What's Going Around: Hand, foot and mouth, stomach bug, strep throat

Penn Medicine Lancaster General Health Physicians Roseville Pediatrics has seen a TON of hand, foot and mouth disease.

They have also continued to see strep throat in moderate amounts in addition to an increase in vomiting and viral gastroenteritis.

Even though it's summertime, they have seen a fair amount of viral colds and ear infections and continue to see swimmer's ear frequently. There's also been an increase in mono cases.
Dr. Joan Thode offered the following advice about hand, foot and mouth:

"Hand, foot and mouth disease is caused by one of a handful of viruses, particularly the Coxsackie virus. The rash appears as flat or slightly raised red spots with a small, fluid-filled bubble. It is often accompanied by a fever and decreased appetite and energy.

The rash can be found from head to toe, and often appears in clusters on the palms/fingers, soles/toes, lips and buttocks. Fingernails and toenails may appear abnormal or even fall off weeks later. (Don't worry; they will grow back!) When the lesions occur in the mouth, they will cause a very painful sore throat that may affect your child's willingness to eat or drink.

 There is no cure, and the virus will run its course in five to seven days. During this time, hydration is the number one goal. Ice water, popsicles, cold smoothies and crushed ice are ways of soothing the throat and maintaining hydration. Your child will regain lost calories once he or she feels better, so there is no need to fret if they are not taking in lots of solid food.

Hand, foot and mouth disease is contagious as long as your child has a fever and/or intact bubbles within the rash. The bubbles on the skin contain active viruses, which will spread the virus if the bubbles open. Once the rash begins to crust over and the fever improves, the immune system has killed the virus, and it no longer can be spread.

The virus can remain on surfaces for long periods of time. Toy-sharing is a major way of spreading the virus, particularly in day-care and school settings. Disinfecting toys and surfaces is a good way to lower the risk of infection. And lots of hand-washing!"
Thode also offered this reminder with the recent hot weather:

"With these hot days, please remember that a child can die within minutes in a hot car. The bodies of infants and children heat up much faster than adult bodies, and they can't dissipate the heat as easily when strapped in a car  seat. Without a way to cool off (and open windows are NOT enough), a child can reach an internal temperature of 107 degrees and die.
The number one reason for pediatric accidental heat stroke in cars is parental distraction. If your child is riding in the back seat, make a habit of creating a reminder. Some suggestions include: taking off one of your shoes and placing it in the back seat, keeping your purse/wallet/cell phone in the back seat, tying a string on the steering wheel or car keys, and turning your watch upside-down so glancing at it will remind you."

UPMC Pinnacle's Heritage Pediatrics is seeing alot of patients coming in for mosquito bites. Many people get "hypersensitivity" reactions to these kinds of bites, which leaves a local area of redness and swelling around the bite. Sometimes these areas are large and can be a few inches in diameter.  This usually happens pretty quickly; usually in first 24 hours after the bites. The redness and swelling can take a few days to go down.

"Over the counter hydrocortisone cream can help reduce the itching and swelling but check with your doctor before using it," Dr. Kathleen Zimmerman said. "If the redness does not decrease or becomes warm and painful to the touch, then you should see your doctor to make sure the skin did not become infected. Skin infection after an insect bite is more serious and needs medical attention."
This week, WellSpan Medical Group providers continue to see cases of sunburn, poison ivy and tick bites.
Following a holiday during which viewers may have spent time in the sun, WellSpan Medical Group providers want to remind everyone that excessive exposure to the sun and its ultraviolet (UV) rays can be serious and even cause skin cancer. Early detection and treatment are important. WellSpan Medical Group providers recommend performing frequent skin self-examinations using the ABCDE's of early detection, the changes in a mole or skin growth that are warning signs of melanoma.
They are:
Asymmetry: One half doesn't match the other half.
Border irregularity: The edges are ragged, notched, or blurred.
Color: The pigmentation is not uniform. Shades of tan, brown, and black are present. Dashes of red, white, and blue add to the mottled appearance. Color may spread from the edge of a mole into the surrounding skin.
Diameter: The size of the mole is greater than 6 mm (0.2 in.), or about the size of a pencil eraser.
Evolution: There is a change in the size, shape, symptoms (such as itching or tenderness), surface (especially bleeding), or color of a mole.
For more information, visit www.WellSpan.org.  Anyone with questions or concerns should contact their WellSpan primary care provider.
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 preforming "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. 

CVS MinuteClinic locations reported the following:
Submitted by: Jessica Myers, Nurse Practitioner, MinuteClinic in Lancaster
With this warm summer weather and outdoor activity we are seeing many bites and stings. Initial treatment for itching and swelling includes oral antihistamines (Benadryl/Claritin), topical anti-itch cream (hydrocortisone) and watchful waiting. If there's significant swelling, follow up with your primary care physician or MinuteClinic. Signs of infection include increasing redness, pain, drainage and fever. Treatment would include antibiotics. Any shortness of breath, racing heartbeat or difficulty breathing would be signs of a more severe allergic reaction to a sting and would require immediate emergency care.
Gastroenteritis or viral stomach illness is a common illness in our area this week in adults and children. We have seen locals and tourists with nausea, vomiting, abdominal cramping and diarrhea. Conservative treatment includes oral rehydration as tolerated, light diet and acetaminophen for headache/fever/body aches. We recommend evaluation by a health care professional for severe pain, bloody emesis or stools, vomiting that won't stop leading to dehydration and failure to improve over 24-48 hours. Prescription remedies are available to ease nausea.
Otitis externa or swimmer's ear was a diagnosed across all ages this week. 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 in York, we're continuing to see the following:
*Contact dermatitis or poison ivy, oak, sumac rash, eczema, and other allergic rashes
*Bug bites (infected and non-infected)
*Camp physicals (summer camps, etc.)
Treatment of poison ivy is based on severity. The number one tip is avoidance! Once the skin is exposed to the plant's oil, the area of skin contact should be cleansed as soon as possible after exposure.  Clothing should be washed in hot water.  To help with skin rash and inflammation, there are several medications that may be recommended.  Some include body soaks, oral anti-histamines, topical steroid creams and for very severe cases of inflammation/rash the patient may be prescribed oral steroid tapers.
Non-infected bug bite symptoms can be treated with cool packs, over the counter anti-inflammatory medications, oral anti-histamines and topical steroid creams.  Very severe cases may be prescribed oral steroid medications.  Avoid picking and scratching.  Avoid bugs when possible.  Protect against ticks and mosquitoes.  Inspect and exterminate if there's an infestation, such as bed bugs.
Infected bug bites will be treated with antibiotics.  Mild infection may be treated with topical prescription antibiotic and more severe cases will typically be treated with oral antibiotics.
Submitted by: Jessica Clabaugh, Nurse Practitioner, MinuteClinic in Lancaster
Strep throat is making a comeback in Harrisburg.  Primarily, we are seeing children with this illness, but adults have also been affected. Strep presents with a sudden sore throat and fever. Cough is usually absent during this infection.  Diagnosis is dependent on a throat sample. If a positive result is found, the infection will be treated with an oral antibiotic. Wash your hands often to help limit the spread of strep in our community.
Insect bites are common this time of year. Be mindful of your surroundings outside, and protect yourself against biting insects like mosquitos and ticks by using a repellant containing Deet. Over the counter products such as topical hydrocortisone or oral antihistamines can help with the itching and swelling associated with many bites. If you have signs of infection such as spreading redness or swelling, warmth to the touch of affected area, drainage of pus, or fever with or without generalized malaise present to your provider for further assessment. If you find a tick that has been attached to your skin for more than 36 hours, or have a spreading rash with a "bull's-eye" presentation present for initiation of antibiotic treatment.
Urushiol oil containing plants like poison ivy are common causes of blistering rash. If you believe you've come in contact with a poisonous plant, immediately rinse skin with water, a specialized poison plant wash, degreasing soap or detergent. Scrub under nails with a brush, and ensure that your pet's fur is also clean to limit spread of the urushiol. To reduce itching and blistering apply wet compresses or hydrocortisone cream to the affected areas. An oral antihistamine can also be taken to help relieve itching. Follow directions on the package, and know that drowsiness may occur with this kind of medication. Seek medical attention in severe cases where much of the body is covered, or if the rash is on the face or genitals.

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