ENTEROVIRUS INFECTIONS

Enterovirus infections are among the most common reasons a child will visit a pediatrician. The enteroviruses cause an estimated 10-15 million or more symptomatic infections a year in the United States. What this means is that you can expect your child to get sick with one of the enteroviruses many times in their childhood. 

Enteroviruses cause many different symptoms in infected individuals. Thankfully, most enterovirus infections are not serious and resolve on their own without treatment. Typically, the younger the infected person, the more severe the disease. Some very young infants infected with an enterovirus may have the appearance of sepsis (a severe bacterial infection of the blood) with high fever and lethargy, requiring tests to investigate what is causing the illness.

Thankfully, older children who become ill with enterovirus, usually develop much milder symptoms. This may include upper respiratory symptoms much like a “cold” with a runny nose, sore throat and cough. Headache is common with an enterovirus infection. Other children may develop a flu-like illness with fever and muscle aches. Many enteroviral infections cause a rash. Typically the rash is characterized by many very small, flat red dots on the skin of the chest and back with individual lesions having the size of a pin head (1/8th of an inch). Most of the time, the rash of enterovirus is the last symptom that kids will get before the virus is cleared from the body.

Another prominent feature of enterovirus infection is the development of vomiting and diarrhea sometimes associated with abdominal pain. Mouth ulcers are also possible. An individual child may have one or all of the above mentioned symptoms with any particular infection.

It is a very common scenario for a child with enterovirus infection to develop fever and vomit a few times on the first day of the illness. Then shortly later develop mild abdominal pain and mild diarrhea followed by symptoms of runny nose, cough and a mild sore throat. As the illness goes away by day 5 to 7, a fleeting rash as described above, lasts for 1 to 3 days and then fades. The child then completely recovers.

Hand, foot and mouth disease is a common peculiar enteroviral infection. Please see our section on this condition for more information. Eye infections (viral conjunctivitis) can also occur with enterovirus infections. The eye is red, but without purulent (pus) drainage. Recovery is the rule. No treatment is needed. Very rarely, a person may develop more severe infections due to enterovirus. These infections are rare.

How does someone become infected with one of these viruses? Enteroviruses can be found in the respiratory secretions (e.g., saliva, sputum, or nasal mucus) and stool of an infected person. Other persons may become infected by direct contact with secretions from an infected person or by contact with contaminated surfaces or objects, such as a drinking glass or telephone. Parents, teachers, and child care center workers may also become infected by contamination of the hands with stool from an infected infant or toddler during diaper changes.

On average, enteroviruses cause about four infections per child per year during the first several years of a child’s life. This is why a child may become repeatedly ill with a virus infection multiple times per year. In the United States, infections caused by the enteroviruses are most likely to occur during the summer and fall. No vaccine is currently available for prevention of infection with the non-polio enteroviruses.

Treatment:

The treatment of an enterovirus infection is supportive and determined by the symptoms present. Because it is a virus, there is no definitive treatment to stop this infection.

1. Cold symptoms are treated according to our “common cold” guidelines. Refer to “common cold” section.
2. Vomiting and diarrhea are treated according to “vomiting and diarrhea” guidelines. Give plenty of fluids to prevent dehydration. Sometimes ondansetron (Zofran) may be prescribed to control nausea.
3. Fever is treated according to our “fever” guidelines. We generally discourage the treatment of fever with enterovirus infections so that your body can fight this infection off unless the fever exceeds 102 degrees.
4. The rash of enterovirus may be treated with Benadryl or cetirizine. See our dosing guidelines for Benadryl and cetirizine. However, the rash will go away with no treatment.
5. More serious symptoms such as meningitis or encephalitis (severe headache and stiff neck), and myocarditis (chest pain and extreme fatigue) require the immediate attention of one of our physicians. These complications are quite rare.
6. Newborns and infants less than 2 months of age with fever require our immediate attention.