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
