Stubborn Summer Viruses
Summer time seems to attract some of the most stubborn and frustrating of viruses. I received two questions recently that drive this point home.
Q1)
Dr. Gwenn:
My 14 month old has had a fever and I believe sore throat, for a week. The doc says that a virus is going around like that and not to worry about his high fever 103 - 104 that he's had for a week. We live in Manhattan Beach, CA. Any thoughts?
Dear CS:
This is a very common scenario this time of year. I dub these “fever viruses” because in most kids they tend to cause prolonged fever and not much else. We’ve been seeing similar “fever viruses” on the East Coast lately, too.
Fever is a sign, not a diagnosis. What is more important than the fever is what else is going on with your child. As long as your child is eating and drinking and not acting sick, we can let these fevers go on for a good week because they often do peeter out at that point. Rest assured if the fever drags on longer, your pediatrician will look into the situation further with some simple tests but more often than not we still find that the virus is simply lingering.
However, if your child is starting to act sick, develop any other symptoms such as a rash, vomiting, diarrhea or low energy, call your pediatrician. Otherwise, hang tight and treat the fever with Tylenol or Motrin.
Best,
Dr. Gwenn
Q2)
Dear Dr. Gwenn:
My 8 year old daughter came down with fever spiking to 104 degrees on July 3rd. She complained of a sore throat, tummy ache, had chills and was pale. We took her to her doc the next day who did a strep test which was negative and a CBC which showed a white blood cell count of 1.2 and she was slightly anemic. We were told this was due to a virus.
Our doc advised rest, gargles with salt water. He saw us back the following Monday and repeated the CBC. The white blood count was up to 4.5 and she was still anemic. The fever was gone by then and he advised starting vitamins. The stomach problems seemed to get worse and moved from the left side to the right lower side so we took her to the ER where they did a mono titre, cat scan of her abdomen and chest xray. Everything came back fine.
This is now July 19th and although she is not running fever, and getting up more she still complains of her throat (swollen , red with white patches) and has fatigue, chills, and occasional pounding headaches that come and go. She is eating but not her usual appetite. If this is not mono then what could it be and how long will until she feels better?
Concerned in Texas
Dear Concerned in Texas:
Your daughter has sure been through a lot but it may help you to know that many of the stronger viruses, especially this time of year, do take 2 weeks, if not more to resolve.
Before I answer your question about Mono let me address a couple questions I'm sure you are wondering about. First, I'm sure the question has crossed your mind as to whether this is more than "just a virus". That is very natural to consider and we'd all be wondering as your daughter's mom by now. The one benefit of all the tests your daughter has had is confirmation that at this point in time, a virus is still all that is present. Viruses are notorious for causing the white blood cell count to plummet as your daughter's has. And, if a bacteria were present, by now the cultures that were sent would have grown. So, while your daughter had to experience a great deal, it was useful and that is reassuring.
Similarly, the change in your daughter's abdominal pain most certainly raised concerns about appendicitis and other abdominal issues. That is the one benefit of the CT scan.
So, having gone through the ER did help confirm what your pediatrician told you two weeks ago which brings me to your original question about Mono. Mono is one type of virus that can be very strong and it lasts a very, very long time. I featured it recently in the Bug Of The Week where you can get more information.
Mono is in the family of the Epstein-Barr virus and has many cousins that cause a “mono-like illness” but we just don’t test for them. If all your daughter’s tests continue to come back negative, she may very well have one of those viruses which is why she is still not 100%. But, she is better and that is what you have to keep your eye focused on.
Your daughter’s tests and symptoms do seem to support a viral diagnosis but it is worth keeping a close eye out for the development of a bacterial complication. How will you know? Fever may return. Her sore throat may worsen or change, become one sided or impair her ability to eat or drink. Or, she may develop symptoms she has not had so far. If any of these situations develop, call your pediatrician for a reevlauation.
It is very, very frustrating when a child is sick for so long but in the end your best ally is your pediatrician. Stay in close contact with him because he sounds right on the ball and will know what to do if your daughter does not improve as expected. But, so far, this sounds right on track for a stubborn and strong virus.
I hope she feels better soon.
Best,
Dr. Gwenn
