Here Come the Germs!

24 09 2013

I love my kids. I do. But, may I just say, entre nous, that my heartbeat slows and I’m immersed in a narcotic sense of freedom when they toddle off to school each September.

That euphoric bliss lasts about two weeks. Maybe. Then come the colds, the aches, the lethargy, the sniffles, the who-knows-what.

Does your family experience the same thing? Here’s what’s going on:

  • In the US, kids under 17 years of age experience over 50 million colds each year. M-m-million!
  • Kids miss almost 22 million (there’s that “m” word again) days of school due to colds.
  • Diarrhea is no slouch when it comes to affecting the health of our kids—it’s a big contributor to missed school days.
  • Bacteria and viruses can survive on desktops, doorknobs, walls, water spigots, cafeteria trays, shoes, backpacks, purses, and other surfaces for minutes or even hours. A few even longer, depending on the environment. The germs lurk on surfaces, waiting for unsuspecting hands to slide by and pick them up.
  • Some kids and teachers don’t cover their coughs and sneezes, and they don’t clean their hands when it’s important to do so. Depending on the germ, it may float in the air and wait to be inhaled, or drop on a surface and wait to be picked up, or transfer from germy hands to surfaces or the waiting hands of others.

What can we do? We can’t completely protect our kids from the germs in the world (and there’s no way I’m homeschooling), so we teach them how to protect themselves and live with the fact that they’re occasionally going to pick up germs. Picking up germs is not a bad thing. That exposure helps strengthen the immune system and does other good things for the body that are best left to another blog post.

To keep illness down to a manageable level, share these tips with your family:

  • Wash hands with soap and water after coughing, sneezing, playing inside or outside, going to the bathroom, or touching animals, and before preparing or eating food and at any time that the hands look dirty. And, wash those hands as soon as you come home from school or, well, anywhere.
  • Use hand sanitizer in place of soap and water if no soap/water is available, but soap and water are preferred. Remember that hand sanitizer kills many germs, but only while it’s being rubbed onto the hands. Once it’s dry and the hand touches something germy even two seconds later, germs will live on the hands again.
  • Cough and sneeze into the crook of the elbow. Coughing and sneezing into tissues is OK, but not ideal. The tissues are thin and the germs blast right through onto the hands, requiring an immediate hand cleaning. Plus, the germs are more likely to escape the tissue and float around waiting to be inhaled, or drop onto surfaces, waiting to be touched.
  • Don’t share with others anything your mouth touches. This means don’t share forks, spoons, water bottles, food, drinking glasses, straws, lipstick or any other makeup, come to think of it, and don’t use anything that’s touched another person’s mouth, such as their pen or pencil or any item already listed. This is not a complete list, just one to get you thinking about how germs can be passed from one person to another.
  • Keep your hands away from your eyes, nose, and mouth, as these are entryways for germs.
  • Walk around your home with a disinfecting wipe and clean doorknobs (interior and exterior), light switches and the wall area around them if the wall surface will hold up to the moisture, keyboards, remote controls—anything around the house that gets touched a lot.
  • Call your provider and your child’s provider and make sure the entire family is up-to-date on immunizations.

Share your tips in the comment section. Let’s try to have a healthy school year!

 

By Trish Parnell

 

 





The Trouble With Some Microbes . . .

7 02 2013

Our battle against bacteria is tilting in our favor. After all, we have vaccines and antibiotics on our side. That doesn’t mean we can get cocky. It’s tilting, not surrendering at our feet.

But we’re still struggling to find ways to kill viruses once they’ve infected us.  At best, we can sometimes control them.

Although we can kill viruses on our bodies and other surfaces with disinfectants, it’s difficult to kill them when they’re living inside our cells.  When we’re infected with a virus, it takes up residence in one of our cells and uses the cell’s machinery to reproduce itself.

Developing a drug that will kill the virus without disrupting the intracellular machinery of uninfected cells is no easy task. It’s like playing Jenga—eventually the whole structure will collapse.

Bacteria, on the other hand, generally live outside of our cells and are easier targets.

There are some bacteria that have developed a resistance to not just one drug, say for instance penicillin, but to many such drugs.  They’re known as multi-drug resistant microorganisms such as streptococcus pneumoniae and mycobacterium tuberculosis, germs that we thought were very much under control and are now surging back into the population.

One major factor in preventing us from understanding the world of microbes is the size of that world.

The folks at the University of Georgia College of Agricultural and Environmental Sciences put bacteria into perspective this way, “Bacteria vary somewhat in size, but average about 1/25,000 inch.  In other words, 25,000 bacteria laid side by side would occupy only one inch of space.  One cubic inch is big enough to hold nine trillion average size bacteria—about 3,000 bacteria for every person on earth.

“Bacteria make up the largest group of micro-organisms.  People often think of them only as germs and the harm they do.  Actually, only a small number of [the thousands of different] bacteria types are pathogenic (disease-causing).  Most are harmless and many are helpful.”

Neal Rolfe Chamberlain, professor at the Kirksville College of Osteopathic Medicine, explains viruses in this manner, “Viruses are very small forms of life.  In fact, people still argue over whether viruses are really alive.  Viruses range in size from about 20 to 300 nanometers (nm).  A nanometer is 0.000001 of a millimeter.  A millimeter is 1/25 of an inch.  So in other words, you can place 25,000,000 nanometers in an inch.  If the biggest virus is 300 nm then you could fit 83,333 of that virus in an inch.

“Viruses are major freeloaders.  They cannot make anything on their own.  To reproduce they must infect other living cells.  Viruses infect bacteria, parasites, fungi, plants, animals, and humans.  No one escapes them.  If you have had the flu, chickenpox, measles, a common cold, mono, a cold sore, or a sore throat you have been infected by a virus!”

Some viruses, like HIV and hepatitis C, tend to develop strains that can resist mono drug therapy (treating the patient with one drug at a time).  We have to try and control the viruses with combination, or “cocktail” drugs (treating the patient with several drugs at once), although even that approach does not always work.  Some viruses can keep mutating until we’ve run out of drugs to try.

All this is to say that fighting microbes is seldom a simple task, and seemingly one that is neverending. For example, we have a whooping cough vaccine, but new strains are popping up and new vaccines are needed for this astoundingly infectious microbe.

We will never be rid of our tiny co-inhabitants on this world, and anyway, most of them we want to keep around. It’s those others . . . wouldn’t it be nice to have a jail for nasty microbes?

By PKIDs’ Staff





Antibiotics and When to Use Them

30 07 2012

Summer has its share of illnesses, but for most physicians, the “illness season” begins to ramp up in the fall. Colds, sore throats and ear infections, among other illnesses, are much more common.

Patients come to the doctor’s to get better, and for many years that has meant leaving the office with a prescription for antibiotics. Many illnesses were treated unnecessarily, and as a result, antibiotic resistance has increased.

Antibiotics first came into widespread use in the 1940s and revolutionized medical care. Bacterial illnesses, such as pneumonia, strep throat, bladder infections, etc. could now be treated. Within a few years, however, bacteria resistant to penicillin were already present.

Antibiotics kill sensitive bacteria, but resistant ones can survive and multiply. Through the years, antibiotics that used to work for infections become less effective.

While antibiotics work against bacteria, they do not treat viruses. Viruses cause the majority of infections (colds, many sore throats, influenza, most coughs). In many cases, however, antibiotics are prescribed for viruses. This leads to increasing bacterial resistance.

Why are antibiotics overused? The answer is multi-fold. Parents often come to the office with an expectation that they will be given something to make their child better. Doctors want to help people.

In the early years of my practice, it was common to treat for an “early” ear infection, or sometimes, “to head off the illness.” Our knowledge of the natural history of illnesses has advanced. We used to think that if a cold produced yellow or green drainage, this was an indicator of sinus/bacterial infection. Now we know that discolored drainage is a normal part of an illness that may last 10-14 days. Some ear infections will clear up on their own. Sore throats that are not caused by strep do not need an antibiotic.

When antibiotics are needed, the most specific antibiotic is best. Some antibiotics are “broad spectrum.” They kill many bacteria, not just the ones causing the infection. Many of these are newer antibiotics, and while they might be more convenient, taste better, etc, they may be more than is needed, hastening antibiotic resistance.

The advantages of using antibiotics wisely are many. Short term, there will be fewer side effects (diarrhea, rashes, stomach ache), and long term, hopefully, when antibiotics are needed for a serious bacterial infection, they will be more effective.

So, when your doctor says, “Good news, they don’t need an antibiotic,” it really is good news.

By Dr. Katherine Vaughn

Image courtesy of AJC1





Microbes R Us

14 06 2012

Well, they’ve finally done it. Researchers have mapped the microbes living on humans.

Seems like they wouldn’t be hard to find, since they’re all over and in the body, but they are little—hence the “micro” part. And there are trillions of them on each of us. But, they are accountable for only 1 to 3 percent of the body’s mass. So if you weigh 180 pounds, the microbes make up between 1.8 and 5.4 pounds. Imagine. Trillions of anything weighing just 1.8 pounds.

If you think about it too much, it’ll give you the willies. Tiny critters in your nose, on your eyelashes, on your mouth, on your skin, on your lips . . . you get the idea.

Humans do have mutually beneficial relationships with some of these microorganisms. The microbes in the gut are famous for being helpful. We give them a place to live and they give us the ability to digest certain foods and produce vitamins and anti-inflammatories.

Other microbes, called pathogens, can and do cause illness in some of us. Yet many healthy people carry pathogens that don’t cause disease. Go figure.

The National Institutes of Health organized a group of researchers to map out the “normal microbial makeup of healthy humans (in the Western population).” The results of this mapping will be a bumper crop of hypotheses followed by a flood of studies which will, it’s hoped, move infectious disease research considerably further down the road.

NIH shares a bit of what’s already come out of this mapping:

CLINICAL APPLICATIONS

As a part of HMP, NIH funded a number of studies to look for associations of the microbiome with diseases and several PLoS papers include medical results. For example, researchers at the Baylor College of Medicine in Houston compared changes in the vaginal microbiome of 24 pregnant women with 60 women who were not pregnant and found that the vaginal microbiome undergoes a dramatic shift in bacterial species in preparation for birth, principally characterized by decreased species diversity. A newborn is a bacterial sponge as it populates its own microbiome after leaving the sterile womb; passage through the birth canal gives the baby its first dose of microbes, so it may not be surprising that the vaginal microbiome evolved to make it a healthy passage.

Researchers at the Washington University School of Medicine in St. Louis examined the nasal microbiome of children with unexplained fevers, a common problem in children under 3 years of age. Nasal samples from the feverish children contained up to five-fold more viral DNA than children without fever, and the viral DNA was from a wider range of species. Previous studies show that viruses have ideal temperature ranges in which to reproduce. Fevers are part of the body’s defense against pathogenic viruses, so rapid tests for viral load may help children avoid inappropriate treatment with antibiotics that do not kill the viruses but may harm the child’s healthy microbiome.

These are among the earliest clinical studies using microbiome data to study its role in specific illnesses. NIH has funded many more medical studies using HMP data and techniques, including the role of the gut microbiome in Crohn’s disease, ulcerative colitis and esophageal cancer; skin microbiome in psoriasis, atopic dermatitis and immunodeficiency; urogenital microbiome in reproductive and sexual history and circumcision; and a number of childhood disorders, including pediatric abdominal pain, intestinal inflammation, and a severe condition in premature infants in which the intestine actually dies.

All good news, but the scope of the mass of microbes on and in me still gives me the willies.

By Trish Parnell

Image courtesy of NIH





Ask Emily

23 02 2012

Why does our skin break out in a rash with some viral infections like measles or Fifth disease?

These sorts of rashes are technically known as viral exanthems (the word derives from the Greek word “exanthema,” meaning “breaking out”).

The skin responds to infection with a rash for one of three reasons: the infectious agent releases a toxin that causes the rash, the infectious agent damages the skin and causes a rash, or the immune response results in the skin outbreak.

The skin responds in only a few ways to these challenges, although the pattern of the response can vary from virus to virus (bacteria and some other infectious organisms can also trigger a rash).

The response is the body’s attempt to deal with the presence of viral particles that find their way to the epidermis, or skin. In general, the upshot of the immune response is an area of inflammation. Because viruses cause a systemic or body-wide infection, viral rashes often cover much of the body.

Although the basic pathway to the rash is similar among viruses, the specific pattern of the rash can help distinguish the virus involved. For example, Fifth disease, so-named because it was the fifth virus in a series to be identified as causing a rash, produces a “slapped-cheek” ruddy appearance on the face and may cause a lacy, rather flat rash elsewhere on the body.

A measles rash, on the other hand, starts as an eruption of raised or flat spots behind the ears and around the hairline before spreading body-wide.

One thing to recognize is that not every rash is a viral rash or a benign viral rash, although most viral rashes will resolve on their own. Usually, a fever accompanies a viral rash. If a rash develops, you should be aware of the following warning signs that signal a call to your doctor:

  • If you suspect you have shingles. This highly uncomfortable rash tends to trace along the nerve routes under the skin but can spread out from those, as well. Starting antivirals within the first 24 hours may ward off a more intense recurrence or a permanent pain syndrome called postherpetic neuralgia.
  • If you suspect measles. Infection with this highly contagious virus should be reported immediately.
  • What you think is a rash from a severe allergic reaction or a rash that arises coincident with taking a new medication.
  • The rash accompanies a high fever, spreads rapidly, and starts to look like purple bruising. This pattern is indicative of meningitis.
  • Any rash involving a very high fever, pain, dizziness or fainting, difficulty breathing, or a very young child or that is painful.
  • Any rash that you find worrisome, including for reasons of persistence or timing with something such as exposure to infection, a new medication, or new food.

Do you have a question for Emily? Send it to: pkids@pkids.org

By Emily Willingham

Image courtesy of HowStuffWorks





Ask Emily

26 01 2012

I’ve just read that there’s a kind of tuberculosis making a comeback that doesn’t respond to any known TB drugs. How does that happen and can anything be done to treat it or stop its spread?

Tuberculosis (TB) is a bacterial infection, usually of the lungs, although it can invade other tissues.

A healthy person may be infected but not show symptoms, but someone with an active infection may have a cough with blood in the sputum, night sweats, weight loss, and fever. The bacteria spread through coughs or sneezes.

As with seemingly all infections we treat with antibiotics, the TB bacterium has evolved to evade the arsenal of medications we throw at it.

While many cases still resolve after the long-term antibiotic treatment required (6 months or more), often people with the infection begin to feel better or get tired of the unpleasant side effects and will cease the therapy.

As with other similar situations with antibiotics, this premature cessation of therapy can give resistant bacteria the upper hand. The outcome is different grades of TB infection, based on the level of resistance. TB that resists most but not all drugs is multidrug-resistant. TB that resists all but drugs of last resort is extensively drug-resistant, and TB that responds to no antibiotics at all is totally drug-resistant (TDR).

That last form of TB strikes fear into the hearts of epidemiologists and public health officials because it is an infectious disease nightmare.

For a series of reasons ranging from an inability of low-resource countries to test for and detect TB to a lapse in treatment adherence because of poor healthcare management and patient follow-up, the most resistant forms of TB often emerge in areas poorly equipped to control it. Thus, when a report surfaced in January 2012 that a research team had identified 12 cases of TDR TB in India, on the heels of 15 identified cases in Iran in 2006, the worldwide response was, essentially, anxiety and fear.

The fear is that if this TDR form of TB gains a stronger foothold in overcrowded conditions where people walk ill and undiagnosed, it would be a plane flight away from toeholds anywhere else in the world. While humanity dealt with incurable and fatal TB for millennia before antibiotics started to fight back in the 1940s, this resurgence at a time when technology can take a disease around the world in a matter of hours adds a whole new dimension to the threat.

There is, of course, already the threat on the ground in India, where one of the cases is a 13-year-old girl and another of the people in the cohort has died from the disease. But lest anyone think that in their comfortable home in the West they are sheltered from threat, the news the day I wrote this contained reports of a student with TB in Fort Wayne, Indiana, which precipitated notification to 100 students who may have come in contact with their classmate. Another student in Westlake, Ohio, also had been diagnosed with TB, precipitating community action to make people aware of symptoms and prevention of spread.

The communities in these cases benefited from a public health surveillance program that moved into action once each diagnosis was made. But in India, the result has led to public health chaos, with officials arguing over whether or not some of the cases truly were TDR TB. That does not change the fact that TDR TB has already been identified in Iran, or the economic and healthcare gaps that will only continue to contribute to the likelihood of its spread.

Do you have a question for Emily? Send it to: pkids@pkids.org

By Emily Willingham

Video courtesy of IBNLive





Pink Eye!

12 01 2012

Evening time. Your little moppet is fed, bathed, and snuggled ‘neath her blanket. You bend to kiss her nose and then, because your mother did the same, you gently press your cheek against your child’s and exchange butterfly kisses.

This is also known as giving (or getting) the gift of pink eye.

In case you haven’t yet experienced it, pink eye is when your eye becomes pink or red because it’s irritated or inflamed.

We all have a thin membrane that covers the inside of our eyelids and the whites of our eyes – it’s called the conjunctiva. When it becomes inflamed or irritated, we have a case of conjunctivitis. Also known as pink eye.

Lots of non-infectious agents can irritate the conjunctiva and cause our eye to get pink. If we’re allergic to pollen or pet dander, that can give us pink eye. Sometimes the chlorine in pools will do the same.

We can also pick up a bacterial or viral infection that results in pink eye and is infectious, easily spreading person to person. That’s the one that is the gift of the butterfly kiss, should one of the eyes doing the kissing be infected.

Prevention is easy, mostly it’s about not touching your eyes with unclean hands and not sharing any items that have been near an infected person’s eye, such as pillowcases, towels, makeup. You get the idea.

If you have pink eye, do all of the above, and don’t use the same eye dropper or bottle on infected and uninfected eyes, as it’s a good way to ensure both of your eyes become infected. And, CDC says to stay out of swimming pools.

Treatment of conjunctivitis depends entirely on the cause of the irritation. If it’s viral, the symptoms are treated and antivirals may be used for severe cases.

Bacterial infections will probably receive antibiotics and treatment to alleviate the discomfort.

It’s best to check with your provider for specifics, and to make sure and revisit the clinic under these circumstances noted by CDC:

  • Conjunctivitis is accompanied by moderate to severe pain in the eye(s).
  • Conjunctivitis is accompanied by vision problems, such as sensitivity to light or blurred vision, that does not improve when any discharge that is present is wiped from the eye(s).
  • Conjunctivitis is accompanied by intense redness in the eye(s).
  • Conjunctivitis symptoms become worse or persist when a patient is suspected of having a severe form of viral conjunctivitis—for example, a type caused by herpes simplex virus or varicella-zoster virus (the cause of chickenpox and shingles).
  • Conjunctivitis occurs in a patient who is immunocompromised (has a weakened immune system) from HIV infection, cancer treatment, or other medical conditions or treatments.
  • Bacterial conjunctivitis is being treated with antibiotics and does not begin to improve after 24 hours of treatment.

One of the best methods of disease prevention (and not just pink eye) is to keep our hands clean and not touch our noses, eyes, or mouth.

I have to confess that, although my teenager no longer tolerates butterfly kisses, my tweener loves them. As long as the whites of her eyes remain, well, white, we will share that bedtime ritual. But, I do perform a quick inspection as I’m leaning in, just in case.

By Trish Parnell

Image courtesy of littlenelly