[jaenelle]

Molluscum Contagion

fungus on their scalp

scabies

giardia

any kind of worms

I'm reading about African adoption and the website I'm reading doesn't say how common these things might be. It does say that some of them are quite hard to treat, and I wondered if anyone had any experience with them. What might our odds be of getting a child with any of these problems and if your child had them, what did you do to get rid of them?

[sak9645]

My daughter's from China, not Africa, but let me weigh in here.

All of the problems you mentioned are very common in internationally adopted children. My daughter had scabies, and although she didn't test positive for Giardia lamblia, I was strongly suspicious that she had it, because she didn't grow well initially. I was confident that she didn't have worms, which tend to show up on tests, if not in the stools, easily; giardiasis is sometimes a little harder to diagnose.

All of the problems are extremely minor, in the grand scheme of things. And they are all very treatable. They are not the sorts of things that are considered special needs. Most adoptive parents don't worry at all about these problems; they focus on the more serious issues that internationally adopted children can face, such as Hepatitis B, attachment disorder, etc.

Let me comment on a few of the conditions, specifically.

1. Scabies is a common, tiny mite that burrows under the skin. Most people have an allergic response to its secretions and body parts, and develop major league itching, even though the actual scabies "tracks" on the skin may be small.

Scabies is very common in group living settings, such as orphanages, nursing homes, barracks, day care centers, etc. It is passed around, just like lice, by contact with bedding, clothing, etc. that an infested person has used, or by direct body contact with an infested person.

Since scabies is contagious, many parents who have adopted infested children wind up getting the mites while on their adoption journey or when the child is newly home, because they hug their children, have them in their beds, share towels, etc. As a result, adoption medicine doctors often recommend that parents travel with enough medicine to treat both the child and themselves, if necessary.

While you can see pictures of scabies tracks in medical books, you should know that you may not be sure whether your child has the mites by a casual look. Because scabies is so itchy, people -- especially young children -- tend to scratch a lot. And because they may do so with dirty fingernails, some scabies lesions develop bacterial infections, which obscure the primary problem.

The treatment for the scabies, itself, usually involves rubbing Elimite or another prescription anti-mite cream all over the infested person's body, from the hairline to the soles of the feet, paying particular attention to the body's creases and folds. The Elimite is left on overnight, and then washed off well the next morning. The treatment should be given only once, unless a doctor recommends a second application, because the medicine is very strong.

Some people do not stop itching immediately. While there MAY be resistant strains of scabies mites, the reason for the continued itching is usually that the dead body parts of the mites are still circulating in the bloodstream, causing a continuing allergic response. As a result, repeated applications of Elimite or another anti-mite drug won't do any good, as the drug simply kills live mites. The person may simply need to take an antihistamine or some other allergy medicine, until the allergic response subsides, which may take several weeks.

If a secondary bacterial skin infection is present, the person may have to take an antibiotic, such as Zithromax. In most cases, the antibiotic will clear up the skin infection right away.

In short, while annoying, scabies is not a very serious problem. Frankly, when my daughter got lice last year at her rather upscale private school, I had a much harder time dealing with it, as success in eradicating lice involves meticulous combing of each strand of hair with a nit comb, and my daughter has long hair. Using the Elimite was a cinch, by comparison.

2. Giardia lamblia is a protozoa (one celled animal). Giardiasis, or infection with this protozoa, is extremely common, and is usually associated with drinking water that is contaminated with the feces of an infected person.

In this country, people sometimes get giardiasis because they swallow water while swimming. Overseas, people are particularly likely to get it from drinking inadequately purified tap water or using ice made from the tap water. People can also get giardiasis by eating food handled by an infected person, or food that has been grown in soil fertilized with human waste. Young children can get it by mouthing toys handled by an infected child who hasn't washed his/her hands after touching his/her bottom.

Giardiasis is very common in developing countries. People from the U.S. who travel to adopt often forget to avoid tap water or ice made from tap water, and pick up the disease. Their children may have it, because of their own exposure to tap water or contaminated food.

The main symptom of giardiasis is diarrhea. An infected person may also have stomach cramps, gas, and nausea. Some young children will show signs of malnutrition, or may get dehydrated from the diarrhea.

With newly adopted children, even those who do not have diarrhea, giardiasis is often the cause if the child fails to grow well, even when given nutritious food. All internationally adopted children should be tested for Giardia, even if they don't have diarrhea. And any parent who comes home and experiences digestive tract disturbances that have no obvious cause should get tested.

The main treatment for giardiasis is an antibiotic, often Flagyl or Furoxone. Flagyl is nasty-tasting, and people can't drink alcohol while they are on it. But it is usually effective. Furoxone is commonly used with children.

Basically, once giardiasis is correctly diagnosed and treated, it will go away and have no lingering effects.

3. While there are many kinds of worms that people can get, the most common is Ascaris. Ascariasis, or infestation with the Ascaris roundworm, is so common that some researchers say that one out of every four people in the world has the problem.

People usually develop Ascariasis by eating food or drinking water contaminated by the feces of an infected person. Children may also get it by playing in dirt contaminated with human waste, or by mouthing toys handled by an infected child who has recently touched his bottom.

Pigs get the same sort of roundworms as people, so a person may also get ascariasis from food or water contaminated with the stool of pigs, or by accidentally ingesting soil in which pigs have defecated.

Ascariasis can sometimes be asymptomatic. Many a parent of a newly adopted child has been surprised to find a worm in his/her seemingly healthy child's diaper. Children may also gain weight slowly, even after a healthy diet is put in place.

Soon after infection, some people develop fever, cough, and wheezing. Later, they will often have symptoms like nausea, vomiting, and abdominal cramping. If an infection is particularly severe, a person may develop obstruction of the bowel or inflammation of organs like the gall bladder.

All newly adopted children should be tested for roundworms, preferably by the three sample stool test, even if they show no symptoms and no worms have been seen. The tests are very accurate.

If worms are found, there are a variety of medications that can be given to kill them. There are usually no consequences, if the infection is not severe and is quickly diagnosed and treated. A person -- usually an adult -- who has a very severe infestation could have a medical emergency caused by blockage of the intestine or the presence of worms in the lungs. I have never heard of any adopted children diagnosed with any severe consequences of their ascariasis.

4. Molluscum contagiosum is not a disease that is commonly seen in Asian adoptees, but it is very common in the population of Africa. I'm not all that familiar with it, as a result, but here's what I know.

It is simply a viral skin disease, characterized by little, flesh-colored papules that are painless. Particularly common in children, it is spread by skin-to-skin contact. In adolescents and adults, it can be spread by sexual contact.

Sometimes, the disease will go away on its own. Sometimes, curettage (scraping the locally anesthetized skin) or cryotherapy (cold therapy) will be used to remove the lesions. Tagamet and some antiviral drugs are used in more difficult cases.

In some cases, a secondary bacterial infection may get started on the lesions -- for example, if they are picked or scratched. An antibiotic will usually get rid of the bacterial infection.

People who have HIV or other diseases that compromise the immune system may be more likely to get molluscum contagiosum.

5. Scalp fungus is also not as common in Asian adoptees as in African children, so I'm not quite as familiar with it. I also don't know what particular fungus you are discussing. But here is what I know.

A particularly common scalp fungus around the world is ringworm. (Ringworm has nothing to do with worms.)

Ringworm often looks like small round or oval patches of bald or scaly skin. However, it can masquerade as seborrheic dermatitis or other conditions.

If untreated, ringworm can result in permanent hair loss or scarred skin. The treatment usually involves a combination of antifungal pills, and antifungal shampoos or lotions.

I hope this helps.


Sharon

[Jensboys]

Both my sons had fungus on their scalps that they transferred to my husband and biological son shortly after we adopted them.

Although they are African-American ... they were both born and raised until adoption in Missouri. The doctor said that moving to a cooler climate probably just made what was a minor problem become SEVERE.

It was horrid to treat and the meds the kids got were REALLY strong ... they threatened to quaranteen us *which seemed fairly pointless seeing as we had been everywhere around town before we had a diagnosis (took several months).

Anways, once they figured it out -- it was treated quickly and resolved quickly and never resurfaced.

Jen

[jaenelle]

Thanks for the input, both of you!

I'm just beginning my African research and I am sure I will have lots of questions -- thanks for helping to answer them!

[Colorbind love]

Our son most likely had parasites. He refused to give a stool sample. But, he had the swollen belly look of parasites, so he was treated anyway.

He also came home with a fungal scalp infection. Its actually never been anything more than mild *on him*. Unfortunately, he spread the joy around as well. It manifested as a scalp fungal infection on both dd's, and as ringworm on Dh, ds and myself. For the ringworm, we used tinactin--no problem. For the scalp infection, I used tea tree oil.

Those worked on everyone but one dd. We've tried every OTC and natural treatment for her scalp infection over the last year, including the 3 MONTHS we treated her with gentian violet and dyed her head purple. We finally had to switch to oral meds. She's about to start week 4 and the infection is finally starting to go away. But, we have to monitor her liver enzymes on this med, which is why we treated it naturally for so long first.

When my sister came home from Ethiopia, she brought home lice (that was a joy) and measles. My 8 month old got measles at that time. That was a bigger joy, he was too young to vaccinate. So, this time I got the baby vaccinated when her brother came home, even though she was just *barely* old enough for the vaccine. Measles as one thing I did NOT want to deal with again.

Oh, and ds came home with malaria. Its been a bigger issue than all the others. Because, it turns out, malaria triggers the body in not so very nice ways. I'm still learning how his life is impacted by malaria, because he will never NOT have it. Its taken research and talking to several adults who actually have it to get a better handle on how it makes him feel. I've also seen several adoptive parents whose kiddos got VERY sick with malaria and US doctors didn't know how to treat it, because they don't see it in the US. But, it doesn't impact his future. Its just how it makes him FEEL. The 3 strains of malaria that are recurring won't kill you with proper treatment (a simple script for meds when flare-ups occur). But, malaria makes you feel icky. And, apparently it makes you feel icky when you get sick with *anything* and not merely a malaria flare-up. I actually recently learned that behaviors I was attributing to adjustment issues/adoption issues are in fact malarial induced issues.

My only regret is that I didn't take malaria as a very serious issue before bringing him home. I should have researched it and known these things 1.5 years ago rather than learning as I went and he suffered the misery of my ignorance.

[jaenelle]

colorblind love -- Did you know that your son had malaria before you brought him home? Is it something that is tested for? Do you know how common it is?

Well, most of these things don't sound too bad. I just wanted to find out what their prevalance might be and if they were easy to treat.

I guess everyone's definition of healthy is different, so I need to ask specific questions and really know what we're getting into so we don't get surprised by an illness or something we weren't prepared for once we get home.

[teranga]

We just returned from Ethiopia on March 7 with our little boy and we have had absolutely no problems. He has no skin issues--in fact, his skin is beautifully clear. He has no intestinal issues or anything else. He did have a horrible cough and diarrhea when we arrived in Ethiopia. We took him to a clinic there and they gave him an antibiotic (bactrim) which cleared up both his diarrhea and cough. He also tested negative for TB, but I know that quite a few kids have come home w/TB and we will retest in a few months to be sure he's negative on that one.. Also a number of children have come home w/Hep A. We had our bio kids immunized against Hep A before picking up our baby so he couldn't pass it on if he did indeed have it (he didn't). It is generally recommended to do this though, as it is common for kids to have Hep A.

[Colorbind love]

Yes, we knew he was believed to have suffered malaria. But, I have encountered many families whose children exhibited the same symptoms as our son and because the history was unknown got very sick before their doctors checked for it.

I forgot about TB. My sister from Ethiopia tested positive for TB. There is some debate whether the TB vaccine causes a positive on the TB test or not. AFAIK, the standard treatment if a child tests positive is to go on TB meds for a year, which is what my sister did. But, the other issue to remember is that typically once you test positive for TB (and that means exposure NOT an active infection of TB), you will always test positive.

[jenlars3]

A positive PPD reaction does not necessarily mean that a person has TB. TB is confirmed with a chest X-ray and other tests. A fair amount of people are considered "positive PPD reactors" meaning that, more or less, they have a reaction to the test that can simulate a positive result. The more they take the PPD test, the worse the reaction will be (like an allergy, almost). I am a RN and every one of the people I've seen with a positive PPD test had chest X-rays that were clear. Of course, from Ethiopia, it is far more likely that a positive PPD test may be, in fact, TB.

If your child has TB, it is important to keep documentation of the treatment because on subsequent PPD tests, they will continue to test positive. That documentation will probably need to be provided for the school system, I'd imagine.