Enterovirus rash treatment

Enteroviruses in Children | Cedars-Sinai

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What is an enterovirus infection in children?

An enterovirus is a very common type of virus. There are many types of enteroviruses. Most of them cause only mild illness. Infections most often occur in the summer and fall. The viruses mostly cause illness in babies, children, and teens. This is because most adults have already been exposed to many enteroviruses and have built up immunity.

The viruses may not cause any symptoms, or they may cause only mild symptoms. Enteroviruses often cause what is known as the “summer flu.” They can also cause a rash known as hand-foot-and-mouth disease. This is generally caused by coxsackievirus, a type of enterovirus.

But in some cases, an enterovirus can be more severe and cause complications. Some of the viruses, such as polio, can cause serious illness. Polio can be prevented with a vaccine and is uncommon in the U.S.. Some types of enteroviruses can cause inflammation of the tissue that covers the brain and spinal cord (meningitis). Enterovirus 68 can cause severe symptoms in some children, such as trouble breathing.

What causes an enterovirus infection in a child?

Enteroviruses can be spread when an infected person sneezes or coughs droplets into the air or on surfaces. A child may then breathe in droplets, or touch a contaminated surface and touch his or her eyes, mouth, or nose. Some of the viruses can spread through contact with infected feces (stool). This can happen when children don't wash their hands or don't wash them properly. It can also happen from eating or drinking food or water that contains the virus.

What are the symptoms of an enterovirus infection in a child?

In many cases, enteroviruses don’t cause symptoms. If they do, the symptoms are often mild. Most symptoms usually go away in a few days and can include:

• Fever
• Muscle aches
• Sore throat
• Runny nose
• Sneezing
• Coughing
• Trouble breathing
• Nausea and vomiting
• Diarrhea
• Red sores in the mouth, and on the palms of the hands and soles of the feet (hand-foot-and-mouth disease)
• Red rash over large areas of the body

The symptoms of an enterovirus can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.

How is an enterovirus infection diagnosed in a child?

A healthcare provider will ask about your child’s symptoms and health history. The provider will do a physical exam. This may include an exam of the mouth, eyes, and skin. The healthcare provider will listen to your child’s chest as he or she breathes.

In the case of severe symptoms, your child may need certain tests. These are done to see if your child has an enterovirus, or has a different kind of illness. The tests can look for problems in the heart, lungs, and brain. The tests may include:

• Virus culture. The healthcare provider takes a small sample of saliva, blood, urine, or stool. It is then tested for a virus.
• Polymerase chain reaction (PCR). The healthcare provider takes a small sample of blood, urine, or saliva. The sample is tested for a virus.
• Spinal fluid test. The healthcare provider takes a small sample of spinal fluid. This is done by putting a small needle into your child's back. The fluid is tested for levels of certain chemicals and cells.
• Blood test. The healthcare provider takes blood from a vein. It is then tested for chemicals that may show the cause of your child's illness, or show organ problems.
• X-rays. This test is done to look at the lungs and heart.
• Electrocardiogram (ECG). This test is done to look at the electrical action of the heart.
• Echocardiogram. This test uses sound waves and a computer to look at the structure and movements of the heart.

How is an enterovirus infection treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Antibiotics don't work on viral illnesses like enterovirus. And no antiviral medicines are available to help cure an enterovirus infection. Instead, treatment is done to help your child feel better while his or her body fights the illness. This includes:

• Pain medicine. These include acetaminophen and ibuprofen. They are used to help ease pain and reduce fever. Don't give aspirin to your child if he or she has a fever.
• Oral pain reliever (anesthetic). This is a gel used to help ease the pain of sores in the mouth.
• Bed rest. This helps your child’s body fight the illness.
• Change in diet. If your child has painful mouth sores, give only bland, soft foods. Don't give your child salty or crunchy foods.

In severe cases, treatment may include:

• Opioid medicines for severe pain
• Medicine for heart problems
• IV (intravenous) fluids for dehydration
• Medicine called immunoglobulin given through an IV
• Antiviral medicine

Symptoms such as muscle aches, fever, and sore throat usually go away in a few days. The red sores known as hand-foot-and-mouth disease usually go away in 7 to 10 days.

Talk with your child’s healthcare providers about the risks, benefits, and possible side effects of all medicines.

What are possible complications of an enterovirus infection in a child?

Complications from enteroviruses are not common. But they can cause severe problems such as:

• Inflammation of the brain (encephalitis)
• Inflammation of the tissues around the brain and spinal cord (meningitis)
• Inflammation of the heart (myocarditis)
• Inflammation of the liver (hepatitis)
• Eye infection (conjunctivitis)
• Severe illness in the lungs
• Paralysis of muscles

How can I help prevent an enterovirus infection in my child?

Children are vaccinated against poliovirus. But there is no vaccine for other enteroviruses. Enteroviruses can spread easily from person to person. They are spread through stool and mucus from coughing or sneezing. They can live on surfaces that sick people have touched, coughed, or sneezed near. To help prevent illness:

• Teach children to wash their hands after using the toilet, before eating, and before touching their eyes, mouth, or nose.
• Wash your hands often, especially if caring for someone who is sick. Use a hand sanitizer if you don't have soap and water handy. 
• Try to have less contact with people who are sick.
• Clean surfaces at home regularly with disinfectant.

When should I call my child’s healthcare provider?

Call a healthcare provider right away if your child has:

• Fever (see Fever and children, below)
• Severe headache that doesn't get better after taking a pain reliever
• Trouble breathing
• Chest pain when breathing
• Confusion
• Seizures
• Pain, swelling, and redness of the eyes
• Stiffness and trouble moving
• Yellow tint to the skin and eyes (jaundice)

Fever and children

Always use a digital thermometer to check your child’s temperature. Never use a mercury thermometer.

For infants and toddlers, be sure to use a rectal thermometer correctly. A rectal thermometer may accidentally poke a hole in (perforate) the rectum. It may also pass on germs from the stool. Always follow the product maker’s directions for proper use. If you don’t feel comfortable taking a rectal temperature, use another method. When you talk to your child’s healthcare provider, tell him or her which method you used to take your child’s temperature.

Here are guidelines for fever temperature. Ear temperatures aren’t accurate before 6 months of age. Don’t take an oral temperature until your child is at least 4 years old.

Infant younger than 3 months old:

• Ask your child’s healthcare provider how you should take the temperature.
• Rectal or forehead (temporal artery) temperature of 100.4°F (38°C) or higher, or as directed by the provider
• Armpit temperature of 99°F (37. 2°C) or higher, or as directed by the provider

Child age 3 to 36 months:

• Rectal, forehead (temporal artery), or ear temperature of 102°F (38.9°C) or higher, or as directed by the provider
• Armpit temperature of 101°F (38.3°C) or higher, or as directed by the provider

Child of any age:

• Repeated temperature of 104°F (40°C) or higher, or as directed by the provider
• Fever that lasts more than 24 hours in a child younger than age 2. Or a fever that lasts for 3 days in a child 2 years or older.

Key points about enteroviruses in children

• Enteroviruses are very common. The viruses mostly cause illness in babies, children, and teens. This is because most adults have already been exposed to many enteroviruses and have built up immunity.
• The viruses often don’t cause symptoms, or cause only mild symptoms.
• Enteroviruses can be spread when an infected person sneezes or coughs droplets into the air or on surfaces. A child may then breathe in droplets, or touch a contaminated surface and touch his or her eyes, mouth, or nose.
• The viruses are treated with supportive care such as pain medicine.
• In some rare cases, the viruses may cause inflammation of the brain, heart, or other parts of the body.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

What Are Enteroviruses? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Enteroviruses, a group of viruses that cause a variety of infections, usually only lead to mild symptoms, such as a common cold. But in some cases — especially in young children or people with compromised immune systems — serious complications can develop.

Traditionally, enteroviruses were classified into four subgroups: polioviruses, coxsackievirus A, coxsackievirus B, and echoviruses.

In 2019, genetic studies led to the reclassification of 15 species of the enterovirus genus into enterovirus species A–L and rhinovirus species A–C, with multiple subtypes (aka “serotypes”).

Members of the enterovirus genus mutate and recombine easily within species, so hybrid and variant enteroviruses continue to be identified.

Because polio infection is complex and has been mostly eradicated worldwide, this article will discuss non-polio enteroviruses.

Signs and Symptoms of Non-Polio Enteroviruses

Often, people infected with non-polio enteroviruses have no symptoms, or they have only mild illness, like the common cold. Common signs of mild illness may include:

• Fever
• Runny nose
• Sneezing
• Cough
• Skin rash
• Sore throat
• Mouth blisters
• Body and muscle aches

Sometimes enterovirus infections can also cause:

• Viral conjunctivitis
• Hand, foot, and mouth disease
• Viral meningitis (infection of the covering of the spinal cord and/or brain)
• Viral encephalitis (infection of the brain)
• Myocarditis (infection of the heart)
• Pericarditis (infection of the sac around the heart)
• Acute flaccid paralysis (a sudden onset of weakness in one or more arms or legs)
• Inflammatory muscle disease (slow, progressive muscle weakness)

Infants and people with weakened immune systems are at greater risk of having these more serious complications.

How Are Non-Polio Enteroviruses Diagnosed?

Infection with non-polio enteroviruses is confirmed by:

• A genetic test like a polymerase chain reaction (PCR) test, or
• Isolating the virus in cell culture and then testing with PCR to identify the virus

Samples can be collected from stool, rectal swabs, respiratory specimens (including the throat), blood, cerebrospinal fluid (CSF) or from the fluid drainage of blisters.

Treatment and Medication Options for Non-Polio Enterovirus Infections

As with most viruses, treatment for enterovirus infections is aimed at helping to relieve the symptoms — for instance, drinking enough water to stay hydrated and taking over-the-counter cold medicine.

Severe infections, which cause serious complications, may require hospitalization.

Currently no medications exist that kill enteroviruses. Because they are viruses, antibiotics are ineffective against them.

There is no vaccine to protect against non-polio enteroviruses.

The best way to prevent the spread of enteroviruses is to stay home when sick and to regularly wash hands for at least 20 seconds with soap and water. Good hand hygiene is especially important after using the toilet, changing diapers, or having physical contact with people who are sick. Regularly cleaning and disinfecting frequently touched surfaces can also help to prevent the spread of enteroviruses.

Related Conditions of Non-Polio Enterovirus Infections

Hand, Foot, and Mouth Disease (HFMD)

Hand, foot, and mouth disease is common in children younger than 5, and it often spreads in schools or day-care centers. The condition is not usually considered very serious, but it is extremely contagious.

Symptoms of HFMD can include fever, sore throat, mouth sores, and a flat, red skin rash that shows up on the palms of the hands and soles of the feet. The rash can sometimes blister and show up on the knees, elbows, buttocks, or genital area. The virus can be found in the fluid of the blister and the scab itself, so the affected areas should be kept clean, and uninfected people should avoid touching them.

HFMD usually causes mild symptoms for 7 to 10 days, but parents may want to contact a healthcare provider if their child is not drinking enough to stay hydrated, if symptoms are severe or last more than 10 days, if the child has a weakened immune system, or if he or she is younger than 6 months old.

HFMD is frequently caused by the enteroviruses known as coxsackievirus A16, coxsackievirus A6, and enterovirus 71 (EV-71).

HFMD is not the same as foot-and-mouth disease, which is a disease that infects livestock.

Doctors warn that enterovirus D68 (EV-D68) can cause particularly dangerous respiratory symptoms in people with asthma. If you are caring for a child with asthma who is sick with EV-D68, it's important to follow their asthma action plan and to have their asthma medications available.