What’s Going Around: Flu, strep throat, bronchiolitis

UPMC Pinnacle’s Heritage Pediatrics is still seeing influenza, stomach viruses, and strep throat. In the past week, they also started seeing more croup.

Croup can start out similarly to influenza and strep, with fevers and sore throat. A croup cough has a unique, hoarse barky sound. The younger a child is, especially babies and young toddlers, the more trouble they have with croup.

“If your child has a barky cough and is breathing loudly or struggling to breathe they need to be seen,” Dr. Kathleen Zimmerman said.

Penn Medicine Lancaster General Health Physicians Roseville Pediatrics reports cases of the flu, viral illnesses, bronchiolitis, pneumonia, coughs and colds, strep throat and fevers this week.    
Dr. Joan Thode offered the following notes about bronchiolitis vs. postnasal drainage cough:

“Babies and toddlers are notorious for wet, goopy-sounding coughs when they’re sick. This is more commonly due to nasal drainage in the throat but sometimes can indicate a more serious infection or inflammation of the lungs. It can be impossible to tell the difference in the cough sound, but the good news is that you don’t need to! The cough sound is not as concerning as the baby or child’s work of breathing. If the child appears to be using a lot of energy and effort to get each breath, it is time for medical evaluation and diagnosis.
Bronchiolitis is a virus-induced inflammation of the tiniest airways in the lungs. This typically affects babies and toddlers. With bronchiolitis, the small airways can swell shut/fill with mucous, preventing oxygen from getting to the air sacs at the end, causing an oxygen deficit. The lungs have millions of these air sacs, so most babies will compensate by using the ones that aren’t swollen shut.
When the body is at a decreased oxygen state, it tries to compensate with an increased breathing rate and breath volume. This includes using the ribcage muscles to forcefully expand the lungs with every breath. The belly will protrude with each breath, and there will be an exaggerated expansion of the ribcage (known as “retractions”). Sustained fast breathing or retractions are concerning signs that warrant medical evaluation.
Bronchiolitis follows a very typical course: It gets worse over the first four days, then starts to improve. The wet cough lasts during that time and for about one to two weeks afterward. There is, unfortunately, no treatment to make bronchiolitis go away faster. (If needed, oxygen can be provided to help the baby maximize use of air sacs that are still open.) Our best advice is to trust your gut as a parent that your child’s breathing isn’t quite right and bring them to medical attention sooner rather than later.
The baby or child will have a post-infection cough that will sound wet as excess mucous is coughed up and out of the lungs.
Viral coughing, on the other hand, sounds wet due to mucous from the nose, not the lungs. As we all know, viral upper respiratory infections create a lot of nasal mucous, which naturally drains down the back of the throat and eventually out of the body.
That descending mucous triggers the nerves at the top of the airway, causing a protective cough to push the mucous away. The blast of air through the thick mucous causes the cough to sound wet.
Viral coughs tend to occur after the start of nasal drainage and persist after the virus is done, due to continued drainage of accumulated nasal mucous. When a child lies down for sleep, gravity causes the mucous to pool in the back of the throat, and this wet cough can sound even worse. Coughing “fits” are more likely at night or early morning, because the mucous has had enough time to accumulate a larger volume in the back of the throat, requiring a lot more coughing to clear.
Again, unfortunately, there is no way to speed up this drainage process. The wet cough following a “cold” will typically not cause high rates of breathing or significant retractions, as the lungs’ ability to get oxygen is not affected by postnasal drainage. Thus, a child may have a similar sounding wet cough to a peer with bronchiolitis, but they are much less likely to have true respiratory distress.”

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

Submitted by: Jessica Myers, Nurse Practitioner, MinuteClinic in Lancaster
Pharyngitis (Sore Throat)- We have seen many patients with sore throat. Strep throat is a bacterial infection warranting antibiotic therapy. If fever, severe sore throat, headache and lack of other cold symptoms is present a rapid strep test would be recommended. Some sore throats are viral and improve with rest, fluids, ibuprofen, hot teas. Strep has been prevalent in the school age population and consideration of flu versus strep is important this time of year during peak flu season.
Influenza- We continue to see a rising number of flu cases. Patients present with abrupt onset of sore throat, fever, chest tightness, body aches, extreme fatigue and cough. Influenza is a viral illness that will run its course in 10-14 days. Patients at high risk should be evaluated by a health care provider. Tylenol and Advil is recommended to alternate for fever/aches. Rest, fluids and isolating from others to prevent spread. Children should not return to school until fever free x 24 hours and able to participate normally in all activities.
Flu vaccine- It is NOT too late. We have many weeks remaining of the 2018/2019 flu vaccine. Patients can be infected with flu A now and get flu B later in the season. Get vaccinated as soon as possible as it can take up to 2 weeks for a good immune response.
Submitted by: Stacey Basta, Nurse Practitioner, MinuteClinic in York
This week in York, mostly seeing flu-like virus, secondary infections from the flu (sinus, ear, pneumonia).
Flu is managed with anti-virals (if started early enough) and over the counter management of cough, fever.
Secondary infections (ear and sinus) are managed with antibiotics and symptom management medications.
Submitted by: Manny Ekwere, Nurse Practitioner, MinuteClinic in Lancaster
This week Harrisburg has seen ear infections, upper respiratory tract infections, allergies, sinus issues, cough and a few cases of the flu.

There’s a lot of the same going around this week at Penn State Children’s Hospital and Penn State Health Medical Group. Pediatricians are seeing upper respiratory infections, gastroenteritis and some bronchiolitis. Particularly at the Children’s Hospital, they’ve seen an increase in flu cases.

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