Getting sick and then getting better, over and over again, is a ritual every human goes through. One of a child’s most important jobs is to collect a wide variety of cooties so he can create immune-system responses that keep him safe for the rest of his life. Many of the common childhood infections mentioned here are inconvenient but not terribly serious to young people, but they can be major problems for adults (and devastating to infants).
For a variety of reasons, you may encounter adult clients who have contracted an illness that is traditionally considered a childhood disease. These illnesses can have an impact on massage therapists—both on your own health and that of your other clients—so this edition of Pathology Perspectives will examine some of them.
Whooping Cough
Whooping cough, also called pertussis (the pathogen is called Bordetella pertussis), is a bacterial infection of the upper respiratory tract.
Dogs also experience a form of this disease called kennel cough. The pathogens—both viral and bacterial—that cause kennel cough in dogs can cause a respiratory infection in humans, although it doesn’t seem to be a common occurrence in people who are healthy.
Whooping cough got its name from the cough it produces. It is so severe and so deep that children must inhale with a deep “whoop” sound to replace all the air they expelled from their lungs while coughing. The bacteria are spread through respiratory secretions, and violent coughing that spews mucus and saliva throughout the environment is an extremely efficient way for this pathogen to find new hosts.
Most people are vaccinated against pertussis in early childhood. The “P” in the DTaP vaccine stands for pertussis. (The “DTa” stands for “diphtheria, tetanus, and.”) Unfortunately, the vaccine does not provide lifelong immunity. Somewhere between five and 10 years after the final dose, the pertussis-fighting antibodies triggered by the vaccine diminish and eventually disappear. This accounts for a spike in diagnoses among children who are between their booster schedules1 and among adults. When adults with no protection come in contact with unvaccinated infants or children, the results can be inconvenient at best, life-threatening at worst.
One of the tricky things about pertussis is that the characteristic “whoop” sound is typical only when it occurs in toddlers and young children. When it occurs in newborn infants or in adults, it creates breathing problems, cough, and fever, but no other distinctive symptoms. Consequently, treatment for this infection may be delayed. For adults, this can mean several weeks or months of coughing so extreme that it can lead to cracked ribs and hernias. But for newborns, the consequences can be much more dire: convulsions, pneumonia, and even death. Of the 41,000 reported cases in 2012, 18 deaths occurred, mostly in infants.2 The public-health community speaks of cocooning newborns—that is, ensuring that they contact only people immune to pertussis until they are old enough to be vaccinated.
Because whooping cough is a bacterial infection, it can be treated with antibiotics. These drugs shorten the duration of the infection, but damage to the respiratory system may take weeks to heal, so the cough may linger. The other main priority for whooping-cough treatment is to keep the breathing passageways open. In terms of home care, this may mean keeping the child in a warm shower so that heated water vapor can help clear out the bronchi.
Impetigo
Impetigo is such a common infection in children that a lot of people think it is actually called infantigo. This is a skin infection that could involve both staphylococcus and streptococcus bacteria. The bacteria cause a skin infection that usually begins with entry through a minor injury like chapped lips or irritated skin from frequent nose blowing. The lesions are itchy but not painful, and scratching spreads the bacteria to new areas.
The hallmark of impetigo is clusters of small, red sores, usually on the face and around the mouth of a young child, which rupture and become honey-colored crusts. Lesions heal in two to three weeks, and although at its height the infection can be visually shocking, it usually heals without leaving permanent scars. One unusual form of impetigo, called ecthyma, can penetrate to deeper layers of the skin and cause permanent scarring, but this is relatively rare.
When impetigo appears in an adult, the sores can be anywhere the skin is compromised. The face is possible, but other areas like the axillae or groin can also be affected due to friction injury.
Impetigo is highly contagious and difficult to control (it is difficult for young children to resist scratching the sores), and it has some serious complications, including the possibility of blood poisoning, central-nervous-system infection, and kidney failure. For these reasons, it is usually treated quickly and aggressively with antibiotics. Caregivers are also counseled to keep the lesions dry and remove the crusts as they form, because the bacteria continue to grow under them.
Conjunctivitis
Conjunctivitis, or pinkeye, is an umbrella term for any situation that causes the conjunctiva, a thin, transparent lining of the sclera and eyelids, to become inflamed. It can be caused by allergens, foreign bodies, fumes, and pollutants. This discussion will focus on viral and bacterial forms of this condition.
Viral conjunctivitis can be caused by several pathogens. Many infections involve viruses associated with common cold and flu, but more serious forms might involve other types of adenoviruses, rubeola (measles), rubella (German measles), herpes, or others. It is highly contagious and can spread through environments like classrooms, day cares, or homes with great speed. Viral conjunctivitis is marked by clear secretions from the eye. It is not responsive to antibiotics, so it is treated palliatively with compresses and eye drops.
Bacterial conjunctivitis is also highly contagious, but is less common among young children. In the United States, it is usually caused by Staphylococcus aureus or Streptococcus pneumoniae, but in developing countries, it is often related to Chlamydia trachomatis, a leading cause of preventable blindness.
Bacterial infections of the conjunctiva create a thick, sticky, pus-filled discharge from the eye, along with crusty deposits on the eyelid. They are usually treated successfully with topical antibiotics. It is important to treat pinkeye quickly, because it can lead to scarring of the cornea.
Pinkeye is spread when hands leave pathogens on surfaces. It is so contagious that students are urged to skip school and employees to stay home if they are infected. It’s important to remember that people in the same household as an infected person are also at risk for having and spreading the disease. This is an issue for massage therapists and clients, of course.
Other Infections
Several other infections that mostly affect children may occur in adults, but they are less common.
Chickenpox: This is a classic childhood infection. When it affects adults, it can be particularly severe and uncomfortable, but it usually occurs as a reblooming of the virus that has been dormant in the nervous system—an extremely painful condition called shingles. Postherpetic neuralgia is a complication involving long-term pain after the lesions have healed. (See “Comforting Clients with Postherpetic Neuralgia,” Massage & Bodywork June/July 2006, page 122, for more information.)
Measles: Most people born before 1957 had measles in early childhood, but a vaccination campaign that began in 1963 decreased the incidence of this disease in the United States by about 98 percent. It is still a threatening infection around the globe, and it claimed 164,000 lives in 2008.3 Measles is now rare in this country, but isolated outbreaks still occur among unvaccinated populations. Young adults moving into college settings are considered especially vulnerable and are often counseled to receive a vaccination booster, as are people working in medical facilities. Adults and very young children are most vulnerable to the complications of this virus, which include encephalitis, pneumonia, and serious problems with pregnancy.
Hand, Foot, and Mouth Disease (HFMD): This virus usually affects children under 5 years old with fever, sore throat, and a blistering rash in the mouth and on palms and soles. It is sometimes subclinical without major symptoms, but extreme cases can lead to the permanent loss of fingernails or toenails. More serious complications include encephalitis, severe dehydration, or viral meningitis. In a recent spike of HFMD diagnoses in the United States, 24 percent of the cases were adults, and all the patients had had recent contact with day-care or elementary-school settings. The strain of virus tied to this outbreak is unusually virulent, leading to blisters covering much more of the body, so this is an infection that bears watching. As of this writing, HFMD is not a reportable disease, so it is difficult to determine how common it might be.4
HFMD is a bigger issue outside of the United States. Recent travelers from China, India, Singapore, and other locations in Asia are at increased risk for exposure to this extremely contagious and potentially painful infection.
Impacts on Massage
How do these “childhood” infections impact decisions about massage therapy? A client with an acute case of pinkeye or chickenpox is unlikely to keep an appointment, so that is not a big issue. But a client who has a child at home with one of these problems may well come for a session and leave some microscopic passengers behind that may infect the massage therapist or subsequent clients. Most massage therapists probably don’t make a habit of inquiring about the health of people living with a client, so we may not know that our massage client had recently been picking at the impetigo lesions on her 5-year-old, or soaking the eye-crusties off her toddler who has pinkeye.
Contrary to how it may seem, this article isn’t intended to discourage massage therapists from practice. Rather, it is meant to point out that we cannot fulfill our potential to serve our clients if we are blindsided by a preventable infection. The potential for these conditions to cross from a family member to a client to a therapist, and then on to other clients, is yet another reason to be extremely conscientious about managing hygiene in our places of work. (See “Hygiene Fact and Fiction,” Massage & Bodywork, May/June 2012, page 36.)
In the meantime, be aware that the best defense is knowledge and appropriate action—consider yourself well armed!
Notes
1. Medscape, “Pertussis Incidence Rises as Fifth DTaP Dose Immunity Wanes,” accessed August 2013, www.medscape.com/viewarticle/780551.
2. Wall Street Journal, “Can Adults Catch Childhood Diseases?” accessed August 2013, http://online.wsj.com/article/SB10001424127887324423904578523194066341344.html.
3. Centers for Disease Control and Prevention, “Measles,” accessed August 2013, www.cdc.gov/vaccines/pubs/pinkbook/meas.html.
4. Washington Post, “A More Virulent Version of Hand, Foot and Mouth Diseases Hits Kids—and Parents,” accessed August 2013, www.washingtonpost.com/national/health-science/a-more-virulent-version-of-hand-foot-and-mouth-disease-hits-kids--and-parents/2012/09/16/63807780-f5f0-11e1-8398-0327ab83ab91_story.html.
Ruth Werner is a former massage therapist, a writer, and a continuing education provider approved by the NCBTMB. She wrote A Massage Therapist’s Guide to Pathology (Lippincott Williams & Wilkins, 2009), now in its fifth edition, which is used in massage schools worldwide. Werner is available at www.ruthwerner.com or wernerworkshops@ruthwerner.com.
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