Search
Close this search box.
December 6, 2024
Search
Close this search box.

Linking Northern and Central NJ, Bronx, Manhattan, Westchester and CT

This week marks the beginning of sum­mer. Children are home from school and the hot weather is upon us. A fre­quent complaint for visits to an urgent care fa­cility during the first hot summer weeks is an irritable child who will not eat. The cause of these symptoms may be enteroviruses, which are a group of viruses that live in the gastroin­testinal tract and are spread through contact with saliva, mucous, and feces.

As much as we mothers hate to admit it, children sneeze, spit, and yes, even pee in pools. All bodily fluids can have viruses which are easily picked up by other children who are enjoying the same body of water to cool them­selves off. One such virus, coxsackie, can infect children and produce a variety of symptoms.

More often than not, children come into contact with the virus and, thankfully, the im­mune system is working well and nothing hap­pens. The second more common event is the child has non-specific symptoms, such as low grade fever, malaise, muscle aches, and head­aches. These can last 3-5 days, and then resolve without any consequences.

Coxsackie virus infections, which are well known and frequently talked about in schools and day care centers, are hand-foot and mouth disease, herpangina, and hemorrhagic con­junctivitus. Hand, foot, and mouth disease should actually be called hand-foot-mouth-and-butt disease. This presents by the pres­ence of red blisters which are generally painful in the throat, gums, palms, and soles, and yes, in the rectal area. While the skin lesions are usu­ally not painful, the oral lesions are very pain­ful. Fever may or may not be present. The child may be less active and have general malaise. Herpangina is the presence of red, painful blis­ters and ulcers in the soft palate, tonsils, and posterior roof of the mouth.

One way to distinguish Herpangina from the oral lesions of Hand, Foot and Mouth Dis­ease is that Herpangina affects the back of the mouth (tonsils and soft palate), while Hand, Foot and Mouth affects the anterior portion of the mouth, such as anterior gums and inside of lips.

Hand, Foot and Mouth Disease and Her­pangina are self-limiting and usually resolve in a few days. No antibiotics are required. Pain management is indicated either with Tylenol (acetaminophen) or ibuprofen. Sometimes drinking is difficult and a numbing solution is indicated. Very rarely will a child become dehy­drated and need intravenous fluids.

Hemorrhagic conjuctivitis is an infection of the white part of the eyes which become red, painful, and itchy. Although viral in nature and generally not responsive to antibiotics, antibi­otic drops are frequently prescribed. If blurry vision is present, the child needs to see an eye specialist.

Other, less frequent, more serious infec­tions caused by coxsackie virus are meningi­tis, encephalitis, and myocarditis. Meningitis is an infection of the membranes that surround the brain and spinal column. The symptoms are irritability or lethargy, neck pain or stiffness, headaches, high fever, and malaise. Encephali­tis is an infection of the brain. In this case the child may have high fever, headaches, and al­tered mental status. Extreme lethargy is usually present. Myocarditis is an infection of the heart muscle which can produce abnormal rhythm of the heart and, in severe cases, heart failure.

Unfortunately the virus can be spread from mother to newborn during or immediately af­ter birth. Newborns and infants are at greater risk for more serious infections. These more se­rious infections require hospitalization with ag­gressive management. Luckily they are very rare.

Coxsackie viral infections are highly conta­gious. Children less than 5 are more at high risk for being infected. The virus survives on surfac­es for several days. Any surface which may con­tain saliva, mucous, or feces—such as chang­ing tables and shared toys—may spread the virus to whole day care classrooms. Prevention is always the same: hand washing, hand wash­ing, hand washing! This is one of those pearls learned from my grandmother that I did not appreciate when I was young. She would ob­sess about hand washing, even when we came out of our neighbor’s pool! And we had to shower immediately after a swim. She wasn’t a doctor, she was just wise!

By Dr. Giuseppina Benincasa-Feingold

Leave a Comment

Most Popular Articles