What’s Going Around: Flu strain not protected by flu shot, allergy symptoms

UPMC Pinnacle’s Heritage Pediatrics in Camp Hill continues to see a lot of fevers and sore throats.  Many are due to influenza. They are also seeing a lot of strep throat and some children are presenting with the classic rash of scarlet fever.

Scarlet fever is like strep throat but there is a classic rash on the body and usually a high fever as well as the usual symptoms of strep throat that include red sore throat, swollen tonsils and swollen neck lymph nodes, sometimes headache, abdominal pain and mild vomiting.  
The rash is actually not dangerous or contagious and the infection is treated with antibiotics the same way that strep throat is treated.  The rash can be quite noticeable; it is typically referred to as a “sandpaper” rash because there are many tiny red bumps on the skin close together so it feels like sandpaper.  

Usually, the redness appears on the face, neck and trunk first, but it can also be on the arms and legs and often in the creases of the groin.  The rash is caused by a skin toxin from the strep bacteria, but the rash does not need any special treatment.  Once antibiotics are started the fever and the sore throat should resolve within 48 hours, but the rash can take days to fade away.  Often as it fades, it is itchy and can cause some faint peeling of the skin.  Lotions can be used to help soothe the itchiness. 

WellSpan Pediatric Medicine Physicians have continued to see an uptick of cases of the flu over the past week, especially influenza A. These have also led into an uptick of sinus and lower respiratory infections. We’re also seeing the first increases in allergy symptoms of the season. This time of year it usually is mold and mildew as homes are very wet with the high water tables and also generally poor ventilation.

Penn Medicine Lancaster General Health Physicians Roseville Pediatrics continued to see an increase in influenza A. The current strain, unfortunately, is not one that is in the flu shot, so they are seeing the flu in the flu-vaccinated population, as well as the unvaccinated population. Flu-vaccinated kids, however, are generally having a less severe flu course overall.

They also have seen an increase in strep, and for the first time all winter, strep throat cases were greater than 50 percent of the sore throat cases they have been seeing. They also have seen more than one patient with flu and strep simultaneously.

Physicians at Roseville also have seen an increase in croup among the toddler population. Fevers, viral colds and ear infections have been persistently high. They have seen a sharp increase in bacterial pink eye in all ages.
Dr. Joan Thode offered the following advice about croup:

“Croup is caused by one of a few different viruses. The muscles that attach to the vocal cords become swollen and less functional due to the virus. As a result, the child will cough through a smaller space between the vocal cords, and that burst of air causes the vocal cords to vibrate, giving the cough a very voice-like, barky sound quality.

Typically with croup, the vocal cords are able to still open enough that the child can get adequate air. However, in severe cases, inflammation can cause the child to breathe through a much smaller hole, which can give the sense of not being able to “get the air in.” This sensation will often cause the child to try to take faster and deeper breaths, creating a voice-like sound called “stridor.” The presence of stridor is a reason to seek medical attention right away.

Croup does not always need to be treated. If the child can remain calm and keep their breathing under control, observation and supportive care during the viral symptoms are all that is needed. But if the croup is severe and the breathing space between the vocal cords is very small, steroids are sometimes needed to acutely relieve the inflammation and open the space between the cords.

Interestingly, warm, moist air and cold, dry air sometimes also can relieve some of the inflammation at the vocal cords. We therefore suggest that a child with stridor and croup be taken into a steamy bathroom or have their face positioned at the door of the freezer (or outside on a cold winter night) to help relieve the symptoms of breathlessness and stridor.

Croup is most common in kids younger than six years old. Older kids tend not to get croup because the diameter of their airway increases as they grow. The viruses may cause older kids to get a little hoarse, though they typically lack the bark cough and stridor. However, rarely older children can get this condition as well, known as “spasmodic croup.” It is treated the same way, with supportive care and sometimes steroids.”

This week at the CVS MinuteClinic in York there was less flu but many patients with continued upper respiratory viruses, as well as many with sinus and ear infections.

Viruses are treated with over-the-counter meds for symptom management.  Ear and sinus infections are treated appropriately with antibiotics and over-the-counter medications. Over-the-counter medications vary as needed per patient symptoms, but primarily target mucous and congestion, relief of pain and fever.

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