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Adenovirus: This Virus Is Super Tricky

Adenovirus is going around. It’s a sneaky little virus (it can infect just about anywhere and happen anytime of the year). However, the sore throat, fever, pink-eye combo that happens most commonly in the summer is in full swing in our community now. The key to this little bug is prevention. Don’t get it in the first place. Wash your hands like crazy and make your kids do the same.

Adenovirus causes all sorts of problems

It can infect multiple organ systems, which makes it unique. There aren’t many viruses out there that can cause respiratory illness, GI illness (the vomit/diarrhea bug), conjunctivitis (pink eye), urinary tract infections, you name it. Stupid, but interesting random fact: the virus causes cancer in rodents, but not in humans. Go figure. Here’s the low down.

Kids hit the hardest

While anyone can get this nasty little bug, kids get the short end of the stick. Young children are affected the most. Interestingly, there is also a peak seen in military recruits (accounted for by their close quarters).

What are adenovirus symptoms?

This is the trick. Because adenovirus can infect all different parts of the body (and sometimes at the same time), it can present in all different ways.

  1. Respiratory symptoms: Cough, runny nose, sore throat, fever. The symptoms can be pretty severe and will even look like RSV. The key is what symptoms go together. If you have a case of bronchitis and conjunctivitis (pink eye), that is almost always adenovirus. Other viruses don’t usually give you pink eye with lower respiratory tract infections.
  2. GI symptoms (Gastroenteritis): Vomiting and diarrhea. It is quite common in the daycare setting.
  3. Urine/kidney symptoms: Painful urination, frequent urination, and blood in the urine.

How do you catch adenovirus?

The site of entry usually determines the site of infection. If the virus goes in the respiratory tract via inhaling infected droplets, you get a respiratory bug. If you ingest fecal material, you’ll get a GI (gastrointestinal) bug. I know the concept is gross, but this is how it works. Infected person A doesn’t wash his/her hands after going to the bathroom (or changing their infected child’s diaper) and touches the door handle. You come along and touch the infected door handle. Your hands now have infected material. When you later wipe your mouth, voila, you’re infected. It’s a hardy little virus and can survive a long time outside of a host (which means surfaces stay infectious for a long time). FYI, water can get infected also. Once again, here’s another reason to make sure pools are chlorinated properly.

How is adenovirus diagnosed?

There are fancy lab tests to diagnose adenovirus. Most of the time we don’t do them as there isn’t a cure and the tests are expensive. However, sometimes there are circumstances where testing is done (e.g., severe symptoms, young infants, prolonged fever, immunocompromised patients). The patients that we have specifically tested in our office over the last few weeks have all been positive for adenovirus. The location tested reflects the presenting symptoms. If the symptoms are respiratory, we usually use a swab that goes up the nose. If the problem is diarrhea or bloody urine, a stool sample or urine sample is tested. Blood tests are hit-and-miss whether they are helpful (as most people will have positive titers anyhow by the time they are school-aged). Most of the time, the diagnosis is made clinically. I feel like such a detective when I piece together some of the adenovirus unique infectious qualities, and make the diagnosis.

Is there a treatment?

Unfortunately, there is no cure to adenovirus. Since it is a virus, antibiotics don’t help. In fact, antibiotics will just make matters worse. Antibiotics screw with your child’s normal flora and contribute to antibiotic resistance. So don’t buy into the “just in case” mentality with antibiotics.

The treatment is completely supportive. In essence, you treat the symptoms to make the infected person feel better. If there is fever, treat the fever (with Tylenol or Motrin). If there is vomiting and diarrhea, push fluids to keep the person hydrated.

Should you take your child to the doctor?

I end up seeing a ton of cases of adenovirus in the office because what to do often isn’t clear cut. The problem is that the symptoms of adenovirus often cross over with more concerning illnesses that should be seen. For example, if your child has a sore throat, it is reasonable to ensure the infection isn’t strep (which has to see a doctor for antibiotic treatment). If your child has pink eye, you probable should get that checked out to make sure it isn’t bacterial and needs a drop. So you can see how it’s a difficult call for a parent to make. If the symptoms are severe, prolonged, or questionable you probably should take your child in (or if your child is under 2 months old). If you’re certain it’s adenovirus (e.g., another child of yours has already seen the doctor and been diagnosed), then you don’t need to see the doctor.

When are you out of the clear?

Now that you have a child infected with adenovirus at your house, when are you done with it? When can you stop worrying about the other kids in your house getting it? Here’s more bad news. Once exposed, it can take 2 days to 2 weeks to develop symptoms. To make matters worse, as already mentioned, the virus is really hardy and lives on surfaces a long time (toys, towels, light switches, etc). Unfortunately, that means more cleaning (add it to the never ending list, right?). It’s not uncommon for me to see families who have been dealing with this virus in one way or another for weeks and weeks in their houses. I’m sorry to be the bearer of the bad news.

One special subtype: the “super cold”

It’s worth mentioning, since it’s gotten a fair amount of press coverage over the years, there is one serotype (which is essentially a certain strain) of adenovirus called serotype 14 that is sometimes referred to as the “super cold.” When people get this strain, the symptoms tend to be very severe (with roughly 40% requiring hospitalization and half of those in the intensive care unit). This is diagnosed when specific testing is done (once again, getting to the severe cases).

Rhinovirus – The Bug That’s Going Around

Rhinovirus seems to be the virus de jour in the last few weeks. In medicine, we often don’t go to the effort to do specific viral testing on kids who appear to have “just a cold.” The test is painful (a swab up the nose), is expensive (hundreds of dollars), and takes time and effort. If there was a cure, it would probably be worth doing more often. However, there are still plenty of reasons to test (e.g., a child who isn’t getting better, a child with an underlying immune problem, a newborn with fever). In the last few weeks, most of the kids we have tested for one reason or another have been positive for rhinovirus. So it is definitely going around.

What is rhinovirus and do I need to stress about it?

Rhinovirus is the most common viral infection in humans. It is the predominant cause of the “common cold,” although there are other viruses that cause colds. It typically infects the upper respiratory system. Random trivia: “rhino” comes from the Greek word meaning nose, so I always think of it as the bug that causes all your crummy runny/stuffy nose symptoms. Rhinovirus is the most common in the fall and spring.

Rhinovirus Signs and Symptoms

  1. Runny or stuffy nose
  2. Cough
  3. Sore throat
  4. Fever
  5. Headache
  6. Decreased appetite
  7. Muscle and body aches (can happen, but are atypical).

Rhinovirus Incubation

Everyone always wants to know where they got a bug (secretly we want to shake our fist and curse the person who possibly gave us the bug). Knowing the incubation period (the time it takes from exposure to showing signs of illness) will help in your detective work. The typical incubation period is 2 days. There have been reports of as short as 20 hours and as long as 4 days, but usually 2 days. The bug is passed via respiratory droplets (people coughing/sneezing around you) and from direct contact or touching (e.g., an infected child wipes his/her nose with his hand, touches a toy, then your child plays with the infected toy and later touches his/her own face).

Rhinovirus Treatment

In case you haven’t heard, there is no cure for the common cold. I’m working on it, but failing miserably. For now, treatment is all symptomatic. (See my article DECODING COUGH AND COLD MEDICATIONS for specifics.) As a quick reminder, rhinovirus is a virus and an antibiotic won’t help (since antibiotics only treat bacteria). So unless there is a complication (e.g., pneumonia, an ear infection), your doctor shouldn’t prescribe an antibiotic. In general:

  1. Treat fever, sore throat, and/or body aches with Tylenol (if over 2 months) or Motrin (if over 6 months)
  2. Run a humidifier
  3. Keep the nose as clear as possible
  4. Try OTC meds (depending on age of child and symptoms)
  5. Encourage fluids
  6. Rest
  7. Let time pass

Colds tend to go away on their own, so be patient. Rhinovirus typically lasts 7-10 days. Complications can happen (e.g., pneumonia, ear infections), but are uncommon. Complications tend to happen in children who are compromised in some way (e.g., have weakened immune systems, asthma). FYI, there is not a vaccine to prevent rhinovirus.

Rhinovirus Prevention:

  1. Wash your hands often
  2. Don’t touch your face (the virus enters through the mouth, nose, and eyes)
  3. Steer clear of sick people (if one of your children is sick, try to keep them away from the others as much as possible)
  4. Disinfect infected surfaces
  5. Improve your immune function (eat healthy, exercise, and sleep well)

Call your doctor if (because I’m worried about developing complications)

  1. Your sick child is under 2 months old (just about any bug under 2 months should be seen by a doc)
  2. The fever goes beyond 5 days or reoccurs (e.g., has been gone for 3 days and starts again)
  3. Any one of the symptoms is getting significantly worse when it should be getting better (e.g., after a week of coughing it should be gradually improving not getting worse)
  4. Your child is disproportionately symptomatic or miserable (e.g., a child shouldn’t cry inconsolably for hours with the common cold)
  5. Your child is having trouble breathing

Rhinovirus isn’t fun, but also isn’t the worst virus out there. If you or your child falls victim, take heart. It too shall pass.

Decoding Cough And Cold Medications

I was recently at the store and went to the cough and cold aisle. There was a mom standing there with an obviously sick kid in the cart. She was just staring at all the meds and looked like she was about to cry. I generally try not to offer friendly, unsolicited advice to strangers (strange, people usually don’t like it), but I decided to speak up in this case. When I told her I was a pediatrician and asked what her child’s symptoms were, she nearly fell into my arms with relief for the help. So I thought I’d pass on a few tips

Age: (Limitations are based on safety data)

  1. Under 2 months: See your doctor.
  2. 2-6 months: Very limited options. Try Tylenol (generic is Acetaminophen), saline nose drops (to loosen and suck out boogers), and a cool mist humidifier.
  3. 6-12 months: Still limited options. All the above, but can add Motrin (generic is ibuprofen).
  4. 1-4 years: All the above, but can add honey. Give it plain or mix it into a tea, etc. Honey has been shown to help some with cough.
  5. 4-6 years: All the above, with caution using cough and cold medications. FDA says yes on cough and cold meds over 4 years. AAP (The American Academy of Pediatrics) says over 6 years before using cough and cold meds.
  6. 6+ years: All the above, plus cough and cold medications.

Decoding the medications:

  1. Dextromethorphan (DXM or DM): Used as a cough suppressant. Commonly found in Delsym, Robitussin, Dimetapp, Coricidin, Mucinex DM, etc. If your kid has a cough, find a med with this in it.
  2. Pseudoephedrine (PSE): Used as a decongestant (helps with the runny or stuffy nose). Found in Sudafed, Tylenol Cold, Robitussin, Benedryl Cold, etc. It may be more effective than phenylephrine, but it is regulated closer (it is used in the manufacture of methamphetamines). As an aside, the FDA warns against using long-acting or extended release preparations of pseudoephedrine to kids under age 12.
  3. Phenylephrine (PE): Used as a decongestant (again helps with the runny or stuffy nose). Meds generally have pseudoephedrine or phenylephrine, but not both. Found in Sudafed PE, Triaminic, etc. The data is hit and miss on the effectiveness of phenylephrine.
  4. Guaifenesin (GG): Used as an expectorant (helps loosen and bring up the phlegm). Found in Mucinex, Duratuss, and Tylenol Complete Cold, Cough & Flu. Medically, I am not sure why cough suppressants and expectorants are put together in combination medications. It is counter intuitive (one stops the cough while the other is trying to bring the stuff up). For that reason, I never buy combination medications with Dextromethorphan and Guaifenesin together. (Note: This is my personal opinion here).
  5. Acetaminophen (APAP): Used as a fever reducer and pain reliever. Trade name Tylenol. Either Acetaminophen or Ibuprofen is in almost all combination cold medications. Advantage over Ibuprofen is that Acetaminophen is easier on the gut and fewer side effects, but shorter acting (4 hrs.).
  6. Ibuprofen (IBU): Used as a fever reducer and pain reliever. Trade name Motrin. Either Ibuprofen or Acetaminophen is in almost all combination cold medications. Advantage over Acetaminophen is that Ibuprofen has an anti-inflammatory effect and lasts longer (6 hrs.), but is harder on the gut.
  7. Chlorpheniramine maleate (CPM): Used as an antihistamine (helps dry up secretions, usually associated with allergies). There isn’t much of a place for allergy meds in colds, unless there is an allergic component playing into the symptoms. Antihistamines are often added to the “nighttime” medication versions, because of the sedating side effects of antihistamines.
  8. Diphenhydramine (DPH): Used as an antihistamine. Active ingredient in Benedryl (see explanation for #7).
  9. Doxylamine Succinate: Used as an antihistamine (see explanation #7).

Wow, that is quite a list. It’s not exhaustive, but should cover 90% of the meds out there. If you got lost, here’s the very short of it: Choose the medications with the smallest amount of ingredients to cover the symptoms. Never give your kid a medication that he doesn’t need. If your child has a cough, choose something with just dextromethorphan (like Delsym). If there is a stuffy nose only, choose just pseudoephedrine (like Sudafed). If you choose single-drug meds, you can add Acetaminophen (Tylenol) or Ibuprofen (Motrin) in addition for fever/pain relief. If the med you choose has Acetaminophen or Ibuprofen, don’t give either in addition or you’ll risk overdosing. Generally limit the medications with antihistamines to nighttime, or shy away altogether. Always dose children’s medication based on weight, not age. Hopefully this helps you as you navigate what meds to use.

Small disclaimer: If your child has any one symptom that is particularly worrisome (e.g., a terrible cough), has gone on for a long time (i.e., more than 10 days), or makes you worried that it is more than just a common cold, you should see your doctor. Also, I didn’t specifically address the role of herbs and alternative options in this article (it’s a whole topic on its own).

How To Prevent Illnesses From Spreading

“Are we all going to get it?” is one of the most common questions I get after diagnosing an illness in a member of a family.

The short answer is, “Probably.” I don’t mean to sound flippant about it, but the truth is that most young children are good at spreading their germs (they don’t cover coughs or wash hands enough) and most moms and dads can’t keep up with disinfecting surfaces. If you manage to contain an illness to one family member, you are to be congratulated. Here are a few simple things you can do to increase that likelihood:

  • Cover your cough. Teach kids to cough into the crease of their elbows. If they cough into their hands and then touch everything, it’s not much better than spewing it into the air.
  • Wash hands with soap. Anytime you blow your nose, wash your hands. It is also a good habit to wash your hands when you first get home from an outing where you are exposed to the public and unclean surfaces. Also, wash hands before eating
  • Hand sanitizer. I love this stuff. You can use it just about anywhere, before eating in public places, after playing with others’ toys, etc.
  • Keep your distance. There is wisdom in keeping the sick ones apart from the healthy ones. If you can limit your sick child to one or two rooms, you’ll decrease the risk of spread to everyone else.
  • Disinfect surfaces frequently. Disinfecting wipes are great for quick wipe downs of door handles, light switches, phones, remote controls, and other frequently infected surfaces. Some viruses can live on surfaces for up to 48 hours.
  • Don’t touch your face. If your sick child coughs in your face, gives you a big kiss, or generally goos you, you are pretty much a goner. However, as you are out and about (touching infected surfaces in the world) and helping your sick child, try not to touch your face. A quick nose itch of a hand with infectious particles on it may be all it takes to catch the bug.
  • Eat healthy. Give your body a fighting chance with good nutrition. Some vitamin deficiencies can make you more susceptible to illness (e.g., vitamin D).
  • Get enough sleep. When your body is sleep deprived your immune defenses are down. You must get adequate sleep for your white blood cells (which are important in fighting infection) to work properly.
  • Vaccinate. I am a big believer in vaccinations. Some causes of infections, such as meningitis, pneumonia, ear infections, and pertussis (whooping cough) can be decreased or completely prevented by vaccinations. An annual flu shot is also a good idea.