PANDAS: What nurses need to know.

Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) describes a disorder that develops in children who abruptly develop neurologic abnormalities following a streptococcal infection. The authors discuss what is known about this poorly understood disorder and how nurses can educate and support patients and their families.

Infection-Related Glomerular Disease.

Glomerular disease results from a complex process. It can occur following acute illnesses or chronic diseases from other organs and body parts that promote bacterial invasion. Assessment and initial identification of the cause of this process is important in order to initiate interventions that promote a return to wellness. Prudent clinician judgment is necessary in client management in order to reduce the potential for long-standing renal disease. Medicinal intervention should be combined with patient education in addressing infection-related glomerular disease.

Group A Streptococcal Infection in Pregnancy and the Puerperium.

There has been an increasing incidence worldwide of invasive group A streptococcal disease in pregnancy and the puerperal period over the past 30 years. Group A Streptococcus (GAS) was identified as the major cause of maternal morbidity and mortality from sepsis before the identification that hand washing techniques could prevent the transmission of the bacteria. Hand washing remains the cornerstone of prevention as transmission can occur directly from an asymptomatic colonized healthcare provider, other patients, or a community-acquired source. Pregnancy and the puerperal period are associated with significant maternal physiologic changes that must be identified and clarified to identify signs and symptoms of GAS so that treatment can be initiated at the earliest moment. Treatment of group A streptococcal sepsis follows the guidelines developed under the Surviving Sepsis Campaign model. Maternal outcomes are improved by identifying risk factors and working with the perinatal team to implement rapid intervention. Even with prompt treatment of invasive group A Streptococcus, it remains the most common cause of infection that results in severe maternal morbidity and death in the world.

School Nurses on the Front Lines of Medicine: A Student With Fever and Sore Throat.

Fever and sore throat are common chief complaints encountered by school nurses. This article explains the etiology of both fever and sore throat in children, describes the office assessment, and delineates life-threatening complications associated with fever and sore throat that may prompt the school nurse to transfer the child to a local emergency department.

Rethinking bugs. Part 2.

Bacteria seem to be getting mentioned everywhere at the moment, and could even be said to be 'trending'. In this second instalment of a two-part article, I argue that we need to re-think the care and treatment we offer to women for a number of reasons. Using the example of group B strep disease, I argue that avenues other than the current treatment pathway are worthy of exploration, and with antibiotic resistance an increasing problem, this may be the best way forward. I conclude that, because the need for reconsideration of some elements of maternity care is so great, the current focus on bacteria and the potential that this has to throw new light onto old areas may be very helpful.

Pharyngitis: soothing the sore throat.

Sore throat is a common presentation in primary care. Accurate identification of cause is important for appropriate treatment. Clinical scoring systems and diagnostic tests are recommended to identify group A beta-hemolytic streptococcus, which warrants guideline-driven therapy. The article explores causes, diagnosis, management, and possible complications of pharyngitis.

Is It PANS, CANS, or PANDAS? Neuropsychiatric Pediatric Disorders That Are Not Black and White--Implications for the School Nurse.

The terms pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), pediatric acute-onset neuropsychiatric syndrome (PANS), and childhood acute neuropsychiatric symptoms (CANS) have all been used to describe certain acute onset neuropsychiatric pediatric disorders. Additionally, controversy is ongoing concerning the diagnosis and etiology of the disorders. The school nurse, as a member of a multidisciplinary team, benefits from an awareness of these disorders, the resulting impact on school performance, and the recommended treatment. The school nurse assists the team through the development of an Individualized Healthcare Plan to help the student to achieve success in school.

Group B streptococcus infection: risk and prevention.

Group B Streptococcus (group B Strep or GBS) is the UK's commonest cause of severe early-onset (up to six days) infection in babies. GBS is a normal body commensal, colonising the gut and vagina. GBS may pass to babies around childbirth; although most are unaffected, some develop severe infection. GBS is also a recognised cause of stillbirth and puerperal sepsis. Most GBS infection in babies is of early onset and most of these infections are highly preventable with the targeted use of intrapartum antibiotic prophylaxis. This article reviews current UK guidelines and prevention strategies.

Waterbirth and GBS.

The literature provides a single case of early onset newborn Group B Strep (GBS) among 4432 waterbirths, suggesting that low-risk women who give birth in water may have a far lower rate of newborn GBS than women who have a dry birth. The last reported rate of newborn GBS for dry births was 1 in 1450. Several theories for this phenomenon are suggested in this article: (1) inoculating the baby with mother's intestinal flora at birth protects against GBS infection; (2) water washes off the GBS bacteria acquired during the descent through the vagina; (3) the water dilutes the GBS bacteria and mixes it with a multitude of other intestinal bacteria that compete with GBS; (4) early onset GBS is elicited by complications and interventions at birth, which occur less often at water-births; (5) kangaroo care at birth promotes healthy newborns; (6) GBS and antibiotic-resistant GBS are more prevalent in hospital environments, where waterbirths are not an option; (7) a higher rate of underreporting of adverse events at waterbirths compared to dry births; and/or (8) a massively successful international campaign has covered up the reporting of all deaths and disease from GBS after waterbirths.