Latest / Pediatrics Now: Cases Updates and Discussions for the Busy Pediatric Practitioner / Bug Bites and Beyond: Summer Safety for Pediatric Practitioners, Part One

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Bug Bites and Beyond: Summer Safety for Pediatric Practitioners, Part One · Pediatrics Now: Cases Updates and Discussions for the Busy Pediatric Practitioner

• 0:01
  I'm Holly Wayment and this is Pediatrics Now, cases, updates,
• 0:06
  and discussions for the busy pediatric practitioner.
• 0:09
  Click on the link in this podcast for free credit that may include CME,
• 0:13
  MOC, or ethics credit depending on our topic or podcast.
• 0:18
  Here we are in summer and we're in extreme heat advisories here in San Antonio
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  and back on the the show is Dr.
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  Tess Barton. She's our pediatric infectious disease expert.
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  Tess, thank you so much for being back on Pediatrics Now.
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  Thanks for having me. So I was in a clinic the other day and the pediatrician
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  I was talking to, she said just that morning, it was noon when I was there,
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  and she said she had had three families in with bug bites.
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  And the parents were saying, you know, tell me what is it that bit my kid?
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  And one of the families said that, and she said, well, I can't tell you that.
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  And she's trying to answer all their questions and said, we're not experts on bug bites.
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  So what advice do you have here for the busy pediatric practitioner now that we're in summer?
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  Sure. So in the summer, the most common bug bites that we're going to see are
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  going to be mosquito bites.
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  But I think that when parents come in and they're worried about bug bites,
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  maybe the thing that they are often worried about are bed bugs.
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  And so I think for the pediatrician, there are a few little clues that you can
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  use to distinguish bed bug bites from mosquito bites.
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  So the most...
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  Common findings for mosquito bites is that mosquitoes generally will bite you
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  where you are exposed, right?
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  So they're small, they're not strong, they don't have a lot of abilities to
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  bite you through your clothes.
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  So, you know, if your ankles, your arms, those places are exposed,
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  those are the places where you will get bites.
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  And, you know, mosquito bites can look very different from person to person
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  because some people are very reactive to them and they will get these really
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  big welts and some people are not, and they'll just get a little,
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  you know, a little pink bump.
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  Bed bugs, on the other hand, of course, they don't bite you when you are outside.
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  They bite you when you are sleeping peacefully in your bed or on your sofa or
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  whatever fluffy place that they happen to be living in.
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  And bed bugs actually like to crawl around under your clothing as well.
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  So they don't limit themselves to the places that are exposed.
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  They also often live at the top of the mattress, underneath the top of the mattress.
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  And so they will bite you on your face, whereas mosquitoes less likely bite you on your face.
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  So if you are seeing large red bumps that are also in places that were covered
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  by clothing and are scattered kind of all over the body or on the face,
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  those are warning signs that that actually might be a bed bug infestation.
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  So in that case, what are we supposed to do? And if anyone who's listening is
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  having trouble sleeping, just skip this episode for now.
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  We can talk about all sorts of other bugs, because there's other things and
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  they each have a pattern.
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  So you want to know what should they do if they suspect they have bedbugs? Yes.
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  All right. So bedbugs are an insect that most commonly lives kind of on the
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  underside of your mattress.
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  And so they come out at night. So you may not ever actually see them crawling
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  around because they burrow and they hide during the daytime. time.
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  So if you feel them and it's the nighttime, you can turn on the lights really
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  fast and sometimes catch them and see them.
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  They vary in size. Most of them are just a few millimeters long.
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  They look kind of just like a boring little gray bug.
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  But the hallmark of finding them is that if you pull up the edges of the mattress,
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  like lift the mattress and look on the underneath side,
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  you know how like some mattresses have
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  that little strip of piping along the edge
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  you might have to like pull that to the side what you may see is you might see
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  the bugs themselves but more commonly what you'll see is you'll see their poop
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  and because they eat blood their poop actually looks like dried blood spots
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  so if you're finding things that look like dried blood spots
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  clustered on the underside of your mattress, that's the telltale sign of bedbugs.
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  So the first thing is...
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  Get rid of the mattress? Yeah, I mean, so you probably, you know,
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  there are many different ways of that have been tried for dealing with bed bugs.
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  Ultimately, getting rid of the mattress is the most effective.
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  But you also have to usually treat the home or the room as well,
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  because they could be hiding in other places, and then they'll just set up shop on your new mattress.
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  So we recommend any
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  pillows or beddings or cushions that can be physically washed in the dryer should
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  be washed on hot water and dried in high heat to really kill them off.
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  The other thing that you can do is if it's something too large or bulky to put
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  in the washer and the dryer, like your sofa or a large pillow,
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  that you can wrap them up in a black plastic bag and ideally place them in the sun where it's hot.
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  But wrap them up in a black plastic bag for a couple of weeks,
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  because that actually allows,
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  it traps the bugs, they can't get out, and they will cycle through their life
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  cycle and any eggs that they have laid will hatch, but they won't have anything
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  to eat, and then they will die.
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  People will often do, you know, like a bug bomb, right, like an insect bomb in the house.
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  And you can get permethrin sprays and spray, you know, spray your sofa,
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  spray the undersides of things.
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  But in general, if it can be if there's toys or cushions or beddings, you want to wash them.
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  And then be vigilant and keep an eye out for them returning.
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  Sometimes bed bugs can be very very persistent.
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  And Tess, or Dr. Barton, do we need to worry about bedbugs or even think about
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  them if we haven't been traveling recently?
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  Sure, sure. We have plenty of bedbugs in Texas. So people do pick them up,
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  you know, often when they are on travels and they stay in a hotel and the bedbug
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  stows away in their luggage and then finds a new home.
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  But it's also possible for your, you know, neighbors to have bedbugs and they
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  come over visiting your house.
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  Not the neighbors the bugs so then they can leave the bugs when they leave no
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  like the neighbors don't bring the bugs the bugs take a journey they come walking
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  over oh seeking out new new new housing ah like walking through the grass and everything yes.
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  Speaking of grass there's also tons of other bugs that you can get in the grass,
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  so so well before we move on so with the bed bugs can they be harmful or make
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  us sick or make children sick no generally they don't make you sick they there's i don't,
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  know of any diseases that I can think of off the top of my head that are transmitted by bedbugs.
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  There are diseases that are transmitted by lice and fleas and mosquitoes,
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  of course, but I don't know that bedbugs actually transmit any diseases.
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  But they are miserable. Like the bites of bedbugs are extremely, extremely itchy.
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  And so people who have those bites are pretty miserable for several days.
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  So what do you recommend for kids? What should the parent do if they are bitten?
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  Yes. I mean, to treat bed bug bites, it's the same kind of grandma medicine
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  that we use for other types of bites.
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  You can use calamine lotion and antihistamines like Benadryl.
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  You can do you know oatmeal
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  baths things that help to dry
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  them up do you recommend benadryl cream
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  you can use benadryl cream but you shouldn't use benadryl cream and benadryl
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  by mouth together because you do absorb some when you put cream on so you can
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  also use hydrocortisone cream or other you know steroid anti-itch creams to
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  to help with those and just follow what it says on the.
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  Tube. Yes, yes.
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  So, and I know you're a world traveler.
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  Do you keep your suitcase not on carpet when you travel for this reason?
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  Or is there anything you do as a lot of us are heading on summer vacations?
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  Yes. So I actually had a bed bug experience when I went to Laos.
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  And I had, It was sort of the very busy New Year's time, so there were limited hotel rooms.
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  And we had booked a hotel for a few days. And...
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  We're peacefully sleeping in the bed when suddenly I felt, I felt things crawling
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  on me and I freaked out and flipped the lights on and started looking.
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  And I found, I saw the bugs and I immediately packed up my luggage and threw it out of the door.
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  And it was two o'clock in the morning and we were like, we're not staying here.
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  And of course, like it was a small town.
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  It wasn't like a big city where things are open 24 hours and had to like walk
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  around looking for another hotel where there was somebody at the desk.
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  And when we finally found one and we told them like, oh my gosh,
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  we were at this other place and there were bugs. You can't bring your things in here.
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  And they put our things outside.
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  And in the morning, right on the street, because it was like right at the street
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  with a little plaza in front of everybody, we had to like unpack our luggage,
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  spray everything down with tons of tons of, you know, insecticide spray.
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  We did find one bug in the luggage. Oh.
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  That are the bed bug poop because I never, ever want to deal with that again.
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  Wow. So you do that every time, but that makes sense. And what were you saying
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  about smelling smoke, smelling for smoke?
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  Well, I just don't like smoke in the room. If someone had been smoking. Exactly.
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  So that's really smart. And then do you keep your luggage not on carpet for
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  24 hours when you get back or do anything like that?
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  No, I don't usually do that. If I see any evidence of bed bugs,
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  I just don't stay at the place.
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  Do you look at all parts of the underside of the mattress or just one corner?
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  Would they be in all corners or can you tell us about that i usually look at
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  the top the two top corners up by the headboard because that's the most common
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  place where they cluster yeah.
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  Have you found any yet hopefully not no yeah okay and did that ruin your trip
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  to laos it did not it did not it was we had an amazing trip i was actually yeah
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  we were actually in in the process of moving there when this happened.
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  So, yeah, so no, it was, it was fine, but it did, it, you know,
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  it did, it did make me very wary of, of, of,
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  of places of hotels so how
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  long did you live in Laos and what were you doing there I lived
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  for a year in Laos and I was there's
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  a little children's hospital that is sponsored by
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  a non-profit organization in a town called Luang
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  Prabang which is a UNESCO world heritage site it's a really lovely town with
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  the sort of highest concentration of Buddhist temples in the world and and so
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  I was volunteering at a little hospital doing pediatric work. That sounds amazing.
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  That's wonderful. Well, thanks for sharing that story with us.
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  So, shall we move on to mosquitoes?
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  When should we worry about mosquitoes? What do you do to protect yourself against mosquitoes?
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  Do you use any kind of spray or is it mostly clothing?
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  So, yeah, we should worry about mosquitoes. Mosquitoes are the most dangerous
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  animal in the world, right?
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  Yeah, they kill more people than any other animal. Wow, I did not know.
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  Because they transmit a variety of diseases. So luckily, you know,
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  here in the US, we don't have many of those diseases.
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  You know, we don't have malaria and yellow fever and dengue,
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  at least not much dengue.
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  So we don't, you know, we don't have to worry as much about mosquito-related
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  diseases, although we do have some.
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  But yeah, mosquitoes are more an annoyance than anything else.
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  But it is a good practice to try to avoid them.
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  So again, as I mentioned, they
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  usually don't bite through clothing because they're not strong enough.
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  So long sleeves, long pants, protective clothing is a good all-purpose way to
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  protect yourself from mosquito bites.
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  And then yes, I do use insect repellent.
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  I unfortunately have to use insect repellent like every day when I go out in
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  my garden to do anything because it's mosquito land.
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  And so for myself, I prefer to use a DEET containing repellent,
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  usually around a 30% DEET.
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  For children, we recommend that children under two months shouldn't use insect
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  repellent. they should use protective clothing.
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  Children over two months, the AAP does recommend that they can use insect repellents,
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  but they need a lower, they should have a lower concentration. So the.
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  So if it's a DEET-containing repellent, they recommend a 10% DEET product,
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  and that will give about an hour and a half of protection against mosquitoes.
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  So you do have to reapply it if you're going to be outside for longer than that.
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  Although when it's a billion degrees outside, I can't imagine why anybody wants
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  to be outside that long. Right, exactly.
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  And do you, again, follow the recommendations that's on the container for children?
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  I do. I do. But it can be very confusing, right?
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  Because they also have a list of ingredients and it's hard to know what's the best one.
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  And a lot of people don't want to use DEET, right? It's a chemical and we do
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  absorb it into our system a little bit. About 10% of it we absorb into our system.
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  And so a lot of parents prefer something that's more natural.
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  And there are there are some
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  alternatives but i think parents need to be aware of
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  kind of the pros and cons of those different things there are
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  you know there's all sorts of like citronellas and oil of lemon eucalyptus and
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  and a variety of like essential oils rosemary oils and things like that that
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  are in if you look at like the you know like the skintastic for kids or whatever
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  It has those kinds of things in them.
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  And there have been comparative studies looking at how well those work compared
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  to DEET and other things.
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  And they are not as effective as DEET.
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  They also, because they are natural plant-derived oils or plant-derived products,
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  sometimes people are actually sensitized to them and they can have like skin
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  reactions to those products.
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  So, you know, it doesn't mean that you can't use them.
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  It just means that you have to anticipate that they may not be as effective
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  and be on the lookout for the potential for skin reactions.
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  So, and the pros and cons. So, for you, where you use DEET, it's more important
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  to avoid the potential harm a mosquito could cause.
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  Can you tell us about that? Well, sure.
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  So, I mean, you know, like I said, here in the U.S., where we don't have as
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  much of an issue of mosquito transmitted diseases, we do have,
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  most commonly, we do have West Nile virus.
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  There are some other viruses that mosquitoes transmit that can cause some serious
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  infections, but they're pretty rare, right?
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  So it's unusual to get a mosquito bite that then leads to some sort of disease
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  here in the U.S., but it's not unusual elsewhere in the world.
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  So little travelers, for sure, should be protecting themselves against mosquitoes.
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  And that's a whole separate issue of bed nets and things like that if you're
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  going to be doing international travel.
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  But here in the U.S., it's really just, you know, doing your best to avoid the
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  bites so that, you know, you don't scratch it like crazy and get impetigo or
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  something to avoid the annoyance and the,
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  you know, the infections that we cause from our fingernails from messing with our itchy skin.
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  So what was your question again? So, and Tess, Dr.
• 19:17
  Barton, and I'm saying both because I'm going for the parents episode, I'll change it to Dr.
• 19:21
  Barton and the pediatrician one, I say Tess, but because we have two podcasts
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  now, but I'll edit this out.
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  And we will have for our pediatric practitioner listeners, we will,
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  our sister podcast is Pediatrics Now for Parents.
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  So you can tell your patients, your families that who come to see you,
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  they could go to Pediatrics Now for Parents, the bug bite episodes so that you
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  don't, hopefully it's one less thing you have to say in the exam room.
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  You can say this is in more detail on Pediatrics Now for parents,
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  wherever you get podcasts.
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  So we were talking about some mosquitoes.
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  Do you think, A, DEET is okay for kids, or is there anything more you want to
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  say on that? And B, when should we worry about mosquito bites?
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  So, yeah, so I think I answered kind of when we should worry about mosquito
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  bites, which is we don't usually have to worry about the health consequences
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  of mosquito bites here in the United States, but we should worry about them when we're traveling.
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  As far as is DEET safe for children? Yes, DEET has been shown to be safe for children.
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  And we do prefer to give a lower concentration because we know there can be some absorption.
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  There are 100% DEET products that are available at outdoors stores.
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  Stores, there's really no reason why anybody needs 100% DEET other than you
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  want to feel macho about your mosquito repellent.
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  But that is too concentrated for children.
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  For parents who want a more natural approach, the next best alternative is a
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  product called oil of lemon eucalyptus,
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  which is a tree with an oily leaf that has a citrusy kind of smell.
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  And there was actually a very interesting comparative trial looking at a variety
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  of different mosquito repelling methods.
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  And the oil of lemon eucalyptus was around the same effectiveness as DEET.
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  And so it is a good, it is a good alternative for parents who are looking for
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  a more natural, less chemical solution.
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  Product for an insect or talent. And with epitaigo, is that you scratch it too
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  much and then there's bacteria under the nail or something? How does that happen? Exactly.
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  So, epitaigo is caused either by staph, a common skin bacteria,
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  or by group A strep, which is a common throat bacteria.
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  And so, you basically scratch the skin.
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  You know, as long as bacteria are sitting on a surface of your skin and not
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  in your skin, They don't really cause you a problem, but if they get to where
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  they don't belong, that's when they begin to cause an infection.
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  And so then you can get impetigo.
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  And that can be, you know, that can be not only very, you know,
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  painful and scarring, that can sometimes turn into a bigger infection or have
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  some of the consequences of, you know, strep infections.
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  But yeah, so that's really the main issue with mosquitoes here.
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  We have not had any human West Nile in Texas this year, although mosquitoes
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  have tested positive, including mosquitoes in Bexar County.
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  Hmm. Wow. But that just means luckily it isn't happening.
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  Is it going to happen this summer, do you think? I don't know.
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  So the health department does these like sentinel screenings.
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  So they have mosquito pools, like collections of mosquitoes,
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  which sounds like the grossest thing ever.
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  And they have what are called sentinel chickens that are these like coops of
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  chickens that they test periodically and horses.
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  So they test sort of the other animals that can carry this virus.
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  And so the mosquitoes have tested positive. But
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  typically what happens when they get a positive test is the health department
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  actually will normally do some sort of like regional or local spraying in the
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  area where those mosquitoes have tested positive.
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  So that we don't have, you know, diseases. And that's been effective.
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  We have really only a handful of West Nile cases each year.
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  For families, you know, there are mosquitoes breed in water and in wet wood.
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  And so anything where there's a pooling of water that's not regularly flowing
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  is where you'll find the little mosquito, wiggling mosquito larvae.
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  So in your like potted plants and if there are, you know, tires or other things
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  that are in your yard that have gotten, you know, rain in them,
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  and they have a little puddle of water, that's a place where mosquitoes will breed.
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  And so, you know, in your own household, making sure that you've,
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  you know, turned, dumped the water out after rains.
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  And that you don't have standing water, that, you know, that you've got a cistern,
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  like a rain cistern or a pool or something.
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  I mean, pools should be circulating, but, or a fish pond, you know,
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  like those kinds of things should be, they either need some kind of circulation
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  system so that the water's not stagnant or they need to be covered.
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  So the mosquitoes don't get in them.
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  That's great advice. And with the impetigo, if it's swelling,
• 25:10
  it looks like an infection, it's red, what do you do from there?
• 25:13
  So, yeah, so impetigo will look like, Like, you know, usually a red,
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  swollen, painful, crusty, oozy little lesion. It's kind of round and raised.
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  In Haiti, they call them boutons, which means buttons. So imagine a button on the skin.
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  And, yeah, and so usually that can be treated if they're early.
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  They can really just be treated with a topical antibiotic ointment,
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  cleaning them, you know, cleaning them well, keeping them dry and treating a
• 25:49
  little topical antibiotic is usually enough.
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  If there's a ton of them, or if they have a larger zone of redness around them
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  where they're causing kind of a larger skin infection,
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  then that might need systemic antibiotics, right? So antibiotics that you take by mouth.
• 26:08
  My last question about mosquitoes, I was reading in the Washington Post that
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  when we breathe out, it's basically telling the mosquitoes that we're there
• 26:17
  and we can be like this giant protein shake for them that's very attractive.
• 26:24
  And but do we build up, you know, like over time, the bites may not show up
• 26:30
  on our skin because we're not getting that reaction.
• 26:32
  We have an immunity to the reaction, but we still would could are we still exposed
• 26:36
  to the potential danger or what do you say about that?
• 26:40
  Yeah, that's actually a great question. So, you know, there are mosquitoes are
• 26:45
  attracted to a variety of chemicals that we, you know, that we exude.
• 26:51
  And some people are kind of more mosquito magnets than others.
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  And actually, people who eat a lot of garlic naturally repel more mosquitoes than other people.
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  Maybe that's a wives' tale. I don't think it's a wives' tale, though.
• 27:09
  And that's part of the basis of the vampire myths.
• 27:16
  Yes. And, and so, yeah, but, but, but many people will report the experience
• 27:22
  of, you know, at the beginning of the mosquito season,
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  you know, in the spring after it's been raining a bunch and the mosquitoes have
• 27:29
  suddenly been breeding and it's starting to warm up, you'll get like 1 million bites when you go out.
• 27:35
  And then, you know, after a month or so, you just don't get bitten anymore. Right.
• 27:40
  And I always joke around that when that's happened to me, that it's like the
• 27:44
  mosquitoes can smell that I'm like all used up and they're not fresh anymore. They don't want that.
• 27:51
  But really, it's much more likely that what happens is our immune systems get
• 27:56
  reminded about the mosquito saliva.
• 28:01
  And, you know, while we initially have a little allergic response,
• 28:04
  which is what makes the the little itchy spot, we get desensitized after repeated
• 28:10
  exposures so that we're just not as allergic to their saliva anymore.
• 28:14
  So they may be that they're still biting us, but we are just not responding
• 28:18
  to those bites the way that we did initially.
• 28:21
  And do we need to not worry about getting one of those rare diseases then too? No, not usually.
• 28:32
  If there's an outbreak, then yeah.
• 28:36
  If there's suddenly on the news that several cases of West Nile have been reported,
• 28:42
  then yeah, I would be a little bit more robust about mosquito avoidance.
• 28:46
  But for the most part, I mean, it is quite rare.
• 28:49
  So really, it's more for mosquitoes in the U.S., more of an annoyance than they are truly dangerous.
• 29:01
  Do you recommend once it seems like the mosquitoes are not biting you,
• 29:05
  still put the DEET on or can we stop them?
• 29:09
  You know, there are mosquito seasons. So actually, when it gets super,
• 29:13
  super hot, it's too hot for the mosquitoes.
• 29:15
  They don't want to be out either. They want to hide in their nice, cool spaces.
• 29:19
  So I think that you can see sort of how often are you getting swarmed by mosquitoes
• 29:26
  when you go out and decide if you want to use the deed or not. Okay. And so...
• 29:37
  So say there's a child who comes into the pediatrician's office and there's
• 29:40
  a bite and it doesn't seem to be a mosquito. Like, number one, it's likely a mosquito.
• 29:47
  Then look at what you're saying. Look at maybe it's bed bugs.
• 29:51
  If there's you described what to look for, then what next would you say?
• 29:55
  What else should we be concerned about?
• 29:58
  Well, we have a lot of biting critters here in Texas. So biting and burrowing
• 30:05
  and blood-feasting creatures that like us.
• 30:11
  So there are other common things that are biting or getting on our skin are fleas.
• 30:22
  And there's also chiggers which is a mite that lives in the grass similar to
• 30:27
  chiggers is scabies which is another mite that you usually get from contact with another person,
• 30:34
  there of course are things like spiders so spiders will absolutely bite you
• 30:39
  if you if you have put yourself in their way so you know i think it for the
• 30:45
  pediatrician you know the usually the way to to figure out what's been biting the child is,
• 30:53
  where's the bite located?
• 30:56
  What were they doing when they were bitten? And obviously, did they see the thing? That's helpful.
• 31:04
  Yeah, one pediatrician was saying to me, like, family was saying,
• 31:07
  well, what bit my child? And she was saying, well, I can't tell you.
• 31:10
  I don't know. I wasn't there.
• 31:11
  She was trying to, you know, can you tell me more information? Right.
• 31:15
  And some things are not bites. Some things are also stings, right?
• 31:18
  So scorpions and wasps and bees, those are actually stings and not bites,
• 31:23
  but they will cause a, you know, a painful lesion, swollen spot.
• 31:28
  Is there some of the ones you just listed? Do you want to mention some telltale
• 31:32
  signs or is there a website you recommend?
• 31:34
  Because it almost seems like it can be overwhelming in that short time you have
• 31:38
  in the exam room and you're trying to help this family and this child and to
• 31:42
  not, you know, to have to try to figure out what is this bite.
• 31:46
  I actually will mention healthychildren.org.
• 31:50
  I'm not sure that there's a lot of information about distinguishing different
• 31:54
  bites on there, but there's actually good information about repellents and dealing
• 31:59
  with bites on that website.
• 32:01
  So it's a handy website for parents to have. So I think that maybe the one that
• 32:10
  I will mention are fleas.
• 32:14
  So fleas, of course, we commonly associate them being on our household pets,
• 32:21
  but fleas are not limited to our household pets.
• 32:26
  Fleas live very abundantly on the backyard wildlife.
• 32:32
  So the possums and squirrels and even birds and things that are in our yards.
• 32:39
  And they will get in our grass. So sometimes there can be flea infestations in your grass.
• 32:49
  And I mentioned that because, you know, what happens is your dog goes outside to go potty and,
• 32:58
  you know, maybe it picks up a flea or something that was on a possum and then
• 33:01
  it comes back in and that flea jumps around and it bites you.
• 33:06
  One of the ways you can tell if you have a flea infestation in your grass is
• 33:11
  that fleas jump and bite, but they don't jump super far.
• 33:16
  So they usually jump all over your
• 33:18
  ankles. And they bite your ankles like crazy, but not the rest of you.
• 33:23
  So if you have a bunch of little tiny, tiny spots, pink, itchy spots on your ankles.
• 33:35
  There can be other things as well, but sometimes that should prompt a concern for fleas.
• 33:42
  And fleas are important in our part of Texas, actually, because fleas do transmit
• 33:47
  disease called murine typhus.
• 33:50
  And we actually have a lot of
• 33:51
  that in San Antonio. And that can be pretty serious and pretty dangerous.
• 33:57
  And so doing flea control is actually pretty important.
• 34:03
  And murine typhus, if you suspect a child has that, what do you do then?
• 34:08
  Well, so murine typhus is an illness where the fleas have a bacteria called
• 34:15
  Rickettsia typhi, and they transmit that bacteria to you when they bite you.
• 34:20
  And that bacteria gets into your bloodstream, and it swims around,
• 34:23
  and it causes a lot of inflammation in your blood vessels, and it can cause
• 34:31
  inflammation in your brain and in your heart.
• 34:34
  So it's actually a pretty serious illness.
• 34:37
  Usually it's a fever illness. So people who have a fever that's been going on
• 34:41
  for more than a few days, right? So usually if you have a fever, like, oh, it's a virus.
• 34:45
  But if it seems like it's going on a little bit longer, or if it has a...
• 34:51
  A rash, a fever and a rash with headache or stomach aches, things like that,
• 34:57
  those should raise a little bit of a suspicion for typhus.
• 35:03
  We've had a significant increase in typhus cases in the San Antonio area for the past 10 years or so.
• 35:12
  So it's actually becoming fairly common here and it is transmitted by fleas.
• 35:18
  Can you treat it with antibiotics?
• 35:20
  Yes, it is treated with an antibiotic
• 35:22
  called doxycycline, which is not the most fun antibiotic to take.
• 35:26
  It's got some side effects, but it would be better to avoid getting typhus in the first place.
• 35:31
  The adage, prevention is the best medicine. Yes, exactly.
• 35:36
  Dr. Tess Barton, thank you so much for being back on Pediatrics Now today.
• 35:42
  I really appreciate it. Thanks. It was lots of fun.
• 35:46
  Music.