Fever + scratchy throat + body aches + maybe some cough & runny nose = ?
If this were winter I’m guessing everyone would say “this is the flu” without any hesitation. Heck, they might not even bring their child in immediately for a medical evaluation because they know that the illness is simply a virus that is managed with time, patience, and supportive care (like fever reducers and hydration).
BUT IT’S NEARLY AUGUST. WHY ARE KIDS HAVING FLU-LIKE SYMPTOMS IN MIDDLE OF THE SUMMER?
Unfortunately, there are a few warm-weather viruses that circulate during the summer that cause flu-like symptoms. They are less notorious than influenza because they aren’t quite as contagious and therefore don’t spread like wildfire like the flu, but they’re out there. As unjazzy as this all sounds, I want to get the message out to the universe that circulating viruses are around all the time, because I’ve seen many patients lately who were surprised by this.
The most common virus that’s “out there” during warm weather months is actually a group of viruses called ENTEROVIRUSES. Coxsackie virus, Echovirus, and Rhinovirus are all in this category. These are described as picornaviruses (25¢). I’ve gotta digress here because of this 25 cent word: “pico” means small, RNA means just that- single stranded RNA for all you biology officianados out there, and virus. So, add them all up and they become smallRNAvirus, or picornavirus. Another fun fact is that the polio virus is related to this group. Enteroviruses are divided up into polio enteroviruses and non-polio enteroviruses. Related, but obviously VERY SEPARATE. ANY OLD HOW—
Non-polio enteroviruses cause a wide spectrum of illnesses—from simple stuff like I described above, to hand, foot and mouth disease, to more serious infections like myocarditis (infection of the heart muscle), and meningitis (infection of the tissues around the brain). Medscape estimates that they cause 10-15 million symptomatic infection per year in the United States. Fortunately, these more serious infections are pretty rare. That being said, in the summer, when kids have fever, headache, neck stiffness, light sensitivity, and sometimes vomiting, most physicians consider enterovirus meningitis on their list of possible causes and will occasionally perform a spinal tap (lumbar puncture) to make the diagnosis. Because the cause is VIRAL, supportive care is the only therapy that’s needed and the overwhelming majority of patients with this diagnosis recover beautifully with no long term adverse effects. No fun during, though.
I want to emphasize what I said just now- that treatment is SUPPORTIVE. What I mean by this is that the goal is to manage discomfort and maintain hydration. In the summer sometimes this can actually be MORE difficult than during the winter because during warmer weather, kids are more active in general, and so can get dehydrated more easily and feel weaker and more “worn out.”
So here are my recommendations:
- Hydrate as much as possible, and in between glasses of water I like to encourage a drink with some sugar in it to help the cells out and generate some energy. That way, kids with a bit more energy might do a better job hydrating on their own. I like to do equal parts apple juice and water, or equal parts Gatorade and water.
- Stay on top of the comfort measures and fever and pain-reducing medicines, like ibuprofen and acetaminophen. Same reason as above- kids who FEEL a little better and not so achy will do a better job hydrating themselves.
Are you noticing a trend here? The hydration component is positively CRUCIAL, and really one of the few risks of having the usual type of infection with an enterovirus.
What should you look out for?
- Signs of meningitis: stiff neck with fever, vomiting, and excessive sensitivity to light. The fancy name for this is photophobia.
- Signs of respiratory distress and/or prolonged, sustained rapid heart rate. Sometimes this can be seen with fever alone, but it needs to be on the radar. Rapid or difficulty breathing always needs to be checked out no matter what.
Now that you’ve read this, are you surprised that enteroviruses don’t get as much attention and publicity as influenza? I kind of am. They make up a lot of my clinical practice during warm weather and, in my opinion, deserve a bit more press than they appear to get. So that’s my feature article for today.