Prolonged Fever in Young Children with Enterovirus

About enterovirus fever lasting 10 days?

Hello Dr.
Hsiao: My daughter (2 years and 3 months old) started having a high fever of 38.6°C on the night of April 6.
I planned to take her to the clinic the next day, but when she woke up in the morning, her fever was gone, and she was active and eating and drinking normally.
However, on the night of April 7, her fever returned to 37.5°C.
The next day, April 8, I took her to the hospital, where she was diagnosed with enterovirus.
We continued to monitor her until April 12, during which she had intermittent fevers, peaking at 39.1°C.
Her activity level did not significantly decline, although she became very dependent on being held during the times she had a fever, and her mood fluctuated greatly.
Other than that, everything seemed normal, and she did not develop any rashes on her hands or feet.
Since she had been feverish for a week, I took her to a regional hospital for blood tests, which showed slightly elevated white blood cell count and liver enzymes, but everything else was normal, and her urine test was also normal.
However, today, the 15th, she still has a high fever of 38.1°C.
Is it common for enterovirus to cause a fever for so many days? Is there anything specific I should be concerned about?

Yang Xiansheng, 30~39 year old female. Ask Date: 2019/04/15

Dr. Xiao Kaiwen reply Pediatrics

The duration of fever caused by a viral infection can vary and depends on individual immune response, the type of virus, and the viral load.
On average, it lasts about 3 to 5 days (this is an average; some may have shorter or longer durations).
It is also possible to be infected by multiple viruses simultaneously, leading to recurrent fevers.
It is important to monitor the child's activity level for any abnormalities.
If the fever persists for several days, a visit to the hospital will typically involve blood tests to check basic infection markers, urinalysis, and basic biochemistry.
However, if the fever continues for an extended period, it is advisable to consult a pediatric infectious disease specialist at a major hospital for further evaluation or testing for any rare infections.

Reply Date: 2019/04/15

More Info

Prolonged fever in young children, especially in the context of enterovirus infections, can be a concerning issue for parents. In your case, your daughter has been experiencing intermittent fevers since April 6, with the highest recorded temperature reaching 39.1°C. While it is understandable to be worried, it is important to recognize that enterovirus infections can indeed cause prolonged fever, typically lasting from a few days to over a week.

Enteroviruses are a common cause of viral infections in children, often presenting with symptoms such as fever, sore throat, and gastrointestinal disturbances. The fever associated with enterovirus infections can be persistent and may fluctuate in intensity. It is not uncommon for children to have fevers that last several days, and in some cases, even up to two weeks. The fact that your daughter’s activity level remains relatively good and that she is eating and drinking normally is a positive sign. Children often exhibit some dependency on caregivers during febrile episodes, which can be attributed to discomfort and fatigue.

When monitoring a child with prolonged fever, there are several key factors to consider:
1. Hydration: Ensure that your daughter stays well-hydrated. Fever can lead to increased fluid loss, and children may not drink as much when they are feeling unwell. Look for signs of dehydration, such as dry mouth, decreased urine output, or lethargy.

2. Symptoms Monitoring: Keep an eye on any additional symptoms that may develop. While enterovirus infections can cause a range of symptoms, the emergence of new symptoms such as a rash, difficulty breathing, persistent vomiting, or severe abdominal pain should prompt immediate medical attention.

3. Follow-Up Care: Since you mentioned that blood tests showed slightly elevated white blood cell counts and liver enzymes, it is essential to follow up with your healthcare provider. While mild elevations can occur with viral infections, persistent abnormalities may require further investigation.

4. Fever Management: For fever management, medications such as acetaminophen (Tylenol) or ibuprofen can be used to help reduce fever and improve comfort. However, always consult with your pediatrician regarding the appropriate dosages and any specific concerns related to your daughter’s health.

5. When to Seek Help: If your daughter’s fever persists beyond a week, or if she develops any concerning symptoms, it is advisable to seek further evaluation. Additionally, if her activity level decreases significantly or if she appears unusually irritable or lethargic, these are signs that warrant immediate medical attention.

In summary, while prolonged fever can be alarming, it is not uncommon in cases of enterovirus infections. Your daughter’s overall well-being, including her activity level and appetite, is encouraging. Continue to monitor her symptoms closely, maintain hydration, and do not hesitate to reach out to your healthcare provider for guidance as needed. It is always better to err on the side of caution when it comes to the health of young children.

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