What’s Going Around: Hand, foot and mouth, insect bites


Penn Medicine Lancaster General Physicians Roseville Pediatrics saw an increase in the stomach bug with vomiting and diarrhea.

They also saw continued high amounts of hand, foot and mouth, an increase in strep throat and sore throats, as well as mono.

They also saw a spike in viral illnesses, particularly adenovirus. Some of those viruses presented with a high fever.
Dr. Joan Thode offered the following advice on sore throats:

“Strep, mono and adenovirus can all cause sore throats that may have white spots on the tonsils, as well as fever and belly pain. Adenovirus can also have a component of viral pink eye where the eyes appear red and tearing, whereas strep and mono do not typically affect the eyes. As its name suggests, adenovirus is a virus and therefore has no treatment. It typically resolves in five to seven days. Strep throat, on the other hand, is caused by a bacteria and needs to be treated with an antibiotic. A throat culture helps differentiate the three causes, therefore sore throats should be evaluated by a physician’s office.
Mono stands for a virus mononucleosis, which affects the spleen, lymph nodes, and tonsils while causing a body-wide illness, at times with extreme fatigue. Though in the past it has been labeled as ‘the kissing disease,’ it’s spread through secretions and even coughing. You can get it at any age. When mono affects the tonsils, they can become red, swollen, and covered in pus. The only way to test for mono is a blood test that is ordered by your child’s doctor.
Currently, another likely cause of sore throat is hand, foot and mouth (aka coxsackie virus). This virus causes blisters, and when present in the throat, can cause enough pain to prevent eating. The rash can be found from head to toe. 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.”

UPMC Pinnacle’s Heritage Pediatrics in Camp Hill reports seeing a lot 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. But the redness and swelling can take a few days to go down.

Over-the-counter hydrocortisone cream or Benadryl cream can help reduce the itching and swelling, but check with your doctor before using it.  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.
Prevention of insect bites includes avoiding being outside at dusk, especially near creeks or lakes where mosquitos are more prevalent.  If you plan to be out at these times, an insect repellant containing DEET is very effective at repelling mosquitoes.  For children, a lower percentage, about seven percent, is recommended.  Insect repellent should be washed off at the end of the day. 

CVS MinuteClinic locations across the Midstate report the following this week:

Submitted by: Jessica Myers, Nurse Practitioner, MinuteClinic in Lancaster
We are seeing an increase in vaccine visits for pediatric patients. Pa. school requires children to be vaccinated within five days of starting school. The most requested vaccine has been meningitis for seventh and 12th grade students. We recommend college students living in a dormitory consider Meningitis B vaccine for additional protection. It is common to experience redness and pain at the injection site, headache and fatigue after a vaccine. An over-the-counter pain reliever and ice to the injection site can help alleviate these expected side effects.
We have seen an increase in hand-foot-and mouth disease. It is a common viral illness in children. It is most common in children under 10 and symptoms can include a rash on hands and feet, sore throat, mouth ulcers, fever, abdominal discomfort and fatigue. The illness will resolve in seven to 10 days. It is contagious and exclusion from school and child care is advised.
Otitis externa was also diagnosed 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 in the York MinuteClinic, wellness visits still seem to be the majority of visits. There were a few visits for sore throats and upper respiratory infections. They are viral infections that are typically treated with over-the-counter medications as needed to help manage symptoms.

This week pediatricians at Penn State Children’s Hospital are seeing hand, foot and mouth disease and some adenovirus; both of which are common viruses that can cause a range of different illnesses, such as sore throat and bronchitis.

At clinical sites in Lancaster and Cumberland counties, providers have been seeing a lot of patients for school physicals and vaccine updates.

Pediatricians and nurses do recommend to start getting your kids back on a school sleep and activity schedules at least two weeks prior to the first day of school to get back in the routine and not be tired at school. Also for parents to know, if your child had any issues at school last year, be sure to touch base with their teacher this year so they can keep an eye out as the school year starts.

This week, WellSpan Medical Group providers are seeing cases hand-foot-and-mouth disease, tick bites and poison ivy.
Hand-foot-and-mouth disease is common in children but can also occur in adults. It can occur at any time of year but is most common in the summer and fall. The illness is caused by a virus that spreads easily through coughing and sneezing. For those affected, cold foods such as flavored ice pops and ice cream also may help with a sore throat. Over-the-counter medications can also help with pain and fever. For prevention, frequent hand-washing is recommended.
For tick bite prevention, WellSpan Medical Group providers recommend for those 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. 
Contact with poisonous plants such as ivy, oak and sumac can 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.

Geisinger Holy Spirit Primary Care in Cumberland County reports bug bites, rashes, coughs and sinus congestion.

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