Health Alert for Back-to-School. Part 2

Some people carry the bacteria in their upper respiratory passages. The bacteria can invade their bodies to cause meningococcal disease or can spread to other people via infectious respiratory secretions.

There are different groups of these bacteria — called serogroups — that cause infection. For example, from 1994 to 1998, approximately two-thirds of cases of meningococcal disease in people ages 18 to 23 were caused by three serogroups: C, Y and W135. This is important because the meningococcal vaccine protects against these three serogroups plus one other — serogroup A.

Signs and symptoms of the types of meningococcal infection include:

Bacteremia — fever; malaise; muscle aches; headache

Meningococcemia — fever; rash; overwhelming infection with multiple organs affected

Meningitis — fever; headache; stiff neck; nausea; vomiting; photophobia (sensitivity to light); confusion; sleepiness; seizures
In newborns and infants, the classic symptoms of fever, headache and stiff neck may be absent or difficult to detect.

If your child has any of these symptoms, he or she should see a doctor immediately, since untreated meningococcal infections can rapidly worsen and lead to shock and death within hours.

For adolescents or college students who don t relish seeing doctors, you as a parent need to impress upon your son or daughter the importance of not ignoring these symptoms.

The diagnosis of meningococcal infection is made in a laboratory by growing the bacteria from the affected site — the blood in bacteremia and meningococcemia and the cerebrospinal fluid in meningitis.

Cerebrospinal fluid, the fluid that bathes the brain and spinal cord, is obtained through a procedure called a lumbar puncture, or spinal tap. This procedure is routinely done when meningitis is suspected. During a spinal tap, a special needle is inserted into an area in the lower back, where fluid in the spinal canal is readily accessible.

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Neck Lump

Q.I have had a hard knot in my neck for two and a half months. I began to worry because my aunt died of Hodgkin’s disease in her 20s, which is my age. I went to a doctor, and he said it was normal and probably left over from a viral infection, and that if it is still present in two months to come and get a biopsy. He did not bother to ask any other questions.

I became very frustrated and upset. Now I’m not sure what to do. It’s only on one side, and it’s immovable and firm. I looked up the symptoms and have experienced most of the ones for Stage I. I’m a medical student and I am sure something is wrong, but I refuse to see that doctor again.


A. As I always say, if you are not happy with Doctor Number 1, go to Doctor Number 2. I must admit I do not like the description of an immobile mass and I would recommend a biopsy.

Certainly lymph nodes may become fibrotic (hardened) after an infection, but they are usually mobile.

(I have one behind my ear, and when I was a med student I was convinced it was a sign of cancer! I also thought I had beriberi; don’t ask me why — med school does strange things to the mind!)

You should have a CBC (complete blood count) done, and you should get a second opinion. Even if you have to see a doctor not covered under your health plan, the investment will be well worth the peace of mind. Good luck — with finding out what is going on with the neck mass as well as with medical school.