Toxic Shock Syndrome

Toxic shock syndrome (TSS) is a potentially deadly illness that is caused by toxins (poisons) made by 2 types of bacteria, Staphylococcus aureus and Streptococcus pyogenes (GAS). It was first recognized in 1978 in children and adults. The vast majority of early cases were associated with S aureus in menstruating teenaged girls and young women who used highly absorbent vaginal tampons.

Although the use of tampons (particularly extended use) can still increase the chance of getting TSS, there are now fewer cases associated with tampons. Other risk factors have been identified, including recent use of barrier birth control methods (eg, diaphragm, vaginal sponge), surgical procedures, recently giving birth to a baby, and a current infection with bacteria such as S aureus. When TSS occurs in young children, it is sometimes present at the same time as a varicella infection (the virus that causes chickenpox).

Signs and Symptoms

The signs and symptoms of TSS develop rapidly, often beginning with a high fever (at least 102°F or 38.9°C) that sometimes includes chills.

Other signs and symptoms can vary, depending on the type of bacteria involved. They may include

  • Red skin rash that looks like sunburn
  • Red eyes (conjunctivitis)
  • Watery diarrhea
  • Vomiting
  • Severe muscle aches
  • Confusion
  • Low blood pressure

A week or more after the beginning of the skin rash, the skin around the nails may begin to peel. Then, as the infection progresses, the skin around the soles of the feet and palms of the hands also begins to peel.

Toxic shock syndrome can affect many organs in the body, including the lungs, bowel, brain, and kidneys. Complications are caused by a decline in blood pressure (hypotension) as well as the direct action of the toxin, which makes organs of the body more likely to fail, leading to the need for respirators and dialysis. Some people die from TSS, but the overall mortality rate is less than 5%. The risk of death is higher in adults than children and depends on which organs in the body are involved.

When to Call Your Pediatrician

Toxic shock syndrome is a serious condition that requires a doctor’s prompt attention. If your child has these symptoms, contact your pediatrician immediately.

How Is the Diagnosis Made?

Your doctor will evaluate your child’s signs and symptoms. The pediatrician will order blood tests and cultures to look for the effects of the toxin and presence of the bacteria (S aureus and S pyogenes) responsible for TSS.


If your child develops TSS, she will need to be hospitalized. She will be treated with antibacterials such as nafcillin, penicillin, or clindamycin for at least 10 to 14 days.

Supportive treatment, such as giving intravenous fluids and stabilizing blood pressure with medicines, will be necessary. Kidney dialysis may be required in cases of kidney failure and ventilators (respirators) are used for failure of the lungs.

Intravenous immune globulin treatment may be given to get rid of bacterial toxins in the bloodstream and help speed up recovery.


If your teenaged daughter uses tampons, she should choose them with care. Tampon manufacturers have changed the way they make their products to decrease their absorbency, and this has significantly lowered the number of TSS cases associated with tampon use. Make sure your daughter uses tampons with low absorbency and changes them often.


Thrush and Other Candida Infections

Thrush and Other Candida Infections


Candida is a type of yeast, part of the fungus family that normally lives in and on our bodies. It can be found on the skin and in the mouth, for example, and in the intestinal tract and genital area. Most of the time, Candida does not cause any problems. However, when it overgrows, it can cause infections such as candidiasis. These fungal infections can become chronic.

What is thrush?

Candidiasis infection of the mouth, also called oral thrush​, is common in infants and toddlers. Thrush can also affect fingernails, eyes, and skin folds of the neck and armpits, as well as the diaper area, including the vagina and folds of the groin.

How do infants and children get thrush and other Candida infections?​

Pregnancy & birth. Newborns can get a Candida infection from their mothers. This can happen while they’re still in the uterus, but also during passage through the vagina during birth. Most of these infections are caused by Candida albicans, although other species of Candida are becoming more common.

Medicine. Sometimes, children develop candidiasis after taking antibiotics. While antibiotics fight germs that make a child sick, they sometimes also affect the “good” bacteria that help keep the body’s balance of microbes in check. This gives fungi like Candida a chance to overgrow. Using inhaled steroids for asthma without rinsing the mouth with water afterward inhaler use can also lead to candidiasis.

Health conditions. In some children with serious health challenges, the fungus may enter the bloodstream. Those most risk of bloodstream infections with Candida include premature or very low birthweight infants, children with long-term intravenous (IV) catheters, and children with weakened immune systems caused by cancers​ or medicines. For these children, oral nystatin and fluconazole are often used to prevent candidiasis.

If Candida infections become chronic or occur in the mouth of older children, it may be a sign of an immune system challenge, such as human immunodeficiency virus (HIV) infection. Candida infections of the skin, mouth (thrush), or vagina in children over 2-3 years of age, can also be a sign of diabetes.

How to help prevent Candida infections​​Here are some ways to help reduce the risk of candidiasis in children:Change diapers frequently. Keep your child’s diaper area as clean and dry as possible.​
Use antibiotics only when necessary. Since fungal infections (thrush or vaginitis) often follow courses of antibiotics, it is important to use them only as prescribed by your doctor.Follow directions for asthma medicines. If your child has asthma, make sure they rinse their mouths with water after using inhaled steroids for the treatment.Keep diabetes in good control. Be sure you are managing it well to reduce candidiasis risk.

Signs & symptoms of Candida infections

Infants. In infants, symptoms include painful white or yellow patches on the tongue, lips, gums, palate (roof of mouth), and inner cheeks (thrush). It can also spread into the esophagus, making it painful to swallow. Candidiasis can make a diaper rash worse, producing redness and sensitivity in the affected area, along with a raised red border in some cases.

Teens. Teenage girls who develop a vaginal yeast infection may have symptoms such as itching, pain, redness, and/or a thick, “cheesy” vaginal discharge. A yeast infection often follows antibiotic therapy.

Children taking IV medications. Symptoms are different for children who get Candida infections while receiving chemotherapy​ treatment, or other long-term home medications delivered through an IV catheter. In these cases, the fungus gets into the blood system. Once in the blood, the yeast can travel throughout the body, causing infection of the heart, lungs, liver, kidneys, eyes, brain, and skin. The early signs of a Candida bloodstream infection are fever and blockage of the IV catheter.

​How is a Candida infection diagnosed?

Your pediatrician will often make the diagnosis by examining your child and reviewing symptoms. Scrapings of Candida lesions (sores) inside the mouth or other spots can be further examined for signs of the infection.

An ultrasound or CT scan can detect candidal lesions that have developed in the brain, kidney, heart, liver, or spleen after a bloodstream infection. Cultures of the blood or mouth lesions are sometimes taken to grow the fungus in the laboratory and identify the type and sensitivity of the yeast.

Treatment for Candida infections

Antifungal drugs are used to treat candidiasis. The antibiotic nystatin is often prescribed for children with infections such as oral thrush or a Candida-related diaper rash, for example. The specific medicines given for candidiasis vary, depending on the part of the body where the infection is concentrated.

If candidiasis has spread through the bloodstream, your pediatrician will usually recommend treatment with an IV medicine. Some of these IV medicines cause uncomfortable side effects, but are still reliable medicine for serious, invasive fungal infections. However, most medications used to treat candidiasis are well tolerated by most children.

​How long does it take for Candida infections go away?

Once treatment starts, most candidiasis infections get better within about 2 weeks. It is not uncommon for infections to return, however. Long-lasting thrush is sometimes related to pacifiers or bottles that have not been properly boiled to remove the fungus.

The infection is much more difficult to treat in children with catheters or weakened immune systems. Typically, the catheter must be removed or replaced to effectively treat infections that are from with these devices. Tests are also usually done to see if the infection has spread to other parts of the body. Antifungal therapy can take weeks to months for the more challenging infections.


Talk with your pediatrician if you think your child may have symptoms of Candida infection, or whenever you have any questions about your child’s health.


Staphylococcal Infections

Infections caused by staphylococcal organisms can lead to a variety of diseases, including pneumonia, abscesses, bone infection (osteomyelitis), joint infection (arthritis), and a number of skin infections (eg, impetigo, pimples, boils). Staphylococcus aureus also causes toxin-related illnesses, including toxic shock syndrome, scalded skin syndrome, and staphylococcal-related food poisoning. In fact, staphylococcal bacteria are the leading cause of food poisoning.

Some of the childhood infections associated with Staphylococcus that you should be familiar with include the following:

  • Cellulitis is a bacterial skin infection that first affects the outer layers of the skin and then may spread more deeply into body tissues under the skin. Although other types of bacteria can cause cellulitis, Saureus is responsible for many childhood cases. Symptoms include redness, swelling, warmth, and tenderness of the skin. Your pediatrician may diagnose the infection by examining the area. The doctor may take a culture of the skin or wound, and blood tests may be ordered to identify the organism involved. Antibiotics taken by mouth are usually prescribed for mild cellulitis. Some severe cases require hospitalization with intravenous antibiotics.With proper treatment, most cases clear up in 7 to 10 days.
  • Impetigo is a common and contagious skin infection in young children, developing most often during hot, humid summers and usually appearing on the face around the nose, mouth, and ears. It can be caused by staphylococcal or streptococcal bacteria. (More often, it is caused by a staphylococcal infection.) Staphylococcal organisms sometimes can cause blisters. Your pediatrician may diagnose the infection by taking a sample of the material from within the blister and having it tested in the laboratory. Antibiotics should be prescribed for this condition and are usually taken by mouth. In mild cases, an antibiotic cream or ointment can be applied to the skin. Until the rash heals or for at least the first 2 days of antibiotic treatment, your child should avoid close contact with other children.
  • Staphylococcal scalded skin syndrome is a disease that affects infants and young children. It tends to begin with a single staphylococcal skin infection, often in a baby’s diaper area, in which bacteria produce a toxin that reddens and damages the skin. Large sections of the top layer of skin (epidermis) can be peeled or slipped away just by pressing down lightly or rubbing the affected area, exposing a raw and red layer that is vulnerable to other infectious organisms. These children can also run a fever. Your pediatrician may put your child on intravenous antibiotics. Warm compresses can be placed on the skin to ease any discomfort. Staphylococcal scalded skin syndrome usually heals without scarring.

Sepsis in Infants and Children

Anyone can get an infection, and almost any infection can lead to sepsis—the body’s extreme response to an infection. Without timely treatment, sepsis (sometimes called septicaemia or septicemia) can rapidly lead to tissue damage, organ failure, and death.

Sepsis can affect anyone at any time, but it does tend to strike the very old and the very young. Children, particularly newborns and young infants, can be more susceptible to developing sepsis. Those with underlying health problems are also at a higher risk.

Each year in the U.S., more than 75,000 infants and children develop severe sepsisAlmost 7,000 of these children die—more deaths than children who die from cancer.

Be Alert to the Signs & Symptoms of Sepsis:

Detecting sepsis early and starting immediate treatment is often the difference between life and death. Parents and caregivers must seek immediate medical care if they suspect their child has an infection that is not improving or is getting worse. Sepsis may have been preceded by an infection such as a urinary tract infection, pneumonia, or a skin or bone infection.

The signs and symptoms of sepsis can include a combination of any of the following:

  • Fever or low temperature (newborns and infants may have low temperature)
  • Fast heart rate
  • Fast breathing
  • Feeling cold/cold hands and feet
  • Clammy and pale skin
  • Confusion, dizziness or disorientation
  • Shortness of breath
  • Extreme pain or discomfort
  • Nausea and vomiting

Important Note: Many of these signs and symptoms alone are common in babies and children when they are sick. Most of the time, they do not have sepsis. However, when more than one of these signs and symptoms happen together, or when a baby or child just seems sicker than usual—you should seek medical help. If your baby or child’s skin is cold, pale, or has developed strange colors or markings; if your baby or child has become unresponsive or is struggling to breathe; or if your baby has dry diapers for more than 12 hours—you should take him or her to the emergency room without delay.

How Is Sepsis Treated?

Sepsis, or even suspected cases of sepsis, are treated in the hospital. Often, babies and children will need care in an intensive care unit (ICU). Fighting the infection is an emergency. Doctors and nurses will give IV antibiotics to fight the infection. Many other things may be needed to fight sepsis—IV fluids, special heart and/or blood pressure medications, and medications to keep children calm and comfortable. In some cases, children may need a ventilator to help with breathing.  

You might hear the term “sepsis work-up.”

“Sepsis work-up” refers to the combination of tests used to diagnose the specific cause of a child’s infection. It is important to figure out what type of virus or bacteria is causing the infection. The sepsis work-up may include testing blood, urine, and spinal fluid; an x-ray or an ultrasound test may also be included.

Neonatal Sepsis:

When a child develops sepsis within a few months of birth (up to 90 days), it is called neonatal sepsis. If the sepsis develops within the first hours or days after birth, it is called early onset sepsis. Sepsis that develops after the baby is 1 week old is called late-onset neonatal sepsis.  Premature infants develop sepsis more often than infants who are born on time.  

Sepsis in Older Children:

As children get older, their exposure to illness can increase as they attend child care, go to school, and participate in activities, such as sports. Children, like adults, can develop bacterial infections such as  urinary tract infections, skin infections, pneumonia, appendicitis, and meningitis. Left untreated, these can all lead to sepsis.

What to Expect in the Hospital:

Most sepsis patients are admitted to the hospital. Babies and children who are extremely sick may be cared for in the hospital ICU.  

Babies and children will need to have IV’s placed to give fluid and medications.  They will have needle sticks for blood tests. Depending on their age, a soft tube or a needle might be needed to get urine for testing. To test spinal fluid, the baby or child may also need a spinal tap. This involves placing a hollow needle in the back to take a small sample of spinal fluid—the fluid that surrounds the spinal cord and brain. Testing the spinal fluid is important to determine the baby or child has meningitis. On occasion, surgery may be required for those who have surgical infections leading to sepsis such as a severe skin or bone infection or appendicitis.

Parents and Caregivers Can Help Stop This Medical Emergency in Its Tracks.

  • Talk with your pediatrician about steps you can take to prevent infections.
  • Some steps include taking good care of chronic health conditions and following recommended vaccination schedules.
  • Practice good hygiene, such as handwashing, and keeping cuts clean until healed.
  • Know the signs and symptoms of sepsis.  
  • ACT FAST. Get medical care IMMEDIATELY if you suspect your child has sepsis or an infection that’s not getting better or is getting worse.

Salmonella Infections in Children

young girl with tummy ache

Salmonella bacteria are best known for being a cause of diarrhea. This type of illness, called gastroenteritis, typically happens after eating food that has been contaminated with salmonella.

While the overwhelming number of patients with salmonella infection have gastroenteritis, the bacteria also can cause a variety of other disorders, including:

  • Bacteria in the blood (bacteremia)
  • Inflammation of the membranes of the brain or spinal cord (meningitis)
  • Inflammation of the bone (osteomyelitis)

Salmonella outbreak from backyard chickens
Public health experts in several states are investigating outbreaks of salmonella infections linked to contact with backyard poultry. Over 200 illnesses have been reported across at least 38 states, including many children under age 5 years. Several people have been hospitalized.

Backyard poultry can carry salmonella germs even if they look healthy and clean. These germs can easily spread in areas where the poultry live and roam. The germs that can make us sick are found on the egg shell. That is why health experts advise us to avoid eating raw eggs and avoid licking the bowl when we make cake or cookie batter. The salmonella outbreaks are not related to recent cases of H5N1 bird flu viruses detected in U.S. wild birds and poultry.

Salmonella infections occur most often in children younger than 4 years. They are usually spread to humans by animal products such as poultry, beef, fish, eggs and dairy products. At times, though, other foods such as fruits, vegetables and bakery products have caused outbreaks, most often when contaminated by contact with an animal product. The bacteria can also be spread by drinking contaminated water, as well as through contact with infected pets such as chicks, snakes, turtles, lizards and other reptiles. Typhoid fever is only spread through contact with an infected person or an item contaminated by an infected person.

Signs & symptoms of salmonella infection

When your child has a salmonella infection that causes gastroenteritis, they may have symptoms such as:

  • Diarrhea
  • Abdominal cramps and tenderness
  • Fever

Typhoid fever develops gradually, with signs and symptoms that may include fever, headache, loss of appetite, lethargy, abdominal pain, changes in mental status, an enlarged spleen and constipation or diarrhea.

The incubation period for gastroenteritis ranges from 6 to 48 hours, while typhoid fever has a longer incubation period of 3 to 60 days.

When to call your pediatrician

Contact your pediatrician if your child shows no improvement within 2 to 3 days of symptoms appearing or if she has blood in her stools or shows signs of dehydration (e.g., the absence of tears when crying, a decline in urination).

How is salmonella diagnosed?

Your pediatrician can test for salmonella organisms from cultures of stool, blood, or urine that are examined in the laboratory.

Any recent travel?

Although very rare in the United States, travelers to India, Latin American, Africa and parts of the Asia may become infected with a strain of Salmonella called typhoid. This is a long lasting febrile illness which if untreated can be fatal in up to 30% of cases. Thus, if you return from travel and have an unexplained fever, it is important to let your doctor know about your recent travels.

Treatment for salmonella infections

If your child only has salmonella-associated diarrhea, the treatment is supportive (fluids and rest). Antibiotics are not prescribed as they do not make your child get better faster and actually may increase the length of time your child has Salmonella in the stool. An exception is infants under 3 months of age, because they have an increased risk of the infection spreading from the intestine to the blood and other organs in the body. However, when the infection is found in the blood, brain, bone or other organs, antibiotics are needed.

A child with severe diarrhea may get very dehydrated and need intravenous fluids or extra fluids given by mouth.

How long does a Salmonella infection last?

Most salmonella gastrointestinal infections last for 4 to 7 days and clear up on their own without treatment.

How to prevent salmonella infection

Salmonella infections can often be prevented by practicing good hygiene techniques during food preparation, as well as regular hand washing. Be sure to thoroughly cook eggs, poultry, and ground beef. Hands should always be washed after playing with pets, especially lizards and pet turtles.

  • If your child has a problem with their immune system: Avoid reptiles used as pets, such as lizards and snakes. Children with sickle cell anemia are at risk for salmonella infection of the bones. Parents of these children should avoid having reptiles and amphibians as pets.
  • If you plan travel to an area where typhoid exists: Make an appointment with your doctor (preferably 1-2 months before travel) to discuss vaccination against the infection.

Overview of Infectious Diseases

Infectious diseases are illnesses caused by germs (microbes). It is important to realize that not all germs (bacteria, viruses, fungi, and parasites) cause disease. In fact, a host of bacteria normally live on the skin, eyelids, nose, and mouth and in the gut. These bacteria are called normal flora and are considered normal inhabitants. These normal flora are helpful to us! The bacteria in our bowels break down foods and form vitamin K, an essential vitamin for all of us. The normal bacteria on our skin and in our mouths protect us by preventing or decreasing the chance that we will become infected with harmful bacteria and fungi.   

The normal balance of bacteria can be upset by antibiotics and some illnesses. Viral infections often damage body surfaces and set the stage for infection by harmful bacteria.

Frequently, bacteria are present on a body surface such as the nose or throat or in the bowels, but there is no illness. This is called carriage of the bacteria, and the person with the bacteria is called a carrier. There is no illness in the carrier, but the carrier sometimes can transmit or spread the bacteria to another person. Many of the bacteria that are carried can cause infection and illness.

It is not always clear why the same strains of bacteria cause carriage in one child, mild illness in another, and serious infection in others. Sometimes it is because of factors in the child or the bacteria, but often doctors don’t understand the reasons.

Some important factors in the child include age, immunity, nutrition, genetic makeup, and general health. Newborns are at risk because their protective systems are not yet tested and are not always mature. Infants are at risk because they tend to put everything into their mouths and rarely clean their hands. Older children are less at risk because their hygiene is better and they have become immune through prior infection or carriage of bacteria.

Another important factor for a child is the use of medical devices such as catheters (tubes placed in blood vessels or into the bladder) and other tubes (e.g., from the nose to the stomach, from the nose to the lungs). These catheters and tubes provide a direct path for bacteria and fungi to get into the blood, bladder, or lungs. Medicines such as corticosteroids (used in asthma and many other conditions) and cancer chemotherapy can interfere with a child’s ability to fight infection. Even antibacterials can be a factor by killing the normal protective flora.

Factors in bacteria, viruses, and fungi include genes that determine how harmful (virulent) the microbe can be. Some germs make toxins that cause illness by themselves or contribute to infections caused by the germ. Examples include enterotoxins, which cause diarrhea; tetanus toxin, which causes lock jaw; and toxic shock toxin, which leads to low blood pressure and collapse (shock).

Infections are a normal part of childhood. Most children will have at least 6 to 8 respiratory (breathing tract) infections each year. These include colds, ear infections, sinus infections, bronchitis, and pneumonia. Infections of the bowels also are common.

When children gather together in child care settings and school, there is the opportunity for infections to spread from one child to another.

Not all infections are contagious (able to spread from person to person). Ear and bladder infections are not spread from child to child, while diarrhea and colds are easily spread.

The incubation period is the time it takes after a child is infected until he becomes ill. Sometimes the incubation is short (e.g., a day or so for the flu), while other times it is quite long (eg, 2 weeks for chickenpox and many years for human immunodeficiency virus [HIV]). In some cases, a person is contagious during the incubation period, while in others the person is not contagious until the illness begins. The amount of time a child remains contagious depends on the infection and the child. Young children are often contagious for longer than older children.

Infections are sometimes so mild that there are few or no symptoms. Other infections cause more severe illness. Infections cause harm by damaging a person’s body parts (cells and organs) and causing inflammation. Inflammation is one way a child protects himself from infection. Inflammation usually destroys the infecting agent. Unfortunately, inflammation can be harmful to the child as well. Inflammation can harm organs, cause pain, and interfere with normal body functions.

Many infections come and go with no harm to the child. Others cause pain and, sometimes, death. Some infections resolve, but leave a child with organ damage. While many germs come and go, some germs stay with your child even after the illness resolves. For example, herpesviruses (herpes simplex, cytomegalovirus, Epstein Barr virus, varicella, and human herpesvirus 6 and 7) remain in your child for a lifetime. If your child gets chickenpox, that virus stays inside his nerve cells after the rash and illness go away. The virus can reappear later in life as shingles (herpes zoster). 

Germs and Children: Terminologynormal floraBacteria that live on or in a childpathogenA germ that can cause a diseasecolonizationPresence of a germ in or on you without disease.infectionA germ causing an illness. Your body will react by making antibodiesintoxicationIllness due to a toxin made by a germlatent infectionA germ (most often a virus) in a resting statereactivationThe latent germ wakes up and reproducescarrierA child who is colonized but not sickcontagiousAble to spread the illnessincubation.Time between infection and symptoms

The World of MicrobesprionsInfectious proteins. The smallest known infectious agentsvirusesVery small. Viruses take over your cells to reproduce themselvesbacteriaTwo types: free-living, normal inhabitants (normal flora); pathogens that produce diseasefungiMolds and yeasts. Fungi colonize (live on or in a child) and are pathogensparasitesForms range from single cells (amoeba, protozoa) to worms


Non-tuberculosis Mycobacteria

A germ from the mycobacterium family, Mycobacterium tuberculosis, causes tuberculosis (TB). A related species of M tuberculosis, which doctors call non-TB mycobacteria (NTM), can cause other illnesses in children and adults.

Although there are many species of NTM (more than 80, according to the Centers for Disease Control and Prevention), the most common in childhood are M avium, M intracellulare, and M fortuitum. Many of these species are found in soil, food, and water. They enter the body through cuts in the skin, via the gums during teething, or through the respiratory tract during normal breathing. Even though many children are exposed to these germs, only a few ever develop a chronic infection or disease.

In youngsters, the most common NTM infection is called cervical lymphadenitis, an inflammation of the lymph nodes in the neck. Other infections occur much less commonly, including bone inflammation (osteomyelitis), ear infections, lung disease, and skin infections.

These NTM illnesses sometimes occur in children with human immunodeficiency virus (HIV) infections. In fact, children and adults with weakened immune systems may be at a higher risk for NTM diseases.

Signs and Symptoms

The signs and symptoms of NTM infections depend on factors such as the specific site involved and species of the bacteria. They may include

  • Swollen lymph nodes
  • Fever
  • Weight loss

How Is the Diagnosis Made

Your pediatrician will take cultures from the lymph nodes, blood, or lungs to test for NTM.


If your child has lymphadenitis, your pediatrician may recommend surgically removing the lymph nodes that have become infected. Antibacterials such as clarithromycin, azithromycin, and ciprofloxacin are often prescribed for other forms of NTM.

Choosing the best medicines for NTM infections depend on factors such as the specific species of germ causing a child’s illness and part of the body that has become infected. Some strains of NTM are resistant to most medicines. Your doctor will choose medicines carefully to make sure that they’ll be effective.


For children 6 years or older with an HIV infection, pediatricians may prescribe preventive use of certain medicines such as azithromycin or clarithromycin to prevent M avium illnesses from developing.


Moraxella Catarrhalis: A Common Cause of Childhood Illnesses

A number of common childhood illnesses, including some middle ear (otitis media) and sinus infections (sinusitis), are caused by Moraxella catarrhalis bacteria. On rare occasions, this same organism may cause a blood infection (bacteremia), an eye infection (conjunctivitis), and meningitis in newborns. It is also responsible for some cases of bronchitis and pneumonia in older children and children who have problems with their immune system.

M catarrhalis ear infections and other respiratory tract illnesses are often treated with amoxicillin clavulanate. Alternative drugs include cefuroxime, cefprozil, erythromycin, azithromycin, and trimethoprim sulfamethoxazole, among others.



Infectious mononucleosis is sometimes called mono or the kissing disease. It is caused most often by the Epstein-Barr virus (EBV), which is in the herpesvirus family of organisms. Most people become infected with EBV at some point in their lives. Like all herpesviruses, EBV stays within the body once a person is infected. Most of the time, the virus is in an inactive (latent) state, but occasionally the virus multiplies and is shed in saliva and other body fluids.

Getting the Facts About Infectious Diseases

Epstein-Barr virus is spread from one person to another in saliva, blood, and other body fluids. Close contact is usually required, such as kissing or sexual contact.

Although the infection can occur at any age, mononucleosis is most common in people between 15 and 30 years of age.

Signs and Symptoms

Many infants and young children infected with EBV have no symptoms or only very mild ones. When there are signs and symptoms of mononucleosis, they usually include the following:

  • Fever
  • Sore throat, including white patches in the back of the throat
  • Swollen lymph glands in the back of the neck, groin, and armpit
  • Fatigue

In addition to these classic symptoms, some children may also have one or more of the following signs and symptoms:

  • Chills
  • Headache
  • Decreased appetite
  • Puffy eyelids
  • Enlargement of the liver and spleen
  • Oversensitivity to light
  • Anemia

Some children with EBV infection develop meningitis, brain inflammation (encephalitis), and a paralyzing disorder called Guillain-Barré syndrome. Occasionally, EBV can cause myocarditis (inflammation of the heart muscle), an abnormal decline in the number of blood platelets (thrombocytopenia), and inflammation of the testes (orchitis).

This virus can cause several types of cancer. In Africa, EBV causes Burkitt lymphoma; in Asia, nasopharyngeal cancer; and in the United States, a type of lymphoma. However, cancer caused by EBV is rare. It is not clear why some people infected with the virus get cancer while the vast majority does not. In patients with organ transplants, EBV can cause a malignant disorder called lymphoproliferative disease.

There is a rare genetic disease, seen mostly in boys, in which the body cannot control the EBV infection. This serious infection may lead to liver failure, decreases in the blood cells, or cancer and is often fatal. The incubation period of infectious mononucleosis ranges from 30 to 50 days.

When to Call Your Pediatrician

Contact your pediatrician if your child has the major symptoms described here, especially a fever, sore throat, fatigue, and enlarged glands.

How Is the Diagnosis Made?

The diagnosis of infectious mononucleosis is usually made through a medical history, physical examination, and blood tests. These tests may include a complete blood count to check for unusual looking white blood cells (atypical lymphocytes). Blood tests can also detect increases in antibodies against EBV.


Much of the treatment for mononucleosis is aimed at making your child more comfortable until the infection goes away on its own. For example

  • Some pediatricians may recommend giving your youngster acetaminophen to reduce the fever and ease pain.
  • Sore throats can be treated by gargling with warm water and salt.
  • Bed rest can be important for a child feeling fatigued.

Because a virus causes mononucleosis, infected children should not be treated with antibacterials.

In a small percentage of EBV-infected children, corticosteroids such as prednisone are given, but only if certain complications are present, such as inflamed tonsils that may block the breathing passages.

Children with infectious mononucleosis should not participate in contact sports until the swelling of their spleens subsides. If the body is hit in the area of an enlarged spleen, the spleen can rupture or tear open, causing internal bleeding that can lead to death. Keep in mind that this is uncommon and that mononucleosis rarely results in death.

What Is the Prognosis?

Most cases of infectious mononucleosis clear up in 1 to 3 weeks (although symptoms, particularly fatigue, can last for several additional weeks in some children). Patients with abnormal immune systems can have a more severe infection that further weakens the immune system, resulting in cancers or death caused by liver failure and bacterial infections.


It is difficult to prevent the spread of this virus because people who have been infected can spread the virus for the rest of their lives. Your youngster should avoid infected saliva by not sharing drinking glasses, water bottles, or eating utensils.

No vaccine is available to protect against infectious mononucleosis.

Prevention Tip

When to share and when not to share? Your child should not share drinking glasses, water bottles, or eating utensils, which can carry infected saliva.


Mad Cow Disease

Occasional news about mad cow disease has caused concern among some parents about buying meat. However, the chance of getting mad cow disease appears to be much smaller than parents may think.

Mad cow disease is the commonly used name for bovine spongiform encephalopathy (BSE). It is one of a number of prion diseases. Prions are a type of infectious particle. Prion diseases are progressive, degenerative infections that affect the central nervous system of cattle. They can be spread to humans who eat the beef of an infected animal or come into contact with tissues of infected animals. The cattle themselves become infected with BSE by eating feed contaminated with the BSE organism. The cattle develop brain disease that results in death. When humans get the disease, it causes a variation of Creutzfeldt-Jakob disease (CJD) called variant CJD (vCJD), which is a fatal brain disorder.

Millions of cattle have been destroyed in Europe since the first cases of mad cow disease appeared in the 1980s. The first BSE case in a dairy cow in the United States was identified by the Department of Agriculture in December 2003. The Food and Drug Administration and other federal agencies have regulations in place to prevent contamination of the US food supply with BSE. At present, the risk of getting BSE from beef available in the United States is considered extremely low.

Worldwide, BSE-related illnesses remain very rare in humans. Through December 2003, there were a total of 143 cases of vCJD reported in the United Kingdom, plus 6 cases in France and 1 each in the United States, Canada, Italy, and Ireland. A person can also become infected if he receives a transplant from someone with the disease or a child receives a growth hormone that was made from the pituitary gland of an infected person. Note that growth hormones are now manufactured rather than taken from human bodies.

Signs and Symptoms

People with mad cow disease can have very serious signs and symptoms, including personality changes, muscle stiffness, involuntary muscle movements, dementia, and seizures. The disease can affect individuals at a younger age than those with traditional CJD (a median age of 28 years in vCJD, compared with 68 years in classic CJD). Most cases have occurred in adults, but an occasional case has been seen in teenagers. The traditional form of the disease has a hereditary basis. Both diseases involve abnormal proteins that accumulate in the brain.

How Is the Diagnosis Made?

The signs and symptoms of vCJD will help your pediatrician make the diagnosis. However, the only way to definitively diagnose any human prion disease is to examine the brain tissue itself.


No treatment is available to slow down or stop the progression of mad cow disease or other prion infections. Studies are currently taking place to investigate a number of experimental treatments.

What Is the Prognosis?

Mad cow disease is fatal. The incubation period for disease related to exposure to infected tissues varies between 1.5 years and more than 30 years.


There is no evidence that cooking contaminated meat will destroy the BSE organism. Government regulations of the beef industry make the risk of transmission of BSE to people very unlikely.