A Tragic Loss that Teaches No Lessons

A Tragic Loss that Teaches No Lessons

Recently we were all shocked an upset to hear that a young 7 year old girl died, apparently from an infection.

This is a tragedy.  A life cut short for a reason that is profoundly unsettling, frightening.

I do not yet have sufficient details to discuss exactly what happened.  The public information available is limited to the fact that a particular germ was identified from tests on the girl.  That germ is a commonly circulating bacteria, Streptococcus pneumoniae, that is known to cause infections, but these days it is extremely rare to hear that this germ could prove fatal in an otherwise healthy 7 year old.  

Given the limited information available, can we offer any advice or learn anything from this tragedy?
Not too much, but here are some items that can be offered:

  • The germ Streptococcus pneumoniae is also called the pneumococcus, and is a common cause of very common and minor infections such as skin infections (impetigo), ear infections, as well as more serious infections like blood infections (bacteremia, sepsis), bacterial pneumonia (not the mild and common walking or viral pneumonias), and bacterial meningitis.
  • Streptococcus pneumoniae, or the pneumoccocus, is not the germ that causes strep throat.  That germ is related, but far different, and is called Streptococcus pyogenes.  This means that no one with strep throat is contagious for Streptococcus pneumoniae, or the pneumoccocus.
  • Thankfully, infections with bacteria, including those like Streptococcus pneumoniae, or the pneumoccocus, are almost always not contagious.  There are some minor exceptions, typically limited to minor infections on the surface of the body that cause no real hazard or harm, like impetigo, bacterial pink eye, and strep throat.  But any bacterial infection inside the body, like an ear infection, bacterial pneumonia, etc., tends not to be contagious.  Think about the rare cases of bacterial meningitis, usually only one person in a family or school comes down with it, a particularly large outbreak may reach only 3 cases.  
  • This is wildly different than how viruses behave.  One cold virus can sweep across literally millions of people before it is done spreading.  Bacteria simply do not act this way.  This means the child with the tragic infection likely posed no risk to those she had occassional contact with.
  • Streptococcus pneumoniae, or the pneumoccocus, is around.  Most people have the germ on them sometime in their life.  The real story of bacterial infection is that these infecting bacteria come and go across our lives, and only cause infection rarely.  Consider the fact that each of us is coated with bacteria all our lives, even now, but only get infections of our skin very occasionally.   So a bacterial infection is not so much about "catching a disease," as much as a bacteria finding its rare opportunity to get inside the body and grow.  This is another way of saying that serious bacterial infections do not tend whip through groups of people, but rather, reflect something complex about that one bacteria managing to find its way into that one person.
  • Streptococcus pneumoniae, or the pneumoccocus, also turns out to one of several bacteria that we can immunize against.  You may recognize the name of the relevant vaccine, derived from the name of this germ- it is the pneumococcal vaccine.  It goes by various names, pneumococcal vaccine, prevnar, PCV.  It comes in dozens of forms.  The first generation of the vaccine protected against 7 forms, and the current one we use protects against 13.  In both instances the 7 and 13 forms are the ones that most commonly cause serious infection.  The use of these vaccines has made serious infection from Streptococcus pneumoniae, or the pneumoccocus, much rarer, but sadly, not extinct.  Use of this vaccine across the United States has also, nicely, sharply reduced the number of ear infections and complications from ear infections as well.
  •  Finally, we really do not know the full story of what happened to this very unfortunate 7 year old girl, and in our experience, the details of a situation make all the difference in understanding it.   And so, we hesitate to draw any lessons from this tragedy.  

  • The primary lesson to take is that there is no lesson.  As noted above, this situation likely reflects very individual circumstances.  Circumstances that are, actually, not contagious, and that are very likely very reflective of details pertinent only to that particular instance of connection between that germ and the specific person.  Such very individual circumstances do not generalize, and hence there are few lessons to be learned in this tragedy.
  • Some lessons that should not be learned:
    • All people get colds, fevers, runny noses, congestion, and coughs.  The fact that this girl had these symptoms does not mean that others with these symptoms are at risk.  If you have a cold, and seem to be comfortable and acting normally, you have a cold, nothing more.
    • There is no deadly epidemic about to break out.  These tragedies are always limited to very small numbers of people, usually one.  Never has such an infection whipped across a large population in recent history.
    • There is no point to running to get an antibiotic just because this one case took place.  The same approach to deciding how worried to be still is in place- if you are comfortable, in no serious pain, able to achieve normal alertness, have no serious trouble breathing, you are safe.  If you have a stiff neck, cannot breathe, cannot wake up normally, have serious pain, then, of course, you should seek medical advice.
Bottom Line

A terrible loss has struck our community, our hearts are with the family that has suffered an inexplicable and terrible loss.

The events that caused this loss are not fully known, but the germ implicated and the infection that took place pose no or very little threat to any one else in the community.  This was a quite unusual event, very, very likely not to recur.

This means that despite this tragedy, families should manage their illnesses as they always have, specifically:
If you or your child has symptoms of a mild viral illness, namely, fever, cough, runny nose, feeling lousy, not eating well, not sleeping well, you should make yourself comfortable, and know that this tragedy has no implications for you and should have no impact on how you care for your mild viral illness.

And, of course, if symptoms of more serious disease appear, specifically having serious pain, or serious trouble breathing, difficulty achieving alertness, stiff neck, or a fever reaching 106 or higher, then call immediately for medical attention.

Advanced Pediatrics stands by ready to help if you have any questions, and certainly if you need help knowing if an illness is mild or more serious.

Dr. Arthur Lavin

*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

No comments:

Post a Comment