What’s Going Around: Croup, seasonal allergies

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UPMC Pinnacle’s Heritage Pediatrics is seeing a lot of croup this week.  Croup is a viral upper respiratory infection that causes a very barky cough, hoarse voice, sore throat and usually a fever the first three to five days.  The cough with croup is worst in the middle of the night and early morning hours.

The virus that causes croup causes swelling and mucous around the vocal cords. This creates a hoarse voice and the classic croup cough that can sound barky like a dog or seal. 

The younger the child is, the more difficulty they have with this cough.  In young children, they can have stridor, which is a loud breathing sound from the vocal cords.

The best thing to help the cough is moisture, such as running a cool mist humidifier in the room while they sleep, and offering cold or warm clear liquids to drink. If a young child is upset and crying, this will make the stridor worse, so calming them should help.  Sometimes sitting in a steamy bathroom can help.   If your child appears to be having trouble breathing and none of these things help, you should call your medical provider immediately.

This week, providers at Penn State Health are seeing some upper respiratory viral infections, including cough, sore throat and congestion. They’ve also treated a lot of pediatric patients for the common cold. They are also starting to see some seasonal asthma and wheezing.
 
Geisinger Holy Spirit Primary Care in Dauphin, Perry and York counties reported fever, colds, sinus issues, vomiting and diarrhea.

Geisinger Holy Spirit Pediatrics in Cumberland County reported croup, strep and seasonal allergies.
Penn Medicine Lancaster General Healthy Physicians Roseville Pediatrics reports continued cases of the stomach bug and rashes.

Colds and viral syndromes have been pretty persistent, and they have seen an increase in seasonal allergy symptoms.

Sore throats were seen in much higher numbers, with strep accounting for 20 to 30 percent of cases. Viral illnesses, as well as post-nasal drip, accounted for the rest. 

They also saw an increase in pink eye cases, with a pretty even split between bacterial, viral and allergic causes.
 
Dr. Joan Thode offered the following advice about conjunctivitis:

“Conjunctivitis is the general term for inflammation (“itis”) of the outer clear layer of the surface of the eye (conjunctiva). It typically appears as a ‘pink eye,’ but there are multiple possible causes of this condition.

Bacterial conjunctivitis is caused by a bacteria infecting the surface of the eye. It is frequently in only one eye and typically has thicker eye discharge. It can be painful or have a scratchy sensation when the child blinks. In babies, bacterial pink eye can frequently affect both eyes at the same time and should be evaluated for possible tear duct blockage. Bacterial pink eye is treated with eye drops by your child’s primary care provider. Until treated, it is very contagious.

Viral conjunctivitis is caused by a virus infecting the surface of the eye, and it is frequently seen in both eyes symmetrically. The discharge tends to be a bit thinner and more watery, though kids with viral conjunctivitis will frequently have crusting on their lashes after a period of sleep. Viral conjunctivitis is often seen in the second half of a virus and is often caused by the child rubbing their nose, then rubbing their eye, thus transferring the virus to the surface of the eye. The viral conjunctivitis will be killed off by the immune system at the same time that the immune system beats the virus elsewhere in the body. Antibiotic eye drops will not do anything to speed that process because they do not affect viruses. Unfortunately, viral conjunctivitis is also contagious by touch.

Allergic conjunctivitis is a reaction to the pollen or other allergens in the air. This causes the immune cells to release histamine, which makes the eyes red, itchy and watery. Itchy eyes are most likely allergic conjunctivitis. There is rarely thick eye drainage, though it is common for the eyes to tear a lot. The appropriate eye drops are antihistamine eye drops, rather than antibiotic drops, and these can be prescribed by your child’s primary care provider.

Reasons to see the doctor: thick drainage from the eye, pain with eye movement, eyelid swelling, pain with light/light sensitivity, symptoms that worsen over two to three days, eye redness with any recent eye trauma or suspected foreign body in the eye, changes in vision.”

CVS MinuteClinic locations across the Midstate reported the following this week:
Lancaster
Submitted by: Jessica Myers, Nurse Practitioner, MinuteClinic in Lancaster
 
Back to school is the perfect time to vaccinate against the flu. We are seeing many patients requesting flu vaccine for themselves and their families. It is not too soon to vaccinate. It can take up to four weeks for your immune system to make adequate antibodies. There are vaccines available for infants through seniors with the goal to protect as many people as possible. There has been reported flu deaths already for the 2018/2019 flu season.
 
We have seen some increase in fall allergy complaints such as runny/stuffy nose, itchy/watery eyes and sneezing. Over the counter remedies can be used initially like antihistamines, nasal sprays and eye drops. If not improving there are prescriptions remedies available to help control symptoms. Avoidance of allergens is a good preventive measure.
 
We continue to see both infected and non-infected insect bites. Symptoms include swelling, redness and itching to the site. Scratching increases risk for infection. Topical hydrocortisone, oral antihistamine such as Benadryl can be used. Avoid perfumed soaps and lotions. Use a mild soap such as Aveeno or Dove sensitive. Monitor for signs of infection.
 
York:
Submitted by: Stacey Basta, Nurse Practitioner, MinuteClinic in York
 
Now that the kids are back in school, our focus shifts to the upcoming flu season. Now is the time to schedule your seasonal influenza immunizations for everyone in the family ages six months and up. While the flu shot does not protect 100% against the flu, it is the single most preventative action we can take to prevent flu in our homes, schools and communities.

And while we are not seeing flu yet, the late summer weather has brought us other upper respiratory infections including coughs, runny noses and sore throats. Don’t forget infection preventions like good handwashing, coughing into your elbow or arm, getting plenty of sleep and good nutrition.

WellSpan Medical Group providers recommend parents and young people be aware of community illnesses that are more likely to spread among children due to the close quarters of school classrooms and day care settings. A few key elements for everyone to practice to prevent the spread of illnesses include frequent handwashing, covering coughs, and limiting face touches.
 
In addition, many illnesses out there, such as bronchitis, sinusitis, and laryngitis are typically viral in nature and do not require antibiotics. An assessment by your health care provider will help determine if an illness is viral or a bacterial infection, and the proper course of treatment.

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