Friday, January 25, 2008

Lydia update

Hi everyone, this is Jen writing from the hospital in Port. Tara asked me to explain a little more about what's going on with Lydie.

Lydia has pneumococcal meningitis. Her initial spinal tap gram stain results on Tuesday night showed bacteria in the spinal fluid that appeared to be a bacterial called Streptococcus pneumoniae. Today the spinal fluid culture results came back and they confirmed the initial gram stain results. They also confirmed that the antibiotic Lydia's been on since Tuesday night is the right one to treat the infection.

Pneumococcal meningitis is a very serious infection no matter what country you're in. Without appropriate treatment it is always fatal. Early treatment with appropriate antibiotics is essential to prevent poor neurological outcomes. Even in developed countries like the U.S., the diagnosis is sometimes delayed, leading to various complications like respiratory failure, coma, shock, seizures, and bleeding disorders.

Babies in developed countries (including the United States) receive the Prevnar vaccine, which protects against seven serotypes of Streptococcus pneumoniae (the types that tend to cause the most serious infections). Lydia received one dose of this vaccine before she left the U.S. To be fully protected, children need to receive four doses (at 2, 4, 6, and 12 months of age). It's possible that she's infected with a serotype that's not in the vaccine, or it's possible that she's infected with a vaccine serotype, but that the one vaccine she received didn't afford her enough protection to fight off this infection completely (though it still probably helped some).

We'll never know where Lydia picked up this infection--because she became ill 7 days after she arrived in Haiti, it's possible she was infected either in the U.S. or in Haiti. Regardless, there's nothing that anyone could have done differently to prevent this from happening.

The great news is that Lydia is doing very, very well. I can't emphasize this enough! The meningitis was diagnosed early, antibiotics were started very quickly, and she hasn't had any concerning complications. She hasn't had any of the complications I mentioned above. Most importantly, she's never had any seizures or other neurological problems, and her fever resolved after 24 hours on antibiotics and hasn't returned. Also, she's been eating like a champ!

She's pretty irritable but this is common and to be expected in a baby who's being treated for meningitis. The reason is because as the antibiotics attack the bacteria around the brain and spinal cord, the immune system goes into overdrive, sending all sorts of cytokines and inflammatory chemicals in to help fight the infection. All of this is very irritating to the brain and spinal cord. If Lydia could talk, I'm sure she'd be telling us she has a massive headache and horrible neck pain. This should gradually get better over the next week or so.

This morning I discussed Lydia's story with Cindy, a good friend of mine who's a pediatric infectious disease doctor with over 20 years of experience working with children in both the United States and in Africa. She's very encouraged by how Lydia's doing, for all the reasons I already mentioned above (no fever, eating well, no seizures or other neurological signs, etc). Being in Haiti can be pretty isolating--it's easy to start second guess yourself on everything--so it was very reassuring to hear her perspective.

Lydia's been receiving Tylenol essentially around-the-clock since Tuesday. Cindy recommended that we watch her off Tylenol for 24 hours to make sure she doesn't develop any significant fevers, which could be a sign of problems and would require more testing and more time in the hospital. If this happens, we'll have to deal with it, but we're at a good hospital that can do the tests she'd need.

Lydia hasn't had any Tylenol since 9 AM this morning, and so far she hasn't had any fevers. If by tomorrow morning she's continuing to do well, we hope to leave the hospital and complete the rest of her 14-day treatment by giving her antibiotic injections twice a day at home (for you medical people--she's receiving Ceftriaxone). The most important thing is to treat meningitis with parenteral antibiotics--whether they're given intravenously (IV) or by intramuscular injection (IM) doesn't matter.

Babies and children who are treated for meningitis are at risk for various neurological sequelae, so Lydia will need close follow-up in the coming months to make sure her hearing and development are progressing normally. However, the risk of her developing these sequelae is relatively low because, again, she hasn't had any seizures or other neurological problems.

This is a scary thing to deal with here or anywhere...Thanks to everyone for praying and caring...we've felt it!!