Haemophilus influenzae type b

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appear in less than 24 hours, with a sudden high fever (100 degrees F to 106 degrees F) chills, vomiting, stiff neck, intense headache in the front of the head, or a seizure. The neck hurts when the child tries to touch his chin to the chest. There may be muscle spasms and photophobia (eye pain from light).

Some children exhibit unusual behavior as the infection begins, including aggressiveness, irritability, agitation, delirium, or screaming, followed by lethargy or coma. Some may experience a cold or an ear infection before the onset of meningitis.

A baby from age three months to two years may exhibit fever, vomiting, irritability, seizures, and a high-pitched cry. The baby may suddenly become rigid, and the soft spot on the front of the head may become hard or bulging.

Diagnosis A lumbar puncture (spinal tap) is necessary to sample the fluid around the spinal cord and check for bacteria, white cells, sugar, and protein. This will help determine what sort of virus or bacteria is causing the meningitis. Bacterial meningitis causes cloudy fluid, with a high amount of certain types of white blood cells, low sugar, and high protein. Bacteria will grow in blood culture or spinal fluid culture in 24 to 48 hours; rapid tests on fluid or blood give results in just a few hours and are often helpful in identifying the type of bacteria.

Recent antibiotic treatment prior to getting meningitis may make diagnosis more difficult. Lumbar puncture is a safe procedure when done in a large emergency room or in an experienced pediatrician's office and is imperative in correctly diagnosing meningitis.

Treatment Without treatment, a child can die from Hib meningitis; with antibiotics, about 95 percent of children recover. Any child with possible H. flu meningitis will be admitted to the hospital for IV antibiotics. A baby or child would also receive dexamethasone with the antibiotic and continue to take it for two to four days to prevent swelling of the brain and subsequent hearing problems. Children should rest in a darkened, quiet room; any fever higher than 101 degrees F should be treated with acetaminophen and sponge baths.

A child with H. flu meningitis is considered to be infectious until after receiving 24 hours of antibiotics; however, even after recovery some children will carry bacteria in nose and mouth. Rifampin is given to eliminate this bacteria. Healthy carriers are infectious for a few weeks to a few months.

Children who recover from this type of meningitis, as well as those who are vaccinated, are immune.

Complications Increased pressure on the brain from fluid buildup is a serious complication; signs of this include changes in head measurement, activity, vision, breathing, pupils' response to light, or decrease in urine.

The most common long-lasting complication is hearing impairment. Recent studies suggest that children over six weeks of age who received dexamethasone immediately had less hearing loss than those who did not receive the steroid.

Other, less common, complications include blindness, hydrocephalus, arthritis, seizures, and permanent developmental delays.

Prevention The best prevention for Hib is vaccination for all infants; in late 1990 the FDA approved two new vaccines for use in children two months of age and older. The Hib vaccine is one of the safest of all vaccine products and cannot cause meningitis. About one in every eight children who receive the vaccine may have some slight redness, swelling, or tenderness at the injection site. About 1 in every 140 children will develop a fever higher than 102 degrees F. The reactions begin within 24 hours of the shot and quickly pass.

Before the vaccine, as many as 5 percent of healthy preschoolers carried H. flu type b but did not get sick. Vaccinated children cannot become carriers.

An antibiotic called rifampin is used to prevent cases of Hib after exposure; if all babies and young children in a home or child care group are vaccinated, preventive medicine after an exposure is not necessary. Rifampin will temporarily get rid of H. flu from the noses and throats of healthy carriers about 95 percent of the time. It helps prevent any exposed child in a day care center or a family from getting H.flu meningitis.

hand, foot, and mouth disease A common infectious disease of toddlers that produces blistering of palms, soles, and the inside of the mouth. The condition often sweeps through day care centers in the summer. There is no connection between this condition and the hoof-and-mouth disease found in cattle.

An infected child can pass on the disease wherever she has the rash or sores; the virus will be present in the stools and the digestive tract for several weeks. Infected children don't need to be isolated, however, because most adults are immune and the illness is not severe. Many children are infected but do not exhibit symptoms; they develop immunity without experiencing the illness. It is possible, however, to get this disease again from a different strain of the virus. The mild illness usually lasts only a few days.

Cause The disease is caused by the COXSACKIEVIRUS which is spread by contact with nose and mouth secretions.

Symptoms Symptoms usually appear within four to six days after infection, and include ulcers inside the cheeks, gums, or tongue, together with a fever, achiness, sore throat, headache, and poor appetite. Two days later, a rash on palms, fingers, soles, and diaper area appear; this is the signal that the virus is abating.

Diagnosis Tests are unnecessary. If the child is very ill, and the diagnosis is not clear, samples can be taken for culture from the lesions or stool.

Treatment There is no treatment other than painkillers to relieve blister discomfort.

Acetaminophen is given for fevers above 101 degrees F or for headaches. Small sips of soothing foods and fluids will ease mouth sores, including frozen or diluted juice, lukewarm broth, soft noodles, or gelatin desserts.

Complications Complications are extremely rare.

Prevention Hand washing is the only way to prevent this disease. This is especially important in a day care or nursery school. Family members can be protected by washing the towels, washcloths, and bedding used by a sick child.

Hansen's disease See LEPROSY.

hantavirus A group of viruses carried by rodents (mice, rats, and voles) responsible for a variety of diseases, including HANTAVIRUS PULMONARY SYNDROME and hemorrhagic fever. The virus is transmitted when humans breathe air contaminated by affected rodents' droppings, urine, or saliva and is not passed directly from human to human.

All of the viruses in this group trigger the leakage of blood from a victim's capillaries, causing rapid organ failure before the immune system can react. Each hantavirus infects primarily one type of rodent. The Hantaan, Seoul, Puumala, Prospect Hill, and Poro-gia strains are five viruses within the hantavirus genus, the newly added fifth genus within the Bunyaviridae family. The newest strain is the SIN NOMBRE (no-name) VIRUS, which first appeared in the Four Corners area of the western United States. (It was originally called Muerto Canyon [Valley of Death] virus for the spot on a New Mexico Navajo reservation where it was isolated. Because this name offended the Navajo, the virus was renamed Sin Nombre.) Deer mice were the rodents responsible in this outbreak.

The Hantaan virus was the first of the group to be identified in a Korean lab in 1976 from the lungs of a striped field mouse. This variety causes a bleeding disease called

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