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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).

The Sore Throat Going Around: Coxsackievirus

This miserable little summer bug is making an early debut in the spring this year (at least in our neck of the woods). I’ve seen a few cases each day for the last week or two, clearly indicating to me that it is now “going around.”

Coxsackievirus (group A subtype) is the virus that causes (among other things) “Hand, Foot, and Mouth disease,” as well as “Herpangina.” The difference between the two is essentially where the infection is. The first is, as the name implies, on the hands, feet, and in the mouth; herpangina is only in the mouth. It is characterized by little sores (that kind of look like canker sores) all on the back of the throat. As you might imagine, it causes a wicked sore throat.  The other symptoms are sort of non-specific.

Coxsackievirus Symptoms

Can include some or all of the following:

  1. Painful throat (with ulcerative sores on the back of the throat)
  2. Decreased appetite
  3. Sores on hands and feet which look like little blisters when they start (a newer strain is causing sores to extend up legs and sometimes onto buttocks)
  4. Fever
  5. Generally feeling crummy (called malaise)
  6. Headache
  7. Joint pains
  8. Muscle aches

How Coxsackievirus is passed?

The virus is very easily spread from person to person. Essentially everything in the infected person is swimming with virus (the snot, spit, fluid in blisters, and feces). Contact with any of the infected fluids (breathing in someone’s cough, touching an infected surface and then touching your face, etc.) will spread it. The infected person is most contagious (there are more viral particles being replicated) early on in the illness. The bug typically lasts a week.

Who gets Coxsackievirus?

Generally, hand, foot, and mouth disease is considered a disease of the very young (think early school-aged kids and younger). While it can happen at any age, it usually happens in toddler and preschool-aged kids. Adults don’t usually get it because they had it when they were younger and the body has created protective antibodies. With that said, I’ve had plenty of patients who have had it more than once though. It’s unclear if that is because the body didn’t mount a lasting response, the virus has mutated, or it’s a different strain altogether.

Coxsackievirus Treatment

Unfortunately, there isn’t a cure. Because it is a virus, an antibiotic won’t do any good (it can actually make things worse due to antibiotic resistance). There isn’t a vaccine. Treatment is all supportive. The treatment is to manage pain (sometimes docs will prescribe oral rinses/mouth washes or numbing suckers) and keep the patient hydrated. As for over-the-counter pain management, I think ibuprofen (Motrin) works better than acetaminophen (Tylenol) for this particular bug because there is an anti-inflammatory effect with the ibuprofen which can really help the inflamed throat.

Coxsackievirus Complications

While there can be serious complications like meningitis and myocarditis (a heart problem), the virus is usually self-limited and resolves on its own without complications. If a child ends up in the hospital or ER, it is usually because the child wouldn’t drink due to the severe sore throat and consequently ended up getting dehydrated. So watch to make sure your child is getting enough to drink and is still peeing.

Hopefully, you can manage to escape this particular bug. But if you don’t, you now know what to look for and how to manage it (and could potentially save yourself a trip to the doctor).

Respiratory Bug (Coronavirus) Is Going Around

If you’re feeling like you’ve simply had enough of the miserable cough and cold bugs this season, you are in good company. I feel like it’s been a particularly bad season this year, and just when I think it is starting to let up, we’ve got a new bug on the forefront: Coronavirus.

Coronavirus is a common virus that causes mild-to-moderate upper respiratory illness. To date, there are 5 different Coronavirus strains that make people sick (that I’m aware of). The infamous SARS outbreak of 2003 and the Middle East Respiratory Syndrome (MERS) of 2012 are both Coronavirus strains. Fear not, the strain that we are seeing in our community right now though is not SARS or MERS. Random trivia, the virus is called Coronavirus because the little virions look like spikes on a crown under the microscope (take that piece of trivia to your next dinner party).

Coronavirus top 10 quick facts:

  1. Most people will get infected at some point in their life with Coronavirus.
  2. Young children are far more likely to get it.
  3. You can get infected over and over with it (there isn’t life-long immunity with it).
  4. Symptoms include: runny nose, cough, sore throat, and fever. (Kind of sounds like every other bug right?)
  5. It’s usually a fall and winter bug, which makes the outbreak in our community this time of year even more interesting.
  6. It’s easily spread from person-to-person through the air by coughing and sneezing, or via direct contact, like touching or shaking hands.
  7. There are no vaccines against it.
  8. Reduce transmission by frequently washing hands, staying away from sick people, and not touching your face.
  9. There is no cure. Treatment is all symptomatic (i.e., decongestants, humidifiers, fever medications, rest, fluids) until your body conquers the bug on its own.
  10. The diagnosis is made by a clinical test (swabs up the nose are easiest, but blood tests also exist). Most doctors don’t bother to test, since there isn’t a specific treatment anyhow and the test is costly, takes time, and isn’t comfortable.

Hopefully, you’ll manage to avoid this one, but in case you don’t, at least you’ll know what you’re up against. Stay healthy!

What Is A Virus?

Kids with viruses constitute a large portion of my “sick visits” in a given day. Naturally, I field a lot of questions about viruses. I’ve included below some good, basic information about viruses.

What is a virus?

(Here is the science lesson for today). A virus is a microscopic (too small to see) infectious agent. Each viral particle is made up of DNA or RNA genes and has a protein coat surrounding the genes. Some viruses have a fat envelope around the protein coating. There are millions of different viruses that affect essentially every ecosystem on the earth.

How are viruses spread?

Viruses are spread in every method possible.

  1. Respiratory viruses, the cough and runny nose type, are spread by respiratory droplets. For example, an infected person coughs and millions of infectious particles get spread in the air. An unsuspecting person then breathes in the air and is now infected. Another way to spread a virus is from all the infected particles in the snot of a runny nose. For example, a sick person doesn’t wash his or her hands after blowing his or her nose (or worse after wiping with one’s hands) and then touches an object. Soon after, an unsuspecting person touches the same (now infected) object and then touches his or her face and the virus enters the body.
  2. G.I. viruses, the vomit and diarrhea type, are spread by the fecal/oral route. Again, if infected people don’t wash their hands after using the bathroom and then touch something, that something now has a virus on it. If an unsuspecting person then touches the infected object (e.g., a door handle) and then touches his or her mouth, he or she is then infected.
  3. Other methods of transmission include sexual contact or exposure to infected blood. HIV is the most noteworthy virus transmitted in this way.

What treatment is there?

There is no medicine, or antibiotic, that can cure a virus. This is why your doctor usually doesn’t give you any medicine after diagnosing a virus. There are a few special viruses or cases in which medications can be used to modify or slow viral replication. For example, an antiviral medication like oseltamivir (Tamiflu) can be used for the Influenza virus if caught early (while the virus is still replicating) to decrease the severity of symptoms and shorten the duration of illness. HIV medications are another example of antiviral medications created to stop the replicating virus and thereby increasing an infected person’s lifespan. For most viruses, there are no modifying antiviral medications. Your body’s own immune system usually works better than anything medicine can offer at overcoming viruses.

Why won’t my doctor give me an antibiotic? What’s the harm, just in case?

If your doctor thinks that your illness is causes by a virus, an antibiotic will not treat the virus. Antibiotics are used to treat bacteria only. In fact, giving an antibiotic when the cause is a virus only contributes to antibiotic resistance.

How long do viruses last?

The average virus lasts 7-10 days. This is why your doctor says things like, “Come back if things aren’t better after a couple of weeks,” or “Let me know if your symptoms get worse, not better.” After the initial few days, most people tend to recover and get better as their body conquers the virus. Of course, there are always exceptions to the rule. Epstein Barr Virus (EBV, which causes Mononucleosis) symptoms can last for weeks. Other viruses, like Herpes, stay in your system permanently, waiting to be reactivated. Some viruses, like HIV, will ultimately kill you.

What are the symptoms?

Just about any symptom can be caused by a virus. The most common symptoms are cough, runny nose, sore throat, vomiting, diarrhea, rash, and fever. However, some bacterial infections can cause the same symptoms. For example, strep throat is a bacterial infection which should be treated with an antibiotic. It usually causes sore throat, headache, fever, and abdominal pain (in younger children).

Should I see my doctor?

You should see your doctor if you have isolated symptoms, sharp or localized pains, or unusual symptoms. If your symptoms have persisted for a long time (keep in mind the average virus lasts 7-10 days) or are getting worse, you should also see a doctor. Finally, if you are concerned, uncertain, or have questions, it is probably a good idea to see your doctor.