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What's Going Around: High fevers, bronchiolitis, strep throat

UPMC Pinnacle's Heritage Pediatrics in Camp Hill reports seeing high fevers with muscle aches, headache, sore throat, and congestion. After three to five days of fever, the congestion and cough worsens.

"Some of these are caused by a virus," Dr. Kathleen Zimmerman said.  "There are some cases of strep throat also this week, which requires an antibiotic and can have similar symptoms."

If the fever is not easily reduced with over the counter fever reducers, including Tylenol and Motrin, or if the fevers go on and off for more than three days, then you should see your doctor or medical provider.  If your child's cough or symptoms are worsening and they are less playful and eating less, they should also be seen.

This week Penn Medicine Lancaster General Health Physicians Roseville Pediatrics saw a consistently high number of viral colds, and continued moderate amounts of pneumonia, both typical and "atypical" or "walking" pneumonia. Fevers are common with these viral illnesses.

Unfortunately, bronchiolitis has continued to steadily rise in babies and younger toddlers, causing varying degrees of respiratory distress.

Croup has persisted in moderate numbers in toddlers.

In older kids, strep was on the rise, being seen in around 40 percent of the sore throats tested.

They have been seeing a small bump in mono over the last couple weeks.

The stomach bug was seen, though in lower numbers than last week.

Dr. Joan Thode offered the following notes about sore throats and strep:

"In the winter months, sore throats are unfortunately common. The most common causes are viruses, post-nasal drip and strep.

Viruses, which often cause additional nasal congestion and fevers, can invade the tissues of the throat, as well as the nasal passages. The immune system responds by sending immune cells to the site to combat the virus. This immune cell invasion causes those tissues to swell slightly, which can cause pain. This pain will typically last throughout the day and go away in two to four days, as the immune system gains the upper hand and kills off the virus.

Post-nasal drip is another huge cause of sore throats. The nose, as part of its function to trap particles before they get to the lungs and to warm the air as it heads for our lungs, produces mucous naturally. Once it's done its job in the nose, this mucous gets sent down the back of the nose, into the throat, down the back wall of the throat and into the esophagus, where it is swallowed subconsciously with our saliva. This is an efficient and necessary process. Our nose essentially uses our GI system as a garbage disposal, and we get rid of the mucous from our other end in a day or so.

When a virus or allergies causes increased production of mucous in the nose, there is an increase in this drainage. Combine that with an increase in mouth breathing as a result of nasal congestion, and the tissues of the throat become raw, similar to how lips get chapped when licked. Even without an active cold, mouth breathing of dry air overnight in the winter months can cause some morning sore throat. Drinking water, warm tea or honey will greatly improve a sore throat from post-nasal drip much more than a sore throat from a virus or strep.

Strep throat tends to be a more severe sore throat, with frequent swelling of the lymph nodes of the throat. Strep often comes along with headaches and belly pain or nausea, and typically does NOT come with nasal congestion or runny nose. The diagnosis of strep is only made with a throat culture, so if your child has a combination of sore throat with either headache or belly symptoms, it's a good idea to get them to their doctor's office for testing.

Dangerous symptoms that warrant an immediate call to the doctor include: difficulty swallowing to the point where your child is drooling because he or she cannot swallow their saliva; severe pain only on one side of the throat that causes their voice to become very whispery; or sore throat that is accompanied by distressed breathing or the child's feeling like they can't inhale enough air."

CVS MinuteClinics across the Midstate reported the following this week:

Lancaster: submitted by Jessica Myers:  MinuteClinic Nurse Practitioner

Otitis Media: Ear infection: We have seen multiple children and adults with ear infections after reporting mild cold and upper respiratory symptoms leading up to new onset ear pain and fever. Treatment includes over-the-counter pain and fever reducers. Antibiotic therapy is indicated in many cases.

Sore throat:  We have tested many adults and children for strep throat this week. Most cases are viral. If sore throat is accompanied by other cold symptoms strep is less likely. If headache, lack of cold symptoms and fever are present or a history of strep throat testing is recommended.

Flu vaccine: We continue to see many requests for flu vaccine across all ages. It is not to late to be vaccinated as the peak of flu will be January through March. Vaccine is recommended for ALL individuals ages six months and up.

York: submitted by Stacey Basta, MinuteClinic Nurse Practitioner

Strep:  I have seen several cases of strep, particularly in the elementary aged school children. Strep is treated with antibiotic and supportive care, including no work or school for at least 24 hours.

Chest Infections:  I have also seen several chest infections, including viral bronchitis. It is best treated with supportive care and a rescue inhaler if needed.

Bacterial conjunctivitis: I have seen a case or two of bacterial pink eye treated with antibiotic drops. Patients should stay out of work and school for 24 hours.

There were a few cases of the flu at Penn State Children's Hospital this week, as well as a lot of viral respiratory infections and colds. Pediatricians at the Children's Hospital and Penn State Health Medical Group also say colds, ear infections, and bronchiolitis are going around. One pediatrician has seen a fair number of kids with allergies, which isn't terribly common this time of year.


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