What's Going Around: Hand, foot and mouth, Fifth disease

Penn Medicine Lancaster General Health Physicians Roseville Pediatrics is seeing a lot of swimmer's ear, as well as a moderate number of inner ear infections.

Strep throat is down, but viral infections are up. They saw an increase in impetigo and infections around the nails of the fingers and toes. Hand, foot and mouth disease is still going strong, in the toddler age group especially.
Dr. Joan Thode offered the following advice about ear infections:

"There are two main types of ear infections: an "inner" ear infection (otitis media) and an "outer" ear infection (otitis externa). The big difference between them is the location of the infection compared to the eardrum. The eardrum is a thin membrane that completely seals off the outer ear canal from the inner ear, thereby blocking fluid and bacteria from the outside world from entering the inner ear space.
Otitis media is an infection of fluid in the inner part of the ear, on the "inside" of the eardrum. It occurs when fluid that is naturally in the inner ear builds up and becomes stagnant due to inflammation, most commonly when the immune system fights a virus. The fluid stuck in the ear, which is a warm place, creates a perfect bacterial breeding ground.

The pain from inner ear infections comes when the fluid builds up and puts pressure on the eardrum. The body's army cells of the immune system also take up space, putting more pressure on the eardrum. The eardrum has a nerve that can take only so much stretch before it sends pain signals to the brain. This pain is best treated with a non-steroidal anti-inflammatory medication (ibuprofen) to decrease some of the inflammation.

Otitis externa is an infection of the ear canal. The most common cause for this is swimming, when water sits in the warm ear canal, creating a perfect environment for bacterial or even fungal infections to grow. The inflammation from the immune system fighting this infection causes acute external ear pain. There sometimes can be a thick ear discharge that frequently has a bad odor, though the symptom that diagnoses otitis externa is the pain.

It's important to try to keep the ears dry after swimming. External ear pain that persists for more than a couple days should be evaluated by a doctor, as antibiotic or antifungal ear drops may be indicated. Ear discharge should also always be evaluated by a doctor.

Pain from an inner ear infection will possibly improve with different positions, whereas pain from swimmer's ear will not. Burping, chewing or sneezing will make the pain of an inner ear infection much worse but will not affect the pain of an outer ear infection. Outer ear infection pain will get much worse when the earlobe is pulled or moved, or if the child sticks a finger into the ear canal.

Otitis externa is treated with drops, while otitis media is treated with oral antibiotics or potentially just with pain control, as the immune system will clear an inner ear infection on its own in most cases. Unless there is a rupture in the eardrum or the child has ear tubes, ear drops can't help an internal ear infection.

Since the eardrum completely seals off the inner ear from the outer ear canal, swimming cannot cause an inner ear infection. If your child has ear tubes, however, there is a connection through the ear canal, so it's important to check with your child's ENT physician about swimming recommendations, use of earplugs, etc."

UPMC Pinnacle's Heritage Pediatrics is seeing a common summer virus that causes "Fifth disease". Despite the name, this is actually a very mild illness. Many children don't feel ill but develop a classic rash with very red "slapped cheeks" and a flat lacy looking red rash on the arms, trunk, and sometimes legs. The rash can come and go for weeks, often it flares up in the heat.

Fifth disease is caused by a parvovirus. Once the rash develops the child is no longer contagious.

"However, if your child was in close contact with a pregnant woman before the rash broke out, she should be made aware to contact her provider in case testing needs to be done," Dr. Kathleen Zimmerman said.  "Parvovirus can have harmful effects on the baby before it's born."

CVS MinuteClinic locations across the Midstate report the following:
Submitted by: Jessica Myers, Nurse Practitioner, MinuteClinic in Lancaster
Tinea pedis (athlete's foot)-  Hot weather brings with it sweaty feet. Symptoms include itchy feet, redness and cracking between toes. Treatment includes good hygiene, careful drying between toes and changing socks and shoes frequently. Parents can send along socks to school especially on gym day and alternate shoes each day so they have a chance to dry. Other over-the-counter treatments include topical anti-fungal twice daily.
Poison Ivy- As it is warmer and children, adults and pets are in the yard we are seeing a few cases of poison. Symptoms included a rash on exposed areas and itching. Only areas contaminated with the plant oil will erupt. It is NOT contagious. Pets can spread the oil to surfaces. Initial treatment can include hydrocortisone creams and over-the-counter antihistamines. If severe or involving the face prescriptions are available for topical steroids or oral steroids.
Otitis externa or swimmer's ear was a diagnosed across all ages again this week among locals and tourists with increased water play and hot weather.  Symptoms include pain, itching and discharge from the ear. The canal appears red and may have drainage or debris inside. The outside of the ear can be tender and warm. Antibiotic ear drops are administered to treat infection and swelling of the canal. No restriction from school or work is needed if fever free. Symptoms improve rapidly with treatment. Risk factors for otitis externa include swimming, hot and humid weather, and eczema. Keep ears dry while undergoing treatment.
Submitted by: Stacey Basta, Nurse Practitioner, MinuteClinic in York
This week we have seen a number of skin rashes and insect bites. While many bug bites resolve on their own, if you are experiencing excessive redness, swelling, pain or symptoms such as fever, dizziness, tingling in the extremity of the bite, you should be evaluated by your trusted healthcare provider.

With the warmer temperatures, many children and adults will take to the pool to cool off. Swimmer's ear, or otitis externa, can result due to retained water in the ear canals and subsequent infection. If you are experiencing pain, muffled hearing or drainage from your ear, please be evaluated by your healthcare provider to determine the proper course of treatment. Don't forget to reapply sunscreen after swimming, even if the formulation is labeled as water resistant.
Submitted by: Jessica Clabaugh, Nurse Practitioner, MinuteClinic in Lancaster
Skin issues are bringing many patients young and old into the clinic. Presenting ailments include insect bites and rashes as well as bacterial and fungal infections. To protect yourself and family members ensure that you are dressed appropriately for outdoor yard work, that you are applying sunscreen and insect repellants, that you change out of damp clothing, and that you are keeping skin clean with soap and water washing.  If you have a spreading rash, infected bite, or area that is not healing, present to your provider for further evaluation.

We are starting to see many young athletes and camp participants for required participation physicals. Beat the rush by scheduling your physical ahead of time online. Also, ensure that your child is up to date on vaccinations as these will be required for school entry in August.

This week, WellSpan Medical Group providers are seeing an increase in the number of heat exhaustion cases, in addition to cases of sunburn, poison ivy and tick bites.
Heat exhaustion generally develops when a person is working or exercising in hot weather and does not drink enough liquids to replace those lost liquids. WellSpan Medical Group providers recommend having drinking water available if outdoors; keeping cool or limiting time outdoors during hot days; and for those who participate in sports or other outdoor activities, to consider a sports drink to replace electrolytes.  However, those with diabetes should keep a close eye on the sports drink's sugar content.
For sunburn prevention, WellSpan Medical Group providers recommend wearing sun-protective clothing, including hats, seeking shade when possible and applying sunscreen with UVA and UVB (broad spectrum) protection with at least SPF 15 before going outdoors.
Contact with poisonous plants such as ivy, oak and sumac can also be serious. It is recommended that those who may have come into contact with a poisonous plant to immediately wash the skin with warm soapy water. To control itching, use cool moist compresses and consider calamine lotion or hydrocortisone creams to cover the rash. Also, individuals are urged to leave the blisters alone and not to scratch or open them. Opening the blisters can increase the risk of infection. For prevention, wearing long sleeves when outdoors and learning which plants are poisonous can help.
For tick bite prevention, WellSpan Medical Group providers want to remind viewers who spend time outdoors to consider using an insect repellent with DEET - which is safe for all age groups - staying covered while in wooded or grassy areas and performing "tick checks" after going outdoors. However, insect repellent with DEET should not be sprayed in the face and eyes, but can be sprayed into the hands and then applied. WellSpan Medical Group providers also urge those individuals to seek treatment for any unusual rash or flu-like illness in the summer months, when tick bites are prevalent. 
Pediatricians and nurses at Penn State Medical Group sites in Cumberland and Lancaster counties are still seeing a lot of hand, foot and mouth disease. They are also seeing sunburns, insect bites, and tick bites. They remind people not to forget the sunscreen, bug repellant, and tick precautions.

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