Category: From insects or animals

Those beautiful summer and early fall days that beckon us outdoors also often expose us to a lot of insects. And that includes stinging insects. Those stings often cause us brief moments of pain. But for some people, a sting can result in a serious, even deadly allergic reaction — including severe lung and breathing problems. That can be especially dangerous for a child who has asthma or other breathing challenges.

“There are between 50 and 100 deaths a year from anaphylaxis as a result of stinging insects,” says John Kelso, M.D. FAAP, of the division of Allergies, Asthma and Immunology at San Diego’s Scripps Clinic. While this figure is low compared to the thousands of anaphylaxis deaths from food and drug allergies each year, many of the sting-related deaths could be prevented.

Allergies and Asthma, Insects and Immunity

Bees, wasps, hornets, yellow jackets, and imported fire ants are the prime villains in such cases. But it’s the nature of the victim’s immune system and sensitivity to the insect’s venom that triggers the reaction.

In severe reactions, the child’s allergic immune response to the sting results in the air passages shrinking, making breathing difficult or impossible. Children experiencing anaphylaxis should receive emergency medical treatment immediately. Among the most common emergency treatments is epinephrine (eh-pih-NEH-frin) — another word for adrenalin — which helps open the airways by reducing the tightening of the muscle embedded in the airway.

“The vast majority of people who are stung won’t have a serious reaction at all,” Kelso says, “much less an anaphylactic reaction. This is even true of those who have asthma or other lung diseases. And any patient experiencing anaphylaxis can display the symptoms of asthma, whether they actually have asthma or not.”

However, if the person stung is allergic and has asthma or other lung disease, the reaction is potentially more dangerous. (See “Stinging Insects and Asthma” below.)

Is Your Child at Risk?

How do you know if you or your children are allergic to insect stings? “A prior exposure to what causes the reaction (the allergen) is necessary in order to be allergic,” Kelso says. “You have to have been stung and had some kind of reaction.” For patients whose insect-sting allergy has been established, Kelso recommends several courses of action.

“Venom immunotherapy is one approach to dealing with the allergy,” Kelso notes. Patients who receive this treatment are injected with small doses of the allergen — bee venom, for instance — which gradually strengthen their immune system’s resistance to the venom’s effects. Many professional beekeepers, for example, have been stung so frequently that their immune systems barely react to the venom.

“It’s also a good idea for people allergic to insect stings to carry a self-injectable dose of epinephrine in order to be prepared for an anaphylactic emergency,” Kelso says. Parents of allergic children should make sure that teachers and school staff members, camp counselors, coaches, and other activity supervisors are aware of the child’s allergy. Facilities should be equipped with epinephrine and other needed emergency treatments.

The best defense against potentially dangerous insect stings is, of course, not to get stung. “Avoidance is the best treatment for all allergic diseases,” Kelso says. He recommends that people remain alert when outdoors for anthills, bee swarms and nests, as well as areas that attract large populations of mosquitoes and other flying insects.

“If you’re allergic, be careful about outdoor strolls and gatherings, such as picnics,” he adds. “Don’t pick up empty soda cans or other trash that might attract insects. Don’t go barefoot. Don’t wear flowery scents. Try to look and smell as little like a flower as possible.”

Stinging Insects and Asthma

The vast majority of asthma patients aren’t allergic to insect stings and won’t experience a severe anaphylactic reaction if stung, notes Dr. John Kelso of Scripps Clinic’s division of Allergy, Asthma and Immunology in San Diego.

But what if you do have both asthma and an allergy to insect venom?

“If you superimpose an anaphylactic event on top of asthma,” Kelso says, “your chances of dying are increased.”

As many as two-thirds of the 50 to 100 annual anaphylaxis deaths from stinging insects are in patients who have both asthma and an allergy to stings. Similarly high asthma-patient figures are noted in the far higher number of anaphylactic deaths from non-insect causes, such as allergies to peanuts, penicillin, and other food and drug allergies.

As with non-asthma patients who are allergic to stinging insects, asthma patients need to be prepared and vigilant in situations that could expose them to insect stings. Asthma sufferers should take extra precautions during insect season. It’s wise to carry an injectable dose of epinephrine, to manage asthma as effectively as possible, and to avoid locations and events likely to attract stinging insects.

In other words, you don’t necessarily have to avoid the outdoors. But you should do everything possible to avoid exposing yourself to the stinging residents you may find there.

Sometimes called rabbit fever, tularemia is caused by the Francisella tularensis bacteria. It is spread to humans through the bites of infected insects—most often, ticks, mosquitoes, and deerflies. It can also be passed to people by direct contact with infected animals, including rabbits, cats, hares, and muskrats. Your child can get tularemia by consuming contaminated food or water, eating inadequately cooked meat, or breathing in the bacteria. It cannot be transmitted from person to person.

Symptoms generally begin after an incubation period of usually 3 to 5 days, but possibly as long as 21 days.

According to the Centers for Disease Control and Prevention, there are about 200 human cases of tularemia reported per year in the United States, mostly in rural regions. Most cases occur during the summer months, similar to tick season.

Signs and Symptoms

Tularemia can cause illnesses that vary depending on how the infection was spread. Most commonly, a painful ulcer develops in the skin at the site of the insect bite, with tender enlarged lymph glands in the groin or armpits. Sometimes the glands may enlarge with no apparent bite.

Infection from food or water begins in the mouth with a severe sore throat, mouth sores, and enlargement of the neck lymph glands. With this form of the illness, your child may develop vomiting, diarrhea, and abdominal pain.

Illness from inhalation of the bacteria mainly results in fever, chills, muscle aches, and a dry cough. When the infection enters through the eyes, it results in swollen and red eyes with tender lymph glands in front of the ears. In many cases, tularemia is seen as a combination of several of these symptoms.

When to Call Your Pediatrician

Call your pediatrician immediately if your child develops an illness that could be a sign of tularemia, especially if he has a high fever, chills, a skin ulcer, or enlarged lymph glands. Prompt treatment is very important with this infection.

How Is the Diagnosis Made?

Your pediatrician will take samples of your child’s blood and have them tested in the laboratory for antibodies to tularemia. Sometimes the bacteria can be grown from the blood or infected sites.

Treatment

The doctor will treat your child with an antibiotic such as streptomycin or gentamicin. Treatment usually lasts for a 10-day period, although sometimes longer for more serious cases. Early treatment of the infection is important.

What Is the Prognosis?

When children are treated with the appropriate antibiotics, their infection will quickly clear up, although relapses occasionally occur. If the infection goes completely untreated, however, it can be life threatening in some cases.

Prevention

You can protect your child from the bites that cause tularemia by making sure he wears protective clothing.  Also, inspect your child frequently for ticks and remove any that may have attached themselves to his skin or scalp. The use of insect repellents, particularly those that contain the chemical DEET, is also recommended. Use gloves, masks, and goggles when skinning or dressing wild animals.

Other preventive measures include:

• Instruct your child not to handle sick or dead animals.
• Make sure all meat is cooked thoroughly before feeding it to your youngster.
• Ensure that drinking water comes from an uncontaminated source.

A vaccine is not available to protect against tularemia, although interest in vaccine development has been growing since concerns have been raised about the use of the F tularensis bacteria as a bioterrorist weapon. This organism could be spread through an airborne route, at which point it could be breathed in and would need to be treated quickly with antibiotics.

Many parents assume that children are most likely to be bitten by strange or wild animals, but in fact most bites are inflicted by animals the child knows, including the family pet. Although the injury often is minor, biting does at times cause serious wounds, facial damage, and emotional problems.

If your child is bleeding from an animal bite, apply firm continuous pressure to the area for five minutes or until the blood flow stops. Then wash the wound gently with soap and water, and consult your pediatrician.

If the wound is very large, or if you cannot stop the bleeding, continue to apply pressure and call your pediatrician to find out where to take your child for treatment. If the wound is so large that the edges won’t come together, it probably will need to be sutured (stitched). Although this will help reduce scarring, in an animal bite, it increases the chance of infection, so your doctor may prescribe preventive antibiotics.

Contact your pediatrician whenever your child receives an animal bite that breaks the skin, no matter how minor the injury appears. The doctor will need to check whether your child has been adequately immunized against tetanus or might require protection against rabies. Both of these diseases can be spread by animal bites.

Like any other wound, a bite can become infected. Notify your pediatrician immediately if you see any of the following signs of infection:

• Pus or drainage coming from the bite
• The area immediately around the bite becoming swollen and tender (It normally will be red for two or three days, but this in itself is not cause for alarm.)
• Red streaks that appear to spread out from the bite
• Swollen glands above the bite

Your pediatrician may recommend antibiotic therapy for a child who has:

• Moderate or severe bite wounds
• Puncture wounds, especially if the bone, tendon, or joint has been penetrated
• Facial bites
• Hand and foot bites
• Genital area bites

Your pediatrician may recommend a follow-up visit to inspect any wound for signs of infection within forty-eight hours.

Tapeworms can cause intestinal infections. When they do, any of a number of tapeworm species may be involved. These may include Taenia saginata (beef tapeworms), Taenia solium (from pork), or Diphyllobothrium latum (from fish). Tapeworms require human hosts to live out their life cycles. They affect people through contact with contaminated human feces found in soil, fresh water, or food. Children can develop these diseases by eating raw or undercooked meat from animals or fish that are infected with tapeworms. Contaminated food contains cysts of the parasite. Your child may have a tapeworm infection and have no symptoms.

When a child eats tapeworm cysts in undercooked beef, pork, or fish, the cyst survives the stomach acids and releases the larvae. The parasite grows within the child’s bowel to become an adult tapeworm. The adult tapeworm has up to 1,000 segments called proglottids, each of which contain 30,000 to 100,000 eggs. A proglottid separates from the adult and travels out of the intestines with the stool. The segment is about 0.5 to 1 inch in length and can sometimes be seen moving in the stool or on the anus. If a child or adult has an adult tapeworm, they will pass segments filled with eggs in their stools.

These eggs are then released onto soil and eaten by cattle or pigs, in which they hatch, enter the bloodstream, and form cysts in the meat, completing the parasitic life cycle. These eggs can also get onto the hands of humans and then into foods that they are preparing. The eggs of the fish tapeworm do not affect humans. These eggs need a different host called a copepod, which is a small fresh-water shrimplike animal. The copepod is eaten by a fish, which then becomes contaminated with the tapeworm, thus completing the life cycle. The eggs of the beef tapeworm also do not affect people. However, when a person eats an egg from pork tapeworms, the egg hatches in the bowel and the larva emerges. The larva then burrows through the wall of the bowel to enter the bloodstream. Because the larva is not in a pig (the preferred host of a pork tapeworm), it cannot go through its normal life cycle. Thus, in its human host, the larva gets stuck in tissues such as the muscles, liver, and brain. Within the tissue, the larva forms a cyst. Cysts within the brain can cause seizures.

When adult tapeworms cause human illness, doctors use the name taeniasis to describe the infection. In contrast, when pork tapeworm larvae lead to illness, it is called cysticercosis.

Tapeworm infections tend to be more common in parts of the world with poor sanitation systems or where beef, pork, and fish are eaten raw or poorly cooked. Some tapeworms can grow up to 30 feet and live as long as 25 years!

Signs and Symptoms

Many tapeworm infections are symptom free. When symptoms are present, they often include

• Nausea
• Diarrhea
• Stomach pain

Fish tapeworm competes with its human host for vitamin B12 in the intestine and, in prolonged cases, can cause pernicious anemia.

Children who ingest pork tapeworm eggs can develop tapeworm cysts (cysticercosis) within their internal organs. If these cysts occur in the brain, they can cause serious symptoms such as seizures, behavioral disturbances, and even death.

When to Call Your Pediatrician

Contact your pediatrician if you notice something moving in your child’s stool that could be a worm segment, your youngster has prolonged stomach pain, or any of the other symptoms appear without another, more obvious cause. If you think your child might have been exposed to tapeworms within the past 2 to 3 months, let your pediatrician know. Make sure your doctor is aware if your child has traveled recently to a developing country.

How Is the Diagnosis Made?

To diagnose a tapeworm infection, your pediatrician will send your child’s stool sample for tests to detect eggs or worm segments of the suspected tapeworm. Children with cysticercosis usually do not have adult tapeworms. Therefore, eggs are not usually found in the stool. Blood tests can be done to look for antibodies to the tapeworm. In patients with seizures, imaging of the brain with computed tomography (CT) or magnetic resonance imaging (MRI) is performed to look for cysts or other abnormalities.

Treatment

Your pediatrician may prescribe oral drugs such as praziquantel or, as an alternative, niclosamide to treat a tapeworm infestation. These medicines are typically given in a single dose.

Other antiparasitic drugs, including albendazole and praziquantel, are available specifically for treating cysticercosis. Anticonvulsant medications should be used to control seizures if they occur.

What Is the Prognosis?

Drug treatment for tapeworms is very effective and can completely kill the parasite. Treatment for the cysts will get rid of them, but the area of the brain may remain abnormal and seizures may continue.

Prevention

To reduce your child’s risk of developing tapeworm infections, do not allow him to eat raw or undercooked fish, beef, or pork. Be sure he always practices good hygiene, including regular hand washing, especially after using the bathroom. To avoid cysticercosis, be sure that all food handlers wash their hands. Proper sanitation is the key to the elimination of tapeworm infestation worldwide.

​Most spiders are poisonous. They use their poison to paralyze and kill their prey. About 60 species of spiders in North America can bite a human. Fortunately, only a few species can cause significant poisonings. Death rarely occurs. However, bites from the black widow and brown recluse spiders have been known to cause death.

Black Widow Spider

The body of the female black widow is shaped like an hourglass. She is a dark color with red or yellow on the abdomen. Black widow spiders are found in all 48 contiguous states. Only the female is dangerous. The male is too small to bite through human skin.

The bite itself often goes unno¬ticed or may be felt as a pin¬prick. Black widow spider venom is very potent. It attacks the muscles in humans. Symptoms are often severe muscle pain and cramping.

Brown Recluse Spider

The brown recluse spider is also known as the fiddle-back or violin spider. A violin-shaped marking on the back helps to identify it. Both the male and female are dangerous. 

It is rare to see the brown recluse spider when it bites because the bite is painless. Most bites happen while the person is sleeping. Reactions to a bite from a brown recluse vary. They range from mild irritation at the bite site to a potentially fatal poisoning.

What to Look For:  

• Tiny fang marks
• Pain 
• Pain begins as a dull ache at the bite site
• Pain spreads to the surrounding muscles 
• Pain moves to the abdomen, back, chest, and legs
• Blister at the bite site 
• Mild swelling and a blue-gray mark at the bite surrounded by lightening of skin color 
• Progressive soft tissue damage; the skin becomes dark blue and then black (necrotic)

First Aid Care for Spider Bites

1. If you suspect that your child has been bitten by a brown recluse or black widow spider, call EMS. Wash the bite area with soap and rinse with water.
2. Cover the area with a cloth and apply ice or a cold pack. This will help relieve pain and delay the effects of the venom. (Always protect the skin by wrapping ice or a cold pack in a thin cloth. Direct contact of extreme cold on the skin can cause tissue damage.)
3. Call the Poison Help hotline (1-800-222-1222).

​Infections from ticks are on the rise in the United States. But while many parents know about Lyme Disease, fewer may be aware of other illnesses children can get from ticks. Fever, headache and other flu-like symptoms a week or two after being bitten by a tick, for example, could be symptoms of human ehrlichiosis infection.

How is it Spread?

Human ehrlichioses infections are caused by at least 3 different types of bacteria that are spread through bites of infected ticks—Ehrlichia chaffeensis, Ehrlichia ewingii, and Anaplasma spp.

Lone star ticks(Amblyomma americanum), named for the single white dot on their backs, are the primary way humans are affected with ehrlichioses. In addition, lone star ticks are aggressive human biters—the most common tick reported to bite humans in the southeastern and southcentral United States. However, there have been reports of long star ticks in states as far north as Minnesota and New Hampshire.

Deer ticks (Ixodes scapularis) and dog ticks (Dermacentor variabilis) also can be infected with and spread the bacteria causing human ehrlichioses.

Signs and Symptoms:

Ehrlichiosis infections have signs and symptoms similar to influenza (the flu), including:

• Fever
• Headache
• Chills
• Muscle and joint aches and pains
• Generally feeling sick and fatigued (malaise)
• Poor appetite
• Nausea and vomiting

In some cases, the child may also develop a rash, cough or confusion. These symptoms typically begin 5 to 10 days after the tick bite. It is important to remember that tick bites often go unnoticed. Many people with tick-borne infections do not realize that a tick has bitten them.

What Parents Can Do:

• Call the pediatrician. Children, or their parents, may not notice if they’ve been bitten by a tick.  Call your pediatrician right away if your child has these symptoms—especially if the family recently spent time in nature areas. Your child may need lab tests and may receive a prescription antibacterial medication, usually doxycycline, if it turns out he or she has a human ehrlichiosis infection. Most children with ehrlichioses who are treated will recover completely within 1 to 2 weeks.
• Prevent exposure. Limit your child’s exposure to ticks and bacteria they may carry as much as possible. Steps that can help include:
  • Stick to the beaten path. Try to stay on the trail in wooded areas where ticks are known to be a problem. Avoid playing in tall grassy areas or those with a lot of leaves on the ground, habitats that ticks also love.
  • Backyard basics. Keep lawns where children play mowed and raked. Try to set up play equipment, such as swing sets, in sunny, dry areas away from wooded edges of yards.
  • Cover up. Dress your child in a hat and long-sleeved shirt and long pants that cover most of the body. Tuck pant legs into his or her socks.
  • Use insect repellent. Apply an EPA-registered insect repellant to exposed skin in a ventilated area. For example, repellents containing 20-30% DEET are safe and effective when used as directed for children. Products containing plant-based picaridin can also be used on skin and can help keep ticks off. Reapply every 6 hours or according to label instructions. Permethrin products can be used to treat clothing and gear, but should not be applied to skin.
• Don’t forget pets. Treat pets with tick repellents as advised by your veterinarian.
• Wash off. Bathing or showering after coming inside makes it easier to spot ticks that may be crawling or attached to the skin. Be sure to check less visible spots such as folds of skin, behind the ears, and the scalp.
• Remove ticks. Gently remove any ticks you see as soon as possible to minimize exposure to the bacteria they may carry. Using tweezers, pull straight out without twisting. After the tick is removed wash the area with soap and water.
• Use the dryer. To help kill ticks, put clothing right into the dryer, if possible, on high heat for at least 10 minutes.

​​If you have any questions about tick-related illness, talk with your pediatrician.

Scorpions look like miniature lobsters. They have pincers and a long up-curved tail with a poisonous stinger. Several species of scorpions live in the southwestern United States, but only the bark scorpion poses a threat to humans.

Severe reactions to the sting of the bark scorpion are usually only seen in children. Some of these reactions are paralysis, spasms, or trouble breathing. The bark scorpion is pale tan in color. It is ¾ to 1 ¼ inches long, not including the tail.

What to Look For:

• Pain in the area of the sting that gets worse in several minutes. Pain may travel up the limb that was stung. 
• Mild swelling.

First Aid for Scorpion Stings: 

• Call EMS.
• Wash the sting site with soap and rinse with water. 
• Cover the area with a cloth and apply ice or a cold pack to the sting site to reduce pain. (Always protect the skin by wrapping ice or a cold pack in a thin cloth. Direct contact of extreme cold on the skin can cause tissue damage.)

A large roundworm, Ascaris lumbricoides is the cause of a parasitic infection of the small intestines called ascariasis. Humans are the preferred hosts for this parasite. Children become infected with this disease more often than adults. The illness often develops after a child puts his hands in his mouth after playing in soil contaminated by feces containing the roundworm eggs. Eating unwashed fruit or vegetables that were grown in contaminated soil can also cause ascariasis. Although the infection can occur in any part of the world, it is more common in developing countries with poor sanitation and areas where human feces are used as fertilizer.

The entire life cycle for this parasite occurs within humans. The adult worm in the bowels of a child lays thousands of eggs a day, which then pass into the stools. In areas with poor sanitation or where human feces are used as fertilizer, the eggs will mature for 2 to 3 weeks in the soil and become infectious on the surface of unwashed fruits or vegetables. If a child plays in the contaminated soil, he can get the eggs directly onto his fingers and put his fingers into his mouth, or a person could eat the parasite’s eggs that may end up on the surface of unwashed vegetables. After the eggs hatch in the bowel, the larvae burrow through the bowel wall and into the bloodstream. The blood carries the larvae to the lung, where the parasites can enter the breathing sacs. The larvae then crawl up the breathing tubes and into the throat, where they are swallowed. Once they are back in the gut, the larvae mature to adult worms.

Signs and Symptoms

Most children with A lumbricoides infections do not have any signs and symptoms. Sometimes youngsters have stomach cramps and, in the more serious cases, even intestinal obstruction that could lead to vomiting. Worms that travel into the bile ducts can cause blockage and infection of the liver, pancreas, or both. When the roundworm’s larvae migrate through the lungs, they can cause an allergic lung inflammation (pneumonitis) along with fever, cough, and wheezing. Sometimes, the worms are seen coming out of the anus, mouth, or nose.

When to Call Your Pediatrician

Contact your pediatrician if your child has any of the symptoms or signs described here, especially if they continue to get worse. Let your doctor know if your child has traveled to parts of the world where parasitic infections are common (ie, areas of poor sanitation, the tropics).

How Is the Diagnosis Made?

Most often, this infection is diagnosed by seeing a worm or worms in the diaper or toilet bowl or detecting eggs in a sample of your child’s stool. The eggs are microscopic in size, while the worms are several inches in length and have an appearance similar to an earthworm.

Treatment

To treat A lumbricoides infections, your pediatrician may prescribe a single dose of medicine called albendazole or 3 days of pyrantel or mebendazole. These treatments should be given whether the infection causes symptoms.

Surgery is occasionally needed to relieve an intestinal or bile duct blockage.

What Is the Prognosis?

With proper treatment, children fully recover from ascariasis.

Prevention

Reinfection is common. Keep your child away from soil that could be contaminated with human feces. Make sure you wash vegetables and fruits prior to eating.

Rocky Mountain spotted fever is a bacterial infection first discovered in the western mountains of the United States. That’s how the disease got its name, but it occurs throughout the country–especially in mid-Atlantic and southern states.

Who is at risk?

The disease most often affects children and teens younger than 15 years old. Those who spend time outdoors or who have pets that may carry infected ticks, are at higher risk. Most cases of Rocky Mountain spotted fever happen between April and September, when ticks are most active, or whenever the weather is warm.

How does Rocky Mountain spotted fever spread?

Children usually get Rocky Mountain spotted fever from the bite of ticks that are infected with bacteria called Rickettsia rickettsii. Ticks that most commonly spread this bacteria include the American dog tick, Rocky Mountain wood tick and the brown dog tick.

Signs and symptoms:

Symptoms of Rocky Mountain spotted fever usually appear about 1 week after the tick bite, but it can range from 2 days to 2 weeks.

• Flu-like symptoms. Children infected with RMSF first have symptoms common to many other infectious diseases, including flu-like symptoms such as fever, muscle pain, severe headaches, vomiting, nausea, and loss of appetite.
• Rash. In addition, a rash usually develops, by the sixth day of the illness. This rash tends to appear first on a child’s wrists and ankles, but within hours it can spread to the torso. It also may spread to the palms of the hands and soles of the feet. Often, it starts out as flat red splotches or pinpoint dots but may change and become bumpy or purplish.
• Other symptoms. Other symptoms can include joint pain, stomach pain, and diarrhea. In severe cases, blood pressure can drop and cause the child to act confused. As the infection spreads, many organs, including the brain, can be affected.

When to call your pediatrician:

If your child has been exposed to ticks has been bitten by a tick and develops any of these symptoms, contact your pediatrician right away. The doctor will examine your child and run tests to confirm the diagnosis of Rocky Mountain spotted fever.

How is Rocky Mountain spotted fever treated?

If your pediatrician suspects your child has Rocky Mountain spotted fever, the doctor will prescribe antibiotic medicine right away. Treatment with this medication usually continues for 7 to 10 days or until the child’s fever has been gone for at least 3 days. Be sure your child takes the medicine for the whole time prescribed to make sure the infection is fully treated.

What is the prognosis?

With early treatment, nearly all children recover completely. In rare cases, Rocky Mountain spotted fever can make a child very sick and even become life-threatening. If left untreated, there can be risk of damage to blood vessels, nerves, and organs such as the heart, lungs and kidneys. Other possible complications can include hearing or vision loss, and gangrene in the fingers and toes that in severe cases can lead to amputation.

Prevention:

• Avoid contact. The best way to prevent Rocky Mountain spotted fever is to avoid direct contact with places ticks prefer, such as wooded and brushy areas with tall grass and leaf litter. Stay in cleared spaces and walk on sidewalks and near the center of trails. Have your child wear a long-sleeved shirt, pants, and hat, ideally in lighter colors that make ticks easier to spot. Avoid wearing sandals in tick-infested areas.
• Repellents. Products containing Environmental Protection Agency-registered insect repellents can be used on skin, but look for family-friendly concentrations and always follow directions. DEET, in concentrations of no more than 30% for children, currently is considered the best defense against ticks. Other repellents that may be effective include picaridin, soy oil, and oil of lemon eucalyptus (although oil of lemon eucalyptus should not be used on children under age 3). Don’t use any insect repellents on babies younger than 2 months old.
• Wash up. Wash the insect repellent off with soap and water when your child comes inside. Taking a bath or shower can also help remove loose ticks, which can take 4 to 6 hours to firmly attach to skin.
• Tick checks. Regularly inspect your child’s clothes and body for ticks, including the scalp and hair. Don’t forget to check your pets too. Ticks can be brought in to the house on a dog’s fur. After coming indoors, check for ticks on your child’s skin—they often hide behind the ears or along the hairline. If you think your child came in contact with ticks, check every day. If you were in an area known to have ticks, check twice a day until you are sure no ticks attached.
• Removing ticks. If you find a tick on your child’s skin, the sooner it comes off the less likely it will spread infection it may carry. But it’s important to remove it carefully.

Remember…

Rocky Mountain spotted fever is relatively rare but can be serious if not treated early. Especially if you live in a tick-infested area, take steps to prevent it, know the symptoms and call your pediatrician promptly with any concerns.  

Rat-bite fever is a disease that occurs in humans who have been bitten by an infected rat or, in some cases, squirrels, mice, cats, and weasels. On occasion, the disease can also be spread by ingestion of contaminated food or milk products (Haverhill fever). Most cases in the United States are caused by bacteria called Streptobacillus moniliformis. Another form of rat-bite fever, caused by Spirillum minus, is almost always caused by a rat bite. It cannot be caught from food or milk and is rarely seen in the United States. Person-to-person transmission does not occur. The incubation period is 3 to 10 days in most cases of S moniliformis and 7 to 21 days in cases of S minus.

Signs and Symptoms

Rat-bite fever symptoms can vary depending on which organism is responsible for the disease. When the disease is caused by S moniliformis, the bite, which usually heals quickly, is followed 3 to 10 days later by:

• Fever and chills
• Headache
• Skin rash (mostly on the arms and leg )
• Muscle pain
• Arthritis (particularly in the knees)
• Vomiting and diarrhea
• Complications (eg, abscesses, pneumonia, meningitis, heart inflammation)

With infections caused by S minus, the site of the bite may appear to heal initially, but 7 to 21 days later, the following symptoms may surface:

• Fever and chills
• Headache
• Ulceration at the site of the bite with red streaks
• Swelling of the lymph nodes
• A skin rash with reddish-brown or purple plaques
• Muscle pain and arthritis (rare)
• Vomiting and sore throat (Haverhill fever)
• Complications (eg, infection of the heart, pneumonia, meningitis, hepatitis)

Both forms of rat-bite fever may result in recurrent fevers, sometimes for months or years.

How Is the Diagnosis Made?

Your pediatrician can conduct tests such as cultures or smears of the blood or fluids from the site of the infection (eg, bite, lymph glands, joints) to find the bacteria responsible for rat-bite fever.

Treatment

To treat rat-bite fever, the doctor will give your child penicillin G by injection or intravenously for 7 to 10 days. Alternative drugs include ampicillin, cefuroxime, and cefotaxime.

What Is the Prognosis?

With prompt treatment, most children with rat-bite fever recover completely.

Prevention

Any animal bite should be cleaned well with soap and water. Treatment for 2 or 3 days with amoxicillin clavulanate by mouth may be helpful in preventing infection. The need for a tetanus vaccine should be reviewed.