Winter illness 101: fever can be key to diagnosis

Published on Monday, February 24, 2020

By: Annie Oeth, aoeth@umc.edu

Coughs, sniffles, sore throats and fever.

These symptoms, along with headaches, muscle soreness and nausea, have been popping up among Mississippi children this winter, prompting parents to question whether to take their children to emergency departments, urgent care or their pediatrician.

“Influenza, RSV, and the common cold all have a great deal of overlap in symptoms,” said Dr. Benjamin Dillard, chief of pediatric emergency medicine at Children’s of Mississippi. “All of these illnesses are related to viral infections. Further testing might be necessary in some instances. Influenza is the only illness of the three that we actually have medications, such as Tamiflu, that work directly against the virus.”

This comes as the U.S. Centers for Disease Control and Prevention reports an active influenza season including at least 26 million flu illnesses, 250,000 hospitalizations and 14,000 deaths. Overall hospitalization rates throughout the country are similar to this time during recent seasons, but hospitalization of children and young adults has increased this season.

Locally, this year’s flu season has not been as severe as in years past, said Dr. Bryant McCrary, assistant professor of pediatric ambulatory medicine, who provides pediatric care at Children’s of Mississippi’s clinic at Acadian Court in Gulfport.

“We continue to see Influenza A and B but not in massive numbers,” he said. “RSV and strep have been steady throughout the winter months. This winter seems typical of other winters thus far. We have seen some cases of pertussis (whooping cough). Hence, immunizations continue to be extremely important for children of all ages to receive.”

Diagnosing these illnesses can be difficult for parents, since influenza, strep throat, colds and other winter illnesses can produce symptoms that mimic an ear infection.

“Ear pain and sore throat symptoms can occur with any of these viral illnesses and, depending on the severity of symptoms, may require an evaluation in your doctor’s office to determine if an ear infection or streptococcal pharyngitis is present,” Dillard said. “Ear infections can be diagnosed by physical exam alone. Strep throat can be diagnosed with a rapid test that is done by swabbing the person’s throat.”   

Sorting children’s symptoms can be difficult, but here are clues to the illnesses that could be afoot.

Cold

The common cold appears gradually with a runny nose and a hacking cough. Fever, chills and headaches are usually not seen with colds and other upper respiratory infections. The American Academy of Pediatrics reports that children can have as many as eight to 10 colds in their first two years of life. Most colds go away on their own, but sometimes they can turn into more dangerous conditions including bronchitis, croup and pneumonia.

Influenza

Human influenza A and B viruses cause the seasonal outbreaks of disease nearly every winter in the U.S. Influenza A can be found in many species, including humans, birds and pigs, while B is typically only found in humans. They are both extremely contagious and produce similar symptoms.

Flu usually comes on suddenly, bringing along symptoms that can include fever, chills, cough, sore throat, runny or stuffy nose, body aches, headaches, fatigue and sometimes vomiting and diarrhea. Most who get the flu recover within a week or two, but some can develop complications such as pneumonia that can lead to death. Among those at risk for flu complications, according to the CDC, are pregnant women and children younger than 5, and especially children younger than 2.

Croup

Known for its barking cough, croup is caused by a viral infection of the voice box and windpipe. Medications may be prescribed to reduce swelling, but antibiotics won’t fight croup since it is caused by a virus. Most cases are mild, but croup can sometimes become severe, leading to blockage of a child’s airway.

Strep throat

Pain and fever without a cough are common signs of strep throat, or a group A Streptococcus infection, the CDC says. Other symptoms may include headaches, stomach pain, nausea and vomiting.

However, these symptoms – cough, runny nose, hoarseness and conjunctivitis, also known as pink eye – may suggest a virus is the culprit and not Strep A.

Doctors treat strep throat with antibiotics, given either as orally or as a shot. These usually have patients feeling better in a day or two. The CDC recommends calling the doctor if a child isn’t feeling better after taking antibiotics for 48 hours.

Treating strep throat is important, as untreated strep can lead to rheumatic fever and long-term heart damage.

RSV

Respiratory Syncytial Virus, or RSV, is the most common cause of lower respiratory tract infections among children, according to the American Academy of Pediatrics. Almost all children have had RSV by 2. RSV causes fever, a runny nose and cough, which in some infants can become a serious infection that leads to hospitalization.

Babies who were born prematurely or have lung diseases are at risk for RSV complications. For this reason, parents, as well as friends, family and caregivers, should wash their hands with soap and warm water before handing these babies to avoid RSV, which is highly contagious.

Ear infections

Ear infections can begin with either a viral infection such as a cold or unhealthy bacterial growth, according to the AAP website healthychildren.org. Symptoms can include more crying than usual, trouble sleeping or hearing, fever, headaches and fluid coming from the ears.

For recurrent ear infections, as well as frequent throat and sinus infections, a referral to an ear, nose and throat specialist may be appropriate.

Children having four ear infections in six months, six infections in a year or an acute ear infection that does not go away after three weeks of taking antibiotics may be candidates for ear tube surgery, said Dr. Jeff Carron, professor of otolaryngology and communicative science and an ear, nose and throat surgeon. This surgery places a tube to equalize pressure between the middle ear and the environment, allowing extra fluid to drain out and reducing inflammation.

Tonsillitis

Children with tonsillitis, whether strep or viral, can be considered for a tonsillectomy if there are seven infections in a year that require missed school or a doctor’s visit, or five per year for 2 years, or three per year for three years, Carron said.

“Kids with complications of strep such as rash, kidney failure, heart disease, recurrent tonsil abscesses, or chronic tonsillitis with pain can be candidates for tonsillectomy sooner,” Carron said.

How to help your child

Keeping a child comfortable during winter illnesses is key. Promote rest and drinking plenty of fluids. Keep nasal passages clear, and humidify the air with a cool-mist vaporizer. Over-the-counter pain medications for children can help reduce discomfort.

When to go to the ED

Symptoms that warrant emergency medical care include trouble breathing, bluish lips or face, dehydration (no urine for eight hours, dry mouth, no tears when crying), seizures, not alert or interacting when awake, or fever above 104 degrees, Dillard said.

Other symptoms that are less severe can be treated through urgent care centers, which offer care for illnesses that are not serious enough to warrant emergency room care, or at a visit to your pediatrician or family health provider.