Greenwich Public School Presentation for School Nurses 9/25/19 - Pink Eye, Rashes Associated with Fever, Vaping

1. Katherine Noble MD | “Dr. Katy”
September 25, 2019

2. OUTLINE
PINK EYE
RASHES ASSOCIATED WITH FEVER
VAPING

5. PINK EYE
SYMPTOMS
TRANSMISSION
TYPES & TREATMENT

6. SYMPTOMS
 Redness or swelling of the white of
the eye or inside the eyelids
 Increased amount of tears
 Eye discharge which may be clear,
yellow, white, or green
 Itchy, irritated, and/or burning eyes
 Gritty feeling in the eye
 Crusting of the eyelids or lashes
 Contact lenses that feel
uncomfortable and/or do not stay in
place on the eye

7. Close personal
contact, such as
touching or shaking
hands
The air, by coughing
and sneezing
Touching an object or surface
with germs on it, then
touching your eyes before
washing your hands

8. BASICS
 Distinguished by discharge/exudate
 Common Dec – April
 Super contagious
 May be associated with an ear infection
CAUSES
 Staphylococcus aureus, Streptococcus
pneumoniae, Haemophilus
influenzae, Moraxella catarrhalis
 Less commonly, Chlamydia
trachomatis and Neisseria gonorrhoeae
TREATMENT
 Most cases improve in 2-5 days
 Erythromycin ointment, Trimethoprim-
polymyxin drops, Tobramycin drops,
Ofloxacin drops

9.  BASICS
 Can occur with symptoms of a cold
 Usually begins in one eye and may
spread to the other eye within days
 Watery or mucoid discharge
CAUSES
 Many …. Adenovirus is common
 TREATMENT:
 Most cases are mild & clear up in 7 to 14
days without treatment and without any
sequelae

10.  BASICS
 More common in patients with hayfever & allergic
diseases
 Usually occurs in both eyes
 Associated with intense itching, tearing, and swelling
in the eyes
 May occur with other allergy symptoms, such as an
itchy nose, sneezing, irritated throat, or asthma
 CAUSES
 Pollen from trees, plants, grasses, and weeds
 Dust mites & Animal dander
 Molds
 Contact lenses and lens solution
 Cosmetics
 TREATMENT
 Lubricant drops & Antihistamine drops

11. RED
Loss of vision
Ciliary flush
(redness at the
juncture between
cornea & sclera)
Photophobia
Severe foreign
body sensation
Corneal opacity
Constant or
severe headache
(concerns about
glaucoma)

12. PREVENTION
TIPS FROM
THE CDC
 Wash your hands often with soap and warm
water
 Avoid touching or rubbing your eyes.
 With clean hands, wash any discharge from
around your eye(s) several times a day using
a clean, wet washcloth or fresh cotton ball.
 Do not use the same eye drop
dispenser/bottle for your infected and non-
infected eyes.
 Wash pillowcases, sheets, washcloths, and
towels
 Stop wearing contact lenses until your eye
doctor says it’s okay to start wearing them
again.
 Clean eyeglasses
 Clean, store, and replace your contact lenses
as instructed by your eye doctor.
 Do not share personal items
 Do not use swimming pools while infected!

14. Fever is a sign of disease,
not a disease itself.
Fever is a normal
response to infection
In immunized children with a normal immune
system, most fevers are due to mild viral
infections which self-resolve
The clinical appearance of a child is important
in assessing fever … more important than the
height of the temperature
Fever persists until the disease process
resolves … prolonged fever or ill-appearance in
a child always warrants medical evaluation!

15. Fever treatment should be focused on making the child
comfortable, rather than treating a specific number
Fever can be treated with
Motrin or Tylenol
Tylenol and Motrin are both safe
Tylenol and Motrin offer similar anti-pain effects
Motrin offers slightly better fever reduction and
lasts longer.... Motrin is also anti-inflammatory

16.  The skin is the largest organ in the body.
Disease can manifest in skin just as it can in any
other organ of the body.
 Defined: “changes in the color or texture of your
skin” (NLM)
 Descriptives:
 Texture: raised or bumpy, flat, thickened,
blistered
 Color: red, pink, purple, brown, flesh-colored
 Location: limbs, torso, face
 Pattern of spread: limbs to torso, torso to
limbs, etc.
 Other qualities: itchy, painful, hot/warm to
the touch

17.  Infection (virus, bacteria, fungal)
 Autoimmune (psoriasis, lupus, Kawasaki’s disease)
 Allergic (hives, eczema)
 Medications
 Insect bites
 Contacts & irritants

18. Viruses
Coxsackie (hand-foot-mouth disease),
Parvovirus (fifth disease), Roseola, Measles,
Varicella (chicken pox) and others
Bacteria
Group A strep (strep throat, scarlet fever)
Strep and Staph (cellulitis, bacteremia)
Neisseria meningitidis (meningococcemia)
Fungus
Do not typically cause rash & fever in
patients with a competent immune
system

20.  Caused most commonly by coxsackie virus A16
 Affects mostly children <10y during summer and early
fall
 Transmission: air droplets, touching droplets and
then touch your own nose or mouth, also contact with
stool or blister fluid of infected person
 Incubation: 3 to 7 days
 Symptoms: fever, headache, loss of appetite, sore
throat with ulcerations of throat, mouth, tongue, and
rash (which can be painful)
 Diagnosis: clinical
 Duration: typically 5-7 days
 Treatment: supportive (Motrin/Tylenol and fluids)

23. Fifth Disease
(Erythema
infectiosum)
 Caused by human parvovirus B19
 Affects preschoolers & school-aged children
during the spring
 Transmission: respiratory/ air droplets
 Incubation: 4-14 days
 Symptoms: fever, headache, runny nose,
rash, sometimes joint pain & swelling
 20% of infected individuals have NO symptoms!
 Diagnosis: usually clinical, but blood testing
can be done
 Treatment: supportive
 Complications: rare but include aplastic
anemia and danger to unborn fetus

26. Chicken Pox
 Caused by the varicella-zoster virus (herpes family) …. Also
causes shingles in adults
 Affects mostly children <10 years. Adults and older children
generally are sicker.
 Incubation: 10-21 days (Contagious 1-2 days before blisters
appear)
 Transmission: respiratory or contact with fluid from a
blister
 Duration: 5-10 days
 Symptoms: fever, headache, stomach ache … prior to rash
 Diagnosis: clinical, labs if needed
 Treatment: supportive – may include antihistamines &
hydrocortisone cream … rarely, an antiviral medication may
be prescribed.
 Back to school when all lesions crusted over!
 Prognosis: excellent, complications are rare but can be
severe, 10% will develop shingles as an adult.

30. Measles
(Rubeola)
 Caused by measles virus
 Can affect anyone, in particular unvaccinated or
partially vaccinated patients
 Transmission: air droplet/ respiratory, highly
contagious
 Incubation: 8-12 days
 Duration: rash starts 3-5 days after symptoms of
illness and may last 4-7 days
 Symptoms: rash is often the main symptoms, also
bloodshot eyes or conjunctivitis, cough, fever, light
sensitivity, muscle pain, runny nose, sore throat, tiny
white spots in mouth (Koplik’s spots)
 Diagnosis: clinically (at least 3 days of fever, then
cough, choryza or conjunctivitis), measles serology
(blood test), viral culture (rare)
 Treatment: supportive, also Vitamin A
 Complications: bronchitis, pneumonia, ear
infections, encephalitis

33. Scarlet Fever
 Caused by Group A Strep – toxin-mediated
rash
 Incubation: 1-2 days
 Transmission: respiratory droplets/ saliva
 Symptoms: fever/chills, sore throat,
strawberry tongue, abdominal pain, vomiting,
red creases in the underarm/groin (Pastia’s
lines), headache, muscle aches

40. Requires
medical
attention

41. Requires
IMMEDIATE
MEDICAL
ATTENTION

42. A NEW PUBLIC HEALTH THREAT ...

43. Battery operated devices
that heat liquid into a vapor
that can be inhaled
Entered the market in
China 2003, in US and
Europe 20016
Up until this point, little to
no government regulation

44. e-cigs
e-hookahs
hookah pens
vapes
vape pens
mods (customizable, more powerful
vaporizers)

46. NICOTINE – OFTEN AT
VERY HIGH LEVELS
PROPYLENE
GLYCOL/GLYCEROL
FLAVORINGS OTHER COMPOUNDS
(METALS, VOLATILE
ORGANIC & PHENOLIC
COMPOUNDS)

47.  Social Media Buzz
 Sponsoring concerts and events
 Appealing Flavors

48. Prevalence in Youth
 2018 NYTS Data: A Startling Rise in Youth E-cigarette Use

49. Prevalence in Youth
 2018 NYTS Data: A Startling Rise in Youth E-cigarette Use

52. This is not the
healthier
alternative to
standard
nicotine-based
cigarette
smoking it was
marketed to be

53. Source: CDC.gov

54. Source: CNBC.com

58. drkaty@soundbeachpediatrics.com
(203) 363-0123