Case report: Clusters

Is it just me—and some mysterious form of ESP—or do other physicians encounter the same situation? Having been in family medicine for many years and now in a walk-in clinic where I see a large volume of various complaints, periodically I see a “cluster” of cases of a particular problem—on the same day.It seems that if one patient presents with a urine infection, two or three more will come on the same day—with the same problem. There are of course, always daily groups of people with sore throats, coughs, allergies etc., but less frequent—but more uncommon issues, also seem to come in clusters. Months apart, if I see one patient on a given day, say with a burn, I will see others that day—also with burns.Read: Case report: Why me?Perhaps it is only an illusion—and I only remember occasions where groups with a similar problem are seen—but this happens sufficiently frequently to appear to be a real phenomenon.A case in point was a nine-year-old healthy fair-skinned girl whose mother brought her in for diagnosis (although the mother already thought she knew the diagnosis—and wanted confirmation and treatment) of a nasty sore rash she had developed five days previously—and was spreading. Not only her arm (as shown in the attached picture), but the more common areas around her mouth and nose, were involved. Polysporin (as usual) had no effect. I agreed that the diagnosis was “impetigo”—bacterial in origin—and prescribed Fucidin cream topically and a course of oral Amoxil suspension. The patient had no known source of contact, no pets and a younger sister with no rash (yet). Curiously, the patient was reported to have had impetigo years before.I seem to recall having seen children with impetigo not infrequently years ago—but rarely for some reason—in recent years. In any case, during the rest of my day at the clinic, I saw two more children with impetigo. There was no connection or contact between the isolated cases. What produced the “cluster” is unknown. Probably random statistics—but one wonders about the possible prevalence of a particular infective organism circulating in children.I would be interested to know if other physicians have noticed the “cluster” phenomenon.Dr. Robert Dickson is a family physician in Hamilton. This report is based on a real case from Dr. Dickson’s files.

Case report: Clusters

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