Fever in the summer

Viruses are present at every time of the year.  They can cause many symptoms including runny noses, sore throats, rashes, and fever.  There is a group of viruses that becomes more prevalent in the summer called enterovirus, which includes more than 90 different types, and can infect people of all ages, most commonly infants and young children.  More than 90 percent of the infections caused by enterovirus are either asymptomatic or will cause a nonspecific febrile illness.  Some examples of enterovirus are poliovirus, for which we vaccinate our patients, and coxsackievirus, more commonly known as herpangina or “hand, foot, mouth” syndrome.

Infants younger than 1 year are more likely to be infected with an enterovirus, and boys may be twice as likely to be infected as girls.  Enterovirus is spread by direct contact, most often by a fecal-oral route, as with diaper changing, or with contact with nasal discharge or saliva.  Once infected, a child can shed the virus, which makes for easy transmission to close household contacts.  The incubation period is usually from 3 to 5 days, and in the case of coxsackievirus, the child is usually most contagious during the first week of the illness.

Many of the enterovirus infections can cause a nonspecific rash and fever.  The fever usually lasts from 24 to 36 hours, followed by the appearance of small, non- itchy, light pink patches on the face and upper chest.  The rash will usually last well beyond the fever, and resolve on its own.

Hand, foot, mouth syndrome is one of the most common enterovirus infections.  It normally presents with fever, blisters on the skin of the lips, cheeks or tongue, and a rash of small, tender patches on the hands, feet, buttock, and sometimes genitalia.  This is a contagious illness, more so in the first week.  Children should be kept out of group settings during the first few days of illness, especially if there are any open lesions.  Hand, foot, mouth syndrome usually resolves in two to three days.

Herpangina, another common infection, normally affects children from 3 to 10 years old.  Like hand, foot, mouth syndrome, this virus causes fever and blisters in the mouth, usually in the back of the throat.  This can result in sore throats as well as some difficulty eating.

It is important to remember that the majority of enterovirus infections are self-limited and do not require any specific treatment other than supportive care.  Pain management with either ibuprofen or acetaminophen is usually sufficient, as well as encouraging fluid intake.

Some forms of enterovirus can cause more serious illness, including polio, viral meningitis, and encephalitis.  If there is any concern for one of these infections, your pediatrician should be contacted immediately.

Fever is a common symptom of illness in all age groups at any time of the year and enterovirus is just one of many sources of fever and infection during the summer.  Fever should not be your only guideline when deciding if your child is ill.  There is a range of normal temperatures, and paying close attention to your child’s behavior is the key to deciding the course of treatment.  Remember to always contact your pediatrician if you have any questions or concerns regarding fever or other symptoms.