March 1, 2001

PURPLE RASH KEEPS PARENTS ON THE ALERT

Summary: Meningococcal disease has caused three deaths in Oregon recently, and parents are
worried

by Kelly Kennedy
The Oregonian

   Connie Liakos Evers rushed her 11-year-old son, Sam, to the hospital with a fever and a rash
-- symptoms that can cause a parent to panic.
   In the past few months, Oregon has lost at least three people to meningococcal disease: a
college student in Eugene, a toddler in Dayton and a toddler in Seaside.
   It strikes quickly, rushing from sore throat to fever to rash to attacking the immune system in a
matter of hours. Liakos Evers had to make sure her boy wouldn't be a victim.
   "We've had quite a night," she said. "It looks like he's OK, but they admitted him overnight just
to make sure."
   In the next bed, a 13-year-old girl also had been admitted, just in case.
   A week later, both children were fine.
   The surge of the rare meningococcal disease has prompted calls from concerned parents.
   At Tualatin's Children's Clinic, office manager Margaret Goodman said the number of calls
from parents has been overwhelming. At the Portland Children's Clinic, advice nurse Trudy
Trezona has received an average of 100 calls a day for the past month.
   Meningococcal disease is caused by bacteria commonly found in about 15 percent of the
population, but they make only a few people sick.
   As the bacteria multiply, they release powerful toxins that damage blood vessels and attack the
immune system. They also can kill skin tissue, which is why some patients lose fingers, toes, noses
and limbs.
   "It's hard to know when to take them in," Liakos Evers said. "I remember going in because my
son stuffed a pea up his nose and being sent home. This was much more serious. This was scary."
   She said doctors are concerned as well.
   "I think doctors are being overly cautious," Liakos Evers said. "That's good. They're treating
them with antibiotics before they even diagnose it. If you catch it early, their chances are better."
   Sam was treated with antibiotics because it can take a little while to grow a culture to find out
whether a patient actually has the disease. In Sam's case, doctors decided not to take any
chances.
   For parents and clinic administrators, the disease causes a huge dilemma. Nurse Trezona said
it's physically impossible to see the 3,000 children of parents who have called worried about a
rash.
   In all the cases Trezona has heard about, secondhand smoke has been an issue -- and she
thinks that parents could use this scare as a reason to stop smoking.
   Though 90 percent of those who contract meningococcal disease live through it, according to
the national Centers for Disease Control and Prevention, there's still a risk of fatality. And 10
percent of those who survive suffer paralysis, stroke, permanent kidney or brain damage, and loss
of muscle, skin or limbs.
   "It's so alarming to people," Trezona said. "I've had parents tell me they've literally sat up all
night watching their children. Most of the time, it's just the flu or a cold, but it moves so fast, it's
difficult to reassure parents."
   So far, none of her patients have had meningococcal disease.
   "The incidence of it is down, but any time it makes the news, people worry," she said. "There
are certainly some other overwhelming infections out there, but this is the scary one. It's so
terrifying and so fatal. People call if their kid has a spot on his cheek."
   She recommends that parents pay close attention to the rash. It's not a bumpy rash, so it feels
smooth like the skin around it. It does not blanch, or turn white when touched; it stays purple.
And remember that it's rare.
   "If you're not medical, it can be hard to tell," Trezona said. "But I have not talked to anyone
who I actually thought had the disease."