the Link Between Tonsillitis and Hand, Foot, and Mouth Disease

Tonsillitis progressing to enterovirus infection?

Hello Dr.
Lin: Thank you for your previous answers and suggestions! My 1-year-old baby had tonsillitis on May 30, and after seeing a doctor on June 1, it was confirmed to be a viral infection due to persistent high fever for four days, mostly maintaining around 38.5 to 39.5 degrees Celsius.
We have seen two hospitals, and the doctors only prescribed antipyretics without any other medications.
I would like to know if my baby can recover solely relying on their immune system, considering the severe throat ulcers.
How long is this illness expected to last? Are there any suitable anti-inflammatory medications or antibiotics that can be prescribed? Today, I noticed a few small pimples on my baby's cheeks, which are not very large.
I am concerned whether this is related to the varicella vaccine administered on May 28 or if it could be hand, foot, and mouth disease.
Is there a clear way to distinguish between varicella, insect bites, and hand, foot, and mouth disease based on appearance? A worried mother.

De De Mama, 30~39 year old female. Ask Date: 2005/06/02

Dr. Lin Huizhen reply Pediatrics

Dear Mother De De,
This is Dr.
Lin Hui-Chen from the Pediatric Department of Tainan Hospital, Ministry of Health and Welfare.

There is no specific medication for enterovirus infections.
Treatment focuses on two aspects: the general course of the illness, which typically lasts 7-10 days for infants under one year old.
As for the lesions on the face and mouth, they may be caused by chickenpox, insect bites, or hand, foot, and mouth disease.
A direct examination is necessary for accurate diagnosis, and I cannot provide an online assessment.
Most enterovirus infections will resolve naturally.
Generally, the first seven days after the onset of the virus pose a risk for severe complications, so parents should be particularly vigilant.
It is recommended that parents encourage their infected children to drink plenty of fluids and rest, as children often refuse to eat or drink due to painful oral blisters and ulcers, which can lead to dehydration.
Infants, especially those a few months old, are at risk of shock from prolonged dehydration.
Therefore, they should rest and engage in minimal physical activity.
Children with oral ulcers may become dehydrated due to an inability to eat, so it is essential to ensure they receive adequate hydration.
Any beverage the child prefers is acceptable.
If the child is unable to drink water, leading to decreased urine output, absence of tears, or dry oral mucosa, it is crucial to take the child to the hospital for intravenous fluid therapy.
Be cautious of complications! Severe cases of enterovirus 71 infection often present with three early signs related to encephalitis before complications arise: unusual drowsiness, myoclonic jerks (sudden muscle contractions resembling a startled response), and persistent vomiting.
Other warning signs of serious complications include prolonged fever, decreased activity, irritability, confusion, neck stiffness, limb paralysis, seizures, rapid breathing, generalized weakness, tachycardia, or arrhythmias.
If any of these warning signs occur, the child must be taken immediately to a major hospital for treatment.
Wishing you and your baby good health and all the best!
Sincerely,
Dr.
Lin Hui-Chen
Pediatric Department
Tainan Hospital, Ministry of Health and Welfare

Reply Date: 2005/06/02

More Info

Hello! Thank you for your detailed inquiry regarding your child's health condition. It sounds like you are dealing with a challenging situation, and I appreciate your concern for your child's well-being. Let's break down the issues you've raised regarding tonsillitis, hand, foot, and mouth disease (HFMD), and the symptoms your child is experiencing.

First, it's important to understand that tonsillitis, especially in young children, can often be caused by viral infections, including enteroviruses, which are the same viruses that can lead to hand, foot, and mouth disease. HFMD is characterized by fever, mouth sores, and a rash on the hands and feet, and it is common in children under five years old. The fact that your child has been experiencing high fevers and has been diagnosed with an enterovirus suggests a viral infection that could indeed be linked to HFMD.

Regarding your concern about your child's tonsillitis and the presence of ulcers or sores in the throat, it's crucial to note that viral infections typically resolve on their own as the child's immune system fights off the virus. While supportive care, such as fever reducers (like acetaminophen or ibuprofen), is often recommended, antibiotics are not effective against viral infections. Therefore, the doctors' decisions to prescribe only antipyretics (fever reducers) are appropriate in this context.

As for the duration of the illness, viral infections can vary widely in their course. Generally, symptoms of HFMD can last about 7 to 10 days, but the fever and discomfort may persist for several days before gradually improving. It's essential to monitor your child for any signs of dehydration, especially if they are having difficulty swallowing due to throat pain.

You mentioned noticing small bumps on your child's cheeks. These could be related to several factors, including the recent vaccination for chickenpox, which can sometimes cause mild rashes or reactions. However, they could also be indicative of HFMD, which often presents with small, red spots or blisters in the mouth and on the skin. To differentiate between these conditions:
1. Chickenpox: Typically presents with an itchy rash that progresses from red spots to fluid-filled blisters, often accompanied by fever and fatigue.

2. Hand, Foot, and Mouth Disease: Characterized by sores in the mouth and a rash on the hands and feet, which may also appear on the buttocks and legs. The rash is usually not itchy.

3. Insect Bites: These usually appear as localized red bumps and may be itchy, often with a central punctum where the insect bit.

If the bumps on your child's face are not blister-like and do not resemble the typical presentation of HFMD, they may be related to the vaccination or simply insect bites. However, if you are concerned about any new symptoms or if your child's condition worsens, it is always best to consult with a pediatrician for a thorough evaluation.

In summary, while your child's body is likely capable of fighting off the viral infection, supportive care is essential. Ensure they stay hydrated, manage fever with appropriate medications, and monitor for any signs of complications. If you have any further concerns or if symptoms persist beyond the expected duration, do not hesitate to seek further medical advice. Your child's health is paramount, and it's always better to err on the side of caution. Wishing you and your little one a speedy recovery!

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