What’s Going Around: strep throat, seasonal allergies, stomach bug

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Providers at Penn State Children’s Hospital and Penn State Health Medical Group have seen cases of common cold and strep throat this week.

They are also starting to see a lot of seasonal allergies and wheezing, which are pretty common around this time of year. They have seen patients in the past week with a lot of asthma flares and remind parents that children with asthma should make sure they are taking any controller medications that have been prescribed.

This week at Penn Medicine Lancaster General Health Physicians Roseville Pediatrics saw a persistent high number of sore throats, with strep still only accounting for about 30 percent. Most, they say, have been viral.

Seasonal allergies increased sharply, and they oddly saw an increase in bad poison ivy cases.
Viral illnesses continue to be seen in high numbers. The stomach bug has been seen in high numbers, equally between school-aged kids and daycare/preschool-aged kids.

And as football and other fall sports seasons hit their busy time, the number of concussions also has increased.
 
Dr. Joan Thode offered the following advice about colds versus seasonal allergies:

“In the pediatric world, the start of school and the fall season typically comes with a lot of nasal congestion and drainage-some from colds and some from allergies.

Regardless of the source of nasal congestion and drainage, the physics of the nose and sinuses remain the same: mucous accumulates, drains the most easily down the back of the nose and into the throat (and thus eventually out of the body via the GI tract), and any “overflow” exits the front of the nose (hopefully into a tissue).

This drainage system is most efficient when the body is upright and gravity helps the mucous move down the throat. When a child lies down for sleep, however, gravity causes the mucous to pool in the back of the throat. This triggers the child’s defensive nerves, causing a cough to prevent choking. For this reason, with any form of nasal congestion at any age, a tickly, frustrating cough at night is the norm. Cough syrups are not suggested, as this cough is a defense mechanism of the body. Honey and warm water can help soothe the throat and stop the cough related to throat irritation, without stopping the defensive, helpful cough. Elevating the mattress or your child (depending on their age) can help gravity with that drainage process.

With a viral cold, the initial active, heavy nasal drainage improves after four to seven days. But the accumulated mucous continues to drain for an additional seven to 10 days, perpetuating the night cough. This is normal and known as a “protracted cough.” During that improvement time, there should not be any resurgence of fever or acute re-worsening of nasal congestion. If either of these situations occurs, your child should be evaluated by their doctor.

Seasonal allergies, on the other hand, occur due to the release of histamine from a subset of the immune system. Histamine is a chemical that aids the immune system in its job. In the case of seasonal allergies, a high amount of histamine is released into the bloodstream, which causes runny nose; congestion; itchy, watery eyes; and sneezing. As long as the allergens are present, that child will potentially have a runny nose and mucous production. However, because less energy is devoted to a large immune system reaction to the virus, kids with allergies tend to be a bit less tired and “wiped out” than kids with acute colds.

Antihistamine medications are designed to be taken daily to maintain a constant state of histamine control. Antihistamine drops can treat eye symptoms that persist despite the oral antihistamine. Nasal sprays do not affect histamine but rather calm the immune system reaction in the nose to help decrease congestion related to allergies. If your child has a known history of seasonal allergies, it’s not too soon to start the antihistamine medication regimen. The good news is that honey will help these kids too!”

CVS MinuteClinics across the Midstate report the following:

Lancaster:
Submitted by: Jessica Myers, Nurse Practitioner, MinuteClinic in Lancaster
 
Serous otitis media (middle ear effusion) – We have seen complaints of ear pain. Patients may suspect they have ear wax build up or an infection. OME is a fluid build-up behind the tympanic membrane. Symptoms include clogged ears, pressure or discomfort. Treatments include steroid nasal sprays (Flonase/Nasacort), antihistamines and/or Mucinex. Follow up if any fever or severe pain. Occasional need for referral to ENT if severe or chronic impacting hearing especially in developing toddlers.
 
Allergic Conjunctivitis- We have had a few complaints of watery, itchy and burning eyes with the increased pollen counts. Symptoms include puffy/swollen eyes, redness and itching. Treatments include oral antihistamine (Claritin/Zyrtec/Allegra) and OTC eye drops like Naphcon-A or Zaditor. Avoid exposure to allergens and rinse eyes with Natural Tears as needed. If eyes are crusting shut in the morning or with green-yellow drainage see a doctor to determine if bacterial infection is also present. Allergy eyes typically have a clear-white ropy discharge.
 
Flu vaccine- We have seen a significant increase in vaccine visit for flu vaccine. CDC recommends flu vaccine for all persons 6 months of age and older. It is not too early to vaccinate as it can take 2-4 weeks for sufficient immune response. Side effects include soreness at injection site, fatigue and minimal malaise for 1-2 days. Most patients report no adverse side effects. OTC pain reliever can be used as needed.
 
York:
Submitted by: Stacey Basta, Nurse Practitioner, MinuteClinic in York
 
This week in the York MinuteClinic the following were the most prevalent:
1) Upper respiratory infection
2) Bronchitis
3) Herpangina
4) Viral Pharyngitis
 
All of the above are viral illnesses that are treated with over-the-counter medications to help manage symptoms of fever, cough, sore throat. Symptoms typically last anywhere from a few days up to two weeks.
 
Harrisburg:
Submitted by: Jessica Clabaugh, Nurse Practitioner, MinuteClinic in Lancaster
 
Hand, foot and mouth disease has been noted in local schools and daycares. This is a common viral illness that usually affects infants and children younger than 5 years old. The illness starts with fever, reduced appetite and a sore throat. One or two days after the fever starts, painful sores can develop in the mouth A skin rash on the palms of the hands and soles of the feet may also develop over one or two days as flat, red spots, sometimes with blisters. It may also appear on the knees, elbows, buttocks or genital area. The viruses that cause hand, foot, and mouth disease can be found in an infected person’s nose and throat secretions, blister fluid and stool. Patients are most contagious the first week of illness, and should stay home while you are affected by hand foot and mouth. Antibiotics are not needed to treat this illness. However, you can do some things to relieve symptoms including taking over-the-counter medications to relieve pain and fever and using mouthwashes or sprays that numb mouth pain.
 
Sinus congestion and sore throat from post nasal drip continues to bring in many patients. Most sinus infections are viral in nature, and the illness tends to last ten to twelve days with symptoms peaking between day three to six. Support yourself through illness with lots of hydration, and a humidifier next to your bed at night. Over the counter medications such a pain relievers, and intranasal steroids can help to reduce the severity of symptoms experienced. If you are past day ten of illness, or if you have increasing facial pain or high fever, present to Minute Clinic or your primary care physician for further evaluation to see if an antibiotic is warranted.
 
Geisinger Holy Spirit Primary Care in Cumberland County reports fevers, cough/colds, and a stomach bug with diarrhea, vomiting and fever.
Geisinger Holy Spirit Primary Care in Dauphin, Perry and York counties reports cough, colds, sinus congestion and infections, fever and vomiting.

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