Which Illnesses are Going Around

by Beril Bayrak Bulucu, MD - May 2009

Which Illnesses are Going Around in Istanbul Schools This Month?

1-Beta strep
Beta hemolytic streptoccus group A, otherwise called as beta strep can cause pharyingitis as well as scarlet fever. This month there has been various cases of both in many schools of Istanbul. I will mention briefly what beta streptoccus is and ways to prevent and treat.

Beta streptococcus is a bacteria which has an incubation period of 3-10 days usually median of 7 days. It is very contagious, easily transferred from one child to the other and easily spreads in the school setting.

Streptoccocal pharyngitis is one picture caused by this bacteria. In this illness,there is usually high fever(38-40 deg celcius) throat pain,difficulty swallowing, belly pain and headaches as well as different rashes. Some kids might only have a belly pain and fever whereas another one might present only with vomiting.It usually responds very well to antibiotics and the fever sunsides within 48 hours. Untreated it usually resolves within 5-7 days but I will explain later why this is not advisable at all.

Scarlet fever is a febrile illness that presents with high fever with or without throat pain and a typical rash that appears like sandpaper.Affects the face and most of the body. Can cause a pale region around the mouth and  peeling of the skin on the fingers. Again if left untreated it would take 5-7 days to get better. With antibiotics the recovery is rather fast. (usually less than 48 hours)

Strep should be diagnosed by a physician. Usually quick tests and/or cultures will be used for diagnosing.Quick tests are very handy as they are quick and very specific (when it is positive it is positive) but they are not so sensitive (when negative can miss some cases of actual strep) . When the quick test is negative and clinical suspicion is high, it might be a good idea to send a culture as well. Sometimes physicians might diagnose strep only with the clinical picture and a typical looking throat especially if there are many cases around.
Usually it is a good idea to do testing as many viruses can imitate the clinical picture.

Why should beta strep be treated?
1-The primary reason is the complications like rheumatoid fever and post streptococcal glomerulonepritis (kidney infection that develops after strep, rare with this kind of strep more common with the skin types) Even though chances are low these complications are so severe that it is not worth to take a risk.All over the world it is a concensus to treat beta hemolytic group A strep, particularly for this reason. If treated within 9 days you practically eliminate the complication risk.

2-Treatment shortens the course of the illness. Children usually feel better in a few days and can continue their normal lives.

3-Treatment also prevents transfer from one child to the other. After 24 hours of the antibiotics children will not be contagious any more.
Treatment is usually penicillin group antibiotics.

How can illness be prevented?
Handwashing is a very important strategy for prevention. Also not sending the febrile kids to school and treating as soon as possible are important strategies as well.Schools should be notified if your child has strep.Also household contacts should be careful. Sick kids should not share drinks, utensils and etc.

2-Conjuctivitis
Also there has been few schools with many cases of conjunctivitis this month.

Conjuntivitis is the infection of the outermost layer of the eye. Can be caused by infectious agents like viruses and bacteria as well as  allergies\chemicals and other irritants (gas, foreign body)

The conjunctivitis that causes outbreaks at school is either viral or bacterial (most of the cases looked bacterial this month) Conjuctivitis causes redness in the eyes(one or both, but is easily transferred from one to the other) itching and a feeling as if there is a foreign body in the eye. Viral conjunctivitis usually causes clear discharge and not so much swelling around the lid whereas bacterial one causes a thick mucousy discharge and the eye appears `stuck together`and there is some swelling on the lid as well.
The diagnosis should be done by a medical doctor.

If the conjunctivitis is bacterial usually antibiotic drops are used as well as saline wash, if the diagnosis is viral only saline wash would be sufficient.

Conjuctivitis is contagious for 3 days, with the bacterial one if adequate therap is used transmission period is as short as 1 day.

It is usually recommended that kids stay out of school till they are not contagious any more. Even though this is debated in many places.`Why should kids be kept out of school for such a mild illness?`,the out of school recommendation is much supported by the rate it is transferred from child to child and it may be very hard to break the vicious cycle without keeping them out of school.

Usually conjunctivitis gets better without any problems and does not cause any further effects in the eye. One should be very careful if a child is complaining of worsening vision or if there is a remarkable swelling or redness around the eye a physician (and likely an eye doctor)should be consulted right away.

Hopefully all kids will have a healthy and joyful summer

Beril Bayrak Bulucu,MD FAAP
Pediatrician
Nispetiye cad, 35-6A Etiler ,Istanbul
Tel.212-3515008
www.berilbayrakbulucu.com

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