Bacterial and Viral Infections in Young Children

Bacteria and viruses?

Hello, doctor.
I have a two-year and two-month-old son.
He started showing some cold symptoms on May 7th, such as a mild fever (not exceeding 39 degrees Celsius), cough, and runny nose.
By May 11th, he was almost recovered.
However, two days later, on May 14th, he began to experience vomiting and diarrhea, along with a high fever.
He would vomit whenever he ate or drank, and the frequency of diarrhea exceeded six times.
The fever could only be controlled with antipyretics, but it kept fluctuating.
We visited two clinics, but the doctors couldn't provide a clear explanation and even suggested that the fever wasn't a major concern and not to worry too much.
However, after taking medication, none of the symptoms improved.
Therefore, we decided to go to the hospital for a consultation.
The doctor immediately conducted routine blood and urine tests and determined that my son was already dehydrated, with blood in his stool.
He was immediately put on a fasting regimen and given electrolytes, and was admitted to the hospital.
Three days later, the test results confirmed that he had a Salmonella infection.
Since the antibiotics covered by health insurance were ineffective against the bacteria, we had to pay out of pocket for a more effective antibiotic.
On May 23rd, the doctor announced that he could be discharged.
However, since the diarrhea persisted, he was only allowed to eat light porridge or toast.
At a follow-up appointment on May 29th, the doctor felt he was recovering well and could start eating other foods.

On May 30th, shortly after 5 AM, my son suddenly woke up crying, "My stomach hurts," and was rolling around in bed.
I thought it was due to gas, so I gave him an anti-gas medication.
After a while, his symptoms seemed to improve, and he fell asleep quietly.
However, I later found out that he had started to run a fever again, though it was not high, around 38 to 39 degrees Celsius.
On May 31st, my husband, worried about him, decided to take him to the emergency room again for a urine test.
The doctor assessed that aside from increased gastrointestinal motility and fever, there were no other symptoms, and the urine showed no signs of inflammation.
It was likely a viral gastroenteritis.
The doctor prescribed antipyretics, but today my son’s fever reached 40 degrees Celsius, which made me very anxious.
Perhaps I shouldn't be so sensitive about fever, but is it really true, as the clinic doctors said, that fever simply indicates that his body cells are fighting the virus and there's no need to worry? I am genuinely afraid of any potential long-term effects, especially since he has been on medication and receiving injections for almost the entire month.
Even an adult's body might not withstand that.
I hope to receive accurate guidance on how to manage fever and what situations we might encounter.
Thank you!

YOYO Ma, 20~29 year old female. Ask Date: 2007/06/01

Dr. Xiao Kaiwen reply Pediatrics

Dear YOYO Mom,
In response to your questions, here are the details:
1.
There are many reasons that can cause a child to have a fever (such as infections, autoimmune diseases, drug fever, summer fever, vaccinations, tumors, etc.).
In pediatrics, over 90% of cases are due to infections (the body's cells are fighting against bacteria or viruses, which leads to fever).
Therefore, the key is to identify the actual cause of the infection.
The most common infections in children include colds, pharyngitis, otitis media, gastroenteritis, pneumonia, and urinary tract infections.
Thus, physicians will typically start with examinations and tests related to these conditions (such as blood tests, urine tests, X-rays, and bacterial cultures).
2.
Viral infections generally resolve on their own in children with normal immunity, but bacterial infections usually require antibiotic treatment.
It is crucial that the treatment duration is adequate.
The most important test report for your child this month should be the blood culture for Salmonella (treatment for bacteremia must be effective and complete).
After discharge, if there is a recurrence of high fever along with gastrointestinal symptoms (abdominal pain), it is advisable to conduct stool or blood tests and cultures to determine if it is a recurrence or caused by another infection.
3.
Generally speaking, if a child has a fever at night but is still active, you can initially manage the fever at home with antipyretics and then observe the child's condition.
If necessary, you can consult a physician the following day.
Pediatrics Department, Qishan Hospital
Dr.
Hsiao Kai-Wen

Reply Date: 2007/06/01

More Info

Understanding bacterial and viral infections in young children can be quite challenging, especially for parents who are understandably concerned about their child's health. Your experience with your son’s symptoms and the subsequent diagnosis of a Salmonella infection highlights several important aspects of pediatric infections, fever management, and the general approach to illness in young children.

Firstly, it's essential to understand that both bacterial and viral infections can present with similar symptoms, such as fever, vomiting, diarrhea, and respiratory issues. In your son's case, the initial symptoms of a mild upper respiratory infection (fever, cough, runny nose) transitioned into more severe gastrointestinal symptoms (vomiting and diarrhea), which can often occur when a child contracts a viral infection or a bacterial infection like Salmonella.
Fever is a common response to infection, as it indicates that the body is fighting off pathogens. While it can be alarming for parents, a fever itself is not necessarily harmful and is often a sign that the immune system is active. The key is to monitor the fever and associated symptoms closely. In children, a fever can be concerning, especially if it exceeds 39°C (102°F) or persists for an extended period. However, as you noted, many healthcare professionals emphasize that fever is a natural part of the immune response.

In your situation, the progression from mild symptoms to severe gastrointestinal distress and high fever indicates that your son’s body was likely overwhelmed by the infection. The presence of blood in his stool and signs of dehydration were critical indicators that warranted immediate medical attention. Dehydration is a significant risk in children with vomiting and diarrhea, and it can lead to serious complications if not addressed promptly. The administration of electrolytes and hospitalization was a necessary step to ensure his safety and recovery.

Regarding the management of fever, it is crucial to use antipyretics (like acetaminophen or ibuprofen) as directed by your healthcare provider to help reduce discomfort. However, it’s also important to allow the body to fight the infection naturally. If a fever is persistent and high, or if your child exhibits other concerning symptoms (such as lethargy, difficulty breathing, or dehydration), it is essential to seek medical advice promptly.

As for the potential for long-term effects or complications from infections like Salmonella, most children recover fully with appropriate treatment. However, some may experience lingering gastrointestinal issues, such as irritable bowel syndrome or lactose intolerance, following a severe infection. Regular follow-ups with your pediatrician can help monitor your child's recovery and address any ongoing concerns.

In summary, while it is natural to feel anxious about your child's health, understanding the nature of infections and the body's response can help alleviate some of that fear. It is always best to err on the side of caution and consult healthcare professionals when you have concerns about your child's symptoms. Keeping an open line of communication with your pediatrician and following their guidance will ensure that your child receives the best care possible.

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