the Severity of Enterovirus in Pediatric Patients

Severity of Enterovirus Infection

My friend's child is in the second grade of elementary school and started having a fever three days ago.
The doctor at the clinic diagnosed it as hand, foot, and mouth disease.
In addition to sores in the mouth, there are many blisters on the hands and feet.
Now on the fourth day, the blisters are still increasing, and there is still a slight fever.
Does this mean the condition has worsened? Should we go to the hospital for admission?

Niming, 40~49 year old female. Ask Date: 2017/11/09

Dr. Xiao Kaiwen reply Pediatrics

Enterovirus infections typically resolve on their own, relying on the body's immune system.
Fever usually lasts about three to four days, while hand and foot blisters and oral ulcers may take approximately seven to ten days to heal gradually.
Therefore, supportive care is generally recommended, including antipyretics and analgesics.
However, if dehydration occurs or there are signs of severe illness (such as lethargy, frequent startle reflex during sleep, severe vomiting, respiratory distress, tachycardia, or weakness in the limbs), hospitalization may be necessary for treatment.

Reply Date: 2017/11/09

More Info

When it comes to enterovirus infections in pediatric patients, it is essential to understand the potential severity and the signs that may indicate a worsening condition. Enteroviruses are a group of viruses that can cause a variety of illnesses, ranging from mild respiratory infections to more severe conditions such as viral meningitis or myocarditis. The symptoms can vary widely, and while many children recover without complications, some may experience more severe manifestations.

In your friend's case, the child has been experiencing fever for four days, along with oral lesions (mouth sores) and an increasing number of vesicular (blister-like) rashes on the hands and feet. These symptoms are consistent with hand, foot, and mouth disease (HFMD), which is commonly caused by enteroviruses, particularly coxsackievirus. While HFMD is usually self-limiting, it can sometimes lead to complications, especially if the child exhibits signs of dehydration, persistent high fever, or neurological symptoms.

Given the situation described, here are several factors to consider regarding the child's condition:
1. Duration and Severity of Symptoms: A fever lasting more than three days, especially if it is high (above 39°C or 102°F), can be concerning. The presence of increasing vesicular lesions and persistent mild fever suggests that the infection may not be resolving as expected.
2. Signs of Dehydration: Children with oral lesions may have difficulty eating or drinking, which can lead to dehydration. Signs of dehydration include dry mouth, decreased urine output, lethargy, and irritability. If the child is not able to maintain adequate fluid intake, this is a significant concern.

3. Neurological Symptoms: If the child begins to show signs of lethargy, confusion, or any unusual behavior, this could indicate a more severe infection that may require immediate medical attention.

4. Worsening Condition: If the child’s symptoms are worsening—such as an increase in the number of lesions, persistent fever, or any new concerning symptoms—it is advisable to seek medical care.
In this case, it would be prudent for your friend to consult a pediatrician or visit an emergency department. The healthcare provider may perform a thorough examination, assess hydration status, and possibly conduct laboratory tests to rule out other infections or complications.
In summary, while many enterovirus infections can be managed at home, the combination of persistent fever, increasing lesions, and potential signs of dehydration warrants a closer evaluation by a healthcare professional. Early intervention can help prevent complications and ensure the child receives appropriate care.

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