteria from the raw poultry can then be transferred to other foods. After working with raw poultry, always wash your hands, utensils, and work surfaces before they touch other foods.

Safe Stuffing
For optimal safety and uniform doneness, cook the stuffing outside the turkey in a casserole dish. However, if you place stuffing inside the turkey, do so just before cooking, and use a food thermometer. Make sure the center of the stuffing reaches a safe minimum internal temperature of 165°F. Bacteria can survive in stuffing that has not reached 165°F, possibly resulting in foodborne illness. Follow the FSIS’ steps to safely prepare, cook, remove, and refrigerate stuffing. Spanish language instructions  are available.

Safe Cooking
Set the oven temperature no lower than 325°F and be sure the turkey is completely thawed. Place turkey breast-side up on a flat wire rack in a shallow roasting pan 2 to 2-1/2 inches deep. Check the internal temperature at the center of the stuffing and meaty portion of the breast, thigh, and wing joint using a food thermometer. Cooking times will vary. The food thermometer must reach a safe minimum internal temperature of 165°F. Let the turkey stand 20 minutes before removing all stuffing from the cavity and carving the meat. For more information on safe internal temperatures, visit FoodSafety.gov’s Safe Minimum Cooking Temperatures.

By CDC, mostly!