What’s Going Around: Hand, foot and mouth, allergies and asthma

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UPMC Pinnacle’s Heritage Pediatrics is starting to see more cases of hand, foot and mouth virus this week.

This virus can start with a fever, sometimes as high as 105, for three to five days. Then, tiny blisters start to show up; typically around the mouth, on the hands and feet, and often in the diaper area. Blisters also develop on the back of the mouth or throat and sometimes on the tongue. This causes a sore throat. Many children drool and refuse to drink or eat.

“Hand foot and mouth virus is very contagious,” Dr. Kathleen Zimmerman said.  “If you see a rash like this on your child or if they are not drinking well or saying they have a sore throat, call your medical provider.

There is no treatment for hand, foot and mouth. It will resolve on its own after about seven days. However, your child should not go to school while they have the fever or rash.   It is important to make sure your child is drinking enough fluids to stay hydrated. If you feel they are not, call your doctors office for guidance on pain control and signs of dehydration.

This week Penn State Children’s Hospital is treating some cases of the common cold and upper respiratory viruses, as well as seasonal allergies and asthma.

Pediatricians at the Children’s Hospital and providers at clinical sites in Lancaster and Cumberland counties say they are seeing a lot of seasonal allergies and asthma exacerbations. They are recommending to be sure children take any preventative medications they’ve been prescribed – such as Flonase or Flovent, or if Albuterol is needed pre-exercise.

To help cut down on seasonal allergy flare-ups, providers recommend washing your hands and face after being outdoors, keep shoes at the door, have clothing designated for “inside” and “outside” use, and don’t drive with the car windows down when the pollen counts are high. Also, some allergy medications take three days or more before seeing an effect, so if your child is trying something new, wait for a week to evaluate if it’s working.

Penn Medicine Lancaster General Health Physicians Roseville Pediatrics continued to see high numbers of allergy-suffering kids with the high pollen counts, which has made it harder for some kids to clear ear infections.  

They continued to see moderate numbers of the stomach bug and pink eye cases.

Strep throat was on the decline. However, they still diagnosed more than 30 cases.

Hand, foot and mouth disease is on the rise, and they saw a big increase in the number of poison ivy cases.
 
Dr. Joan Thode offered the following advice about conjunctivitis, or pink eye:

“Conjunctivitis is the general term for inflammation of the outer, clear layer of the surface of the eye. 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 physician. Until treated, it is very contagious.

Viral conjunctivitis is caused by a virus infecting the surface of the eye, and it frequently is seen in both eyes symmetrically. The discharge tends to be a bit thinner and waterier, 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 often caused by the child rubbing their nose and 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 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 anti-histamine eye drops rather than antibiotic drops, and these can be prescribed by your child’s primary physician.

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:

Lancaster:
Submitted by: Jessica Myers, Nurse Practitioner, MinuteClinic in Lancaster
 
Pharyngitis- (aka: sore throat)
Fifteen to 30 percent are bacterial with the remaining cases being attributed to viral or allergic causes. A higher fever and absence of cough are more predictive for strep throat (bacterial). A rapid test can be performed with results within five minutes. A confirmatory DNA probe is sent if needed with results within 24-48 hours. Bacterial strep throat is treated with antibiotics for 10 days. A child can return to school after 24 hours of therapy and fever free. Viral sore throats are treated with ibuprofen, gargles and supportive care. If allergies are the cause, over-the-counter antihistamines are recommended. See below for further related allergic conditions.
 
Allergic Rhinitis is a collection of symptoms involving the nose, eyes, ears and throat after exposure to an allergen like pollen. Symptoms include nasal congestion, runny nose, itching of the nose/ears, sneezing and itchy eyes. OTC antihistamine is first line treatment (Claritin/Allegra/Zyrtec). Nasal steroids are now over-the-counter and include Flonase and Nasacort. If allergies are unable to be managed with OTC therapy consider seeing an allergist for immunotherapy. Most weather phone apps include allergy information along with pollen.com to help guide decision making with outdoor activities.
 
Tinea versicolor is a common skin condition in teens and young adults. Symptoms include small scaled lesions that do not tan. Sometimes itching is present. It is caused by yeast and worsened by hot weather. Treatment includes topical antifungals like clotrimazole (Lotrimin) twice daily for 2-4 weeks. Prescription remedies are available if widespread or resistant to treatment. Retreating each spring is helpful to prevent recurrence.
 
York:
Submitted by: Stacey Basta, Nurse Practitioner, MinuteClinic in York
 
This week in the York MinuteClinic, spring allergies (allergic rhinitis), as well as conjunctivitis (both allergic and bacterial) account for the greatest number of visits.   Viral upper respiratory infections are the second highest reason for patient visits.  There was a marked decline in the number of visits for strep than the previous two weeks.
 
There were also a few visits for sprains.  Sprains are fairly common injuries to our ligaments that work to support our joints. Common parts of the body for sprains include areas such as our ankles, knees, wrists.  Sprains can result from various activities, but often occur as a result of sport activities, trauma, falls, etc. Treatment for sprains may vary some based on the severity of the sprain, but most commonly includes rest, ice, compression, and elevation of the affected site (RICE).
 
Harrisburg:
Submitted by: Jessica Clabaugh, Nurse Practitioner, MinuteClinic in Lancaster
 
We are seeing an increase in the number of patients presenting with symptoms of wheezing and shortness of breath. Many of these patients are known asthmatics. Asthma causes repeated episodes of wheezing, breathlessness, chest tightness, and nighttime or early morning coughing. If you have asthma, make sure that you have a good supply of your medication, and that you are working to avoid or control known triggers. If your child has asthma, ensure that they have access to their inhaler at school and sporting events. It is good practice to develop an asthma action plan with your provider. This plan shows your daily treatment, such as what kind of medicines to take and when to take them. It describes how to control asthma long-term AND how to handle worsening asthma, or attacks. The plan explains when to call the doctor or go to the emergency room. Children should have their plan on file at their school or daycare center.
 
Late spring sports and activities are bringing more minor sports injuries through the clinic door. Most of these injuries will improve with the use of simple analgesics (pain medication such as Tylenol) or Non-steroidal anti-inflammatory drugs (such as Ibuprofen). In addition, consider the practice of R.I.C.E (Rest, Ice, Compression, Elevation) along with range of motion and strengthening exercises to improve symptoms. If you have experienced a trauma, you have severe pain or inability to use the joint or affected body area, or if you have systemic symptoms like fever or weight loss please present to your provider or a higher level of care for prompt evaluation.
 
Sore throats and mild coughs continue to be a challenge this spring. There has been a reduction in the number of strep cases treated. This means that viruses and allergies are the most common causes for patient’s symptoms. If you have allergies, make sure you’re taking your daily medication, and avoiding triggers as able. Most viruses will peak between days three to six, antibiotics will not help this kind of illness. Ensure you stay hydrated and control the aches and pains with over the counter pain medication as needed. Coughing helps to clear mucus from your respiratory system, so allow yourself to cough throughout the day. Wash your hands often and cover your mouth to limit the spread of illness.

This week, WellSpan Medical Group providers continue to see a spike in seasonal allergy cases with eye and upper respiratory symptoms, in addition to asthma cases.  
 
It is recommended that asthma sufferers follow their asthma action plan and keep quick-relief inhalers close, if needed.
 
Seasonal allergies can cause complications for those who suffer from conditions, such as asthma and chronic obstructive pulmonary disease, or COPD. For those with mild seasonal allergies, WellSpan Medical Group providers say low-drowsy, over-the-counter antihistamines can help. They urge users to follow label instructions. In addition, other measures, such as limiting time outdoors and staying in air-conditioned areas, checking home air filters and wearing what is commonly referred to as a dust mask while performing tasks outdoors, such as mowing the lawn, may help.

Geisinger Holy Spirit reports the following this week:
Geisinger Holy Spirit Primary Care (Cumberland County): allergies, sore throat, cough, rashes, poison ivy
Geisinger Holy Spirit Primary Care (Dauphin and York counties): sinus issues, allergies, ticks
Geisinger Holy Spirit Primary Care (Perry County): allergies, coughs, ticks
Geisinger Holy Spirit Pediatrics (Cumberland and Dauphin counties): seasonal allergies, colds, diarrhea, strep, and hand, foot and mouth disease



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