Oh poor sweet Coby,
This one's for you.
Coby is 15 ½ months old.
Last weekend his parents had flown off for a well earned quick getaway. He and his brother Elliot were staying with the other set of grandparents.
Murphy’s Law was on the case. On Saturday Coby developed a fever and was absolutely miserable.
‘Bobbie’ and ‘Zayde’ called me to check in. The fever was still up an hour after the Tylenol, and I could hear him pitifully wailing in the background. He is generally a mild mannered little fellow.
I suggested that it was worth taking him to urgent care. I thought it was a good idea to rule out an ear infection. Also, Dr Ted had been seeing a lot of Influenza type B (odd for June) so I told them to get that checked as well.
Important note…make sure that anytime parents leave kids with anyone, the caregivers have an official permission to be able to get the children medical care in case of a situation like this!
Ah second kids…While there was a healthcare proxy, signed and sealed for his big brother, but no one had thought to update it to include Coby.
We all hated to put a damper on their weekend, but it was time to call Lauren and Adam, let them know what was going on and get that paperwork taken care of just in case it was needed.
At urgent care Coby’s ears got the ‘all clear’. The rapid test for flu was negative. He was obviously sick with something, so they sent off a complete respiratory panel. The following morning we had our answer. Poor guy had a nasty case of Adenovirus.
Here is the post that I had done a couple of years ago.
At the end, I will give you all the details of what Coby’s particular course looked like. (it was no fun)
Adenovirus
Is this a new virus? Nope!
What’s new is the ability to easily do a respiratory panel to identify the actual virus. What I used to refer to as a ‘viral package’ or the ‘creeping crud’ now has a specific diagnosis.
So, what is adenovirus?
Adenovirus is a family of viruses that has more than 60 types. The correct pronunciation stresses the second syllable. (I was saying it wrong for years)
It is quite common. You've probably been exposed to it at some point in your life. In fact, by the age of 10- years, most kids have had at least one adenovirus infection.
It can happen year round but tends to be more common in the Winter and Spring. It is very contagious. Symptoms are variable and range from a mild cold to severe illness. Most people don’t bother to test a little sniffle, so it is hard to have accurate data on how common it actually is.
The more annoying and serious presentations include:
Runny nose and congestion
Pinkeye
fever
Cough
Headache
Sore throat
Muscle aches
Pneumonia
Ear aches
Vomiting
Diarrhea
This is indeed the ‘viral package’ with a little bit of everything. The wave that was going around when I first did this post, as reported by Dr. Ted, was a “pharyngo-conjunctival fever,” aka sore throat, pink eye, and fever. Most cases last from 3 to 7 days, but the more severe cases can last for weeks. We once had a colleague whose child had a fever for 3 weeks with adenovirus.
Like other nasty viruses, there can be secondary infections.
People with weakened immune systems, or existing respiratory or cardiac disease, are at higher risk of developing severe illness from an adenovirus infection.
Exposure and spread
The onset of respiratory symptoms is usually between two and fourteen days after exposure. When it is gut related (vomiting and diarrhea) it moves a little more quickly and you will see signs within 3-10 days.
People are most contagious right before they get sick or within the first couple of days of the illness. Even people with very mild cases can spread it.
The most common ways that it spreads are
Close contact (shaking hands)
fecal/oral transmission
contaminated surfaces
airborne transmission from one infected person to another.
Occasionally it can be spread through water and public pools
Testing
More often than not the diagnosis is the ‘best guess’ based on the symptoms. Those red eyes are often a big clue. If the patient is pretty sick or has a persistent illness, then your doctor may opt to do a respiratory panel to get a more definitive answer. A stool sample might also give a diagnosis. Blood work is not usually done, unless your provider wants to rule out something else, but it might show an elevated white blood cell count.
Note about nasal swabs in pediatrics.
Kids' noses are a breeding ground of all sorts of stuff. It is quite common to have an assortment of various bacteria show up. Pediatricians are skilled at knowing what needs attention. Adult doctors might tend to ‘over-treat’
Treatment
Most of the time treatment is based on the symptoms and there are no special medications (or magic wands). Antibiotics will not be helpful.
Symptomatic treatment includes, fluids, rest, fever medications as needed and a humidifier at night. Soothing eye drops are helpful for the pinkeye and Manuka honey feels great for the throats (only for folks older than a year.)
Saline mist inhalers are a game changer, especially if you can get your little one to cooperate. A little mist followed by snot suckers can be very helpful for clearing the nasal passages.
People who are immunocompromised and get a severe version may need to be hospitalized for supportive care. Those folks may have access to antiviral medications.
Prevention
Good hand washing and wiping down surfaces are important ways to protect yourself from this.
Try hard not to touch your face with unwashed hands.
Boost your immune system
Try to get enough sleep. Vitamin D and ZInc are associated with a healthy immune system. I also like sambucol/elderberry at the first sign of illness.
So, what did Coby’s course look like?
This is absolutely the sickest he had ever been. He had Covid when he was 5 months old, and it isn’t even close.
With this virus, the fever lasted for a full 6 days. The baseline was 101-102 even with meds. The highest that they measured was 103.7. The method of measuring was a forehead thermometer.
Motrin clearly had a bigger impact than the Tylenol, but he was most comfortable when he had both in his system. Bless his heart, there were a few moments, on full medication when he did a little dancing. That kept Grandma from being too worried.
His poops were mushy and very stinky.
His nose ran like a faucet, with thick yellow/green snot.
His breathing sounded noisy, but his lungs were mostly clear. There was no labored breathing (he wasn’t out of breath), but when the fever was high, his respiratory rate was elevated. Read here for more on what labored breathing looks like.
His appetite was pathetic, but he was drinking and fortunately still had some ‘Baboo’ available (Coby’s term for breastmilk). He did accept some sips of smoothies.
His cry was a bit hoarse, so he may have had a sore throat.
He was clingy and lethargic. Days were full of one contact nap after another. With all the congestion, this was the easiest way for him to breathe, since he was in a more upright position. Nights were awful.
He might have had some mildly pink eyes the week before, but that was the one classic symptom that really didn’t come into play.
Lauren called to check in with the regular pediatrician first thing Monday morning, just to keep them in the loop.
On Tuesday, day four of high fever, Coby went in to get checked. The doctor confirmed that this looked exactly like “classic adenovirus.”
She was told not to fret about the poor appetite as long as he was staying hydrated.
This link about tummy bugs has a good review of how to assess hydration status
She was also warned that this could linger for 10 days.
At that point it was all about symptomatic treatment. (and of course to check in if things seemed to be getting worse).
Happily on Day 6, the fever was gone, the poops returned to normal and the appetite came back. Kids are resilient!
Extra thoughts.
Sometimes after hours urgent care that doesn't specialize in pediatrics may be quick to prescribe medication that isn’t strictly necessary. To the doctor’s credit, this is often because that is what some parents seem to be looking for.
I know that it isn’t always an option, but seeing an actual pediatrician is preferable. Especially for kids younger than 3.
In Coby’s case they sent him out with both a course of antibiotics and a course of steroids. Neither was necessary or appropriate.
When the diagnosis came through the following day, we were all glad that the decision had been made by the family (and the wisdom of Dr Ted) to hold off.
Update:
Eight days after Coby first showed any symptoms, EJ succumbed. Enough time had passed that we thought we were in the clear. Suddenly he complained of feeling cold. “Ruh Roh”. This was soon followed by 102 fever and a headache. We are assuming, based on the timing, that it’s also adenovirus. As noted above the exposure for this can be 14 days.
Interestingly, one other of Elliot’s early symptom was pain with peeing. Specifically he reported that his pee felt hot, thick and stingy. Bet you didn’t know that a virus could start in your urinary tract! Sure enough, some strains of adenovirus are well known to cause “urethritis.” We did a home urine test to rule out a urinary tract infection. Fortunately, that particular complaint lasted only for one day. Ongoing pee issues would have required an ‘in office’ urine test.
The fever has lingered as a low-grade temp for 4 days, so far. There hasn’t been any congestion. Not all viruses present the same way in different people.
Now the countdown continues. I for one had been sharing spoons and closely snuggling with him for days.
Fingers crossed that the other adults (myself included) in his life don’t get it!