Zika Virus

Zika virus is forefront in the news. It is a virus that is transmitted by mosquitoes and rarely is sexually transmitted. Zika infections tend to be well tolerated in children and adults with nonspecific fevers and red eyes. In actuality, most Zika infections go unnoticed. There have been reports of Guillian-Barre with Zika, however, many viruses have been associated with Guillian-Barre.

The major concerns are reports of microcephaly (small head and brain) in babies born to mothers who had Zika in pregnancy. Zika has been shown to infect developing brain cells. Pregnant women are currently advised to avoid travel to areas of active Zika. If they must travel, they should use barrier protections and mosquito repellent with DEET. Males who are infected are advised to where condoms for at least 6 months after infection.

As of May 2016, there have been no cases contracted in the continental United States from a mosquito bite. Currently, the mosquitos that live in Western New York are not thought to be the best mosquitos for transmitting the Zika virus, however they are able to transmit this. The mosquitos that are in much of the Southern states are much more efficient with transmission.

As the summer months approach, please stay up to date with Zika, particularly if you are pregnant or are interested in becoming pregnant. For further questions, please visit the CDC website.

Fevers and Illness

The causes of fever are many and varied. Most commonly in children, fevers are a normal response to minor viral and bacterial infections such as common colds or ear infections. Call your pediatrician if your infant has a fever of 100.4 or for any other concerns. Fevers are not generally harmful and only persistent high fevers (near 106 Fahrenheit, 41 Celsius) are in and of themselves dangerous. However, fevers of any range, and even low temperatures, can correspond to serious illness. If there are concerns, discuss with your pediatrician.

But my child is sick all the time

As an adult, you have been exposed to and fought off many infections over the years and your immune system has built up defenses that fight off similar infections. Your child hasn’t had that experience yet so they are still working on building up those defenses. When parents say their children seem sick “all of the time” that is actually not far from normal. In certain studies, it is “normal” for children to have 5-8 common cold-type infections per year and 2-4 diarrheal illnesses per year. All of these can have associated fever and at times can last 1-2 weeks. Adding this up to the extreme equals 24 weeks of illness being within the norm. Some children fair better and some fair worse, yet all would be considered to have normal immune systems.

Other causes of fever are somewhat rarer and include medicine reactions, inflammatory disorders, such as rheumatic fever or lupus, inflammatory bowel disease, and periodic fever syndromes. Cancer does not usually cause intermittent fevers (they tend to be more persistent) and usually are associated with other more worrisome signs, such as weight loss, night sweats, morning vomiting that relieves a headache or large rubbery lymph nodes. Of the periodic fever syndromes, PFAPA is one of the more common; it stands for Periodic Fever, Adenopathy (swollen nodes), Pharyngitis (red throat) and Apthous stomatitis (mouth sores). Other than the concerning symptoms, this disorder has not been associated with long-term adverse outcomes. Fevers persisting for two weeks without a source for the fever are referred to as “Fevers of Unknown Origin” and deserve special consideration.

Our clinic has interest in and provides consultative services for recurrent fevers, periodic fevers and fevers of unknown origin.

Lyme disease

Lyme disease is the most common tick-borne illness in America. However, the geography is very limited to mostly eastern coastal regions of America. In Erie County, New York, it would be a rare event to contract Lyme disease. In most cases, there is a bulls-eye rash with fevers. Arthritis can develop later and is usually in a single large joint.

Unfortunately, the testing is not straightforward. Please review test results with your physician as Lyme antibody positive screens are not definitive and do not necessarily mean a patient has Lyme. The FDA recommends all positive screens to have a Western blot confirmatory test. These also require interpretation, as only 1 or 2 bands being positive are not confirmatory. Generally, reliable testing centers will provide the necessary interpretation in the reports.

I have chronic complaints, is this Lyme?

The official statement of the Infectious Diseases Society of America (IDSA) is that Lyme disease is unlikely to explain generalized fatigue symptoms. To quote the IDSA July 17th, 2012 report from the Africa, Global Health and Human Rights Subcommittee of the House Foreign Affairs Committee’s Hearing on Global Challenges in Diagnosing and Managing Lyme Disease — Closing Knowledge Gaps:Neither the diagnosis of so-called “chronic” Lyme disease, nor long-term antibiotic therapy are supported by the NIH, CDC, American Academy of Neurology, the American College of Physicians, and the American Academy of Pediatrics, or by an overwhelming majority of experts in the field of infectious diseases medicine in this country and abroad.”

You can read the full statement by clicking here.

When Lyme does have lingering effects it is usually arthritis in a large joint. This does not necessitate recurrent prolonged treatments. Although, at times if the initial treatment was of a shorter course, a one-time repeated 28 day course may be helpful and recommended.

If there are still concerns or questions, discuss with your physician regarding a referral to our clinic. More information on Lyme disease can be obtained at the IDSA’s website: http://www.idsociety.org/Lyme.

Kawasaki disease

Febrile illnesses lasting 5 days or greater should be discussed with your pediatrician. Kawasaki disease is an inflammatory disorder that can be confused with many common infections. There is no specific test for Kawasaki disease so the diagnosis can be difficult. Usual cases have four of the five following symptoms: large one-sided neck mass, hand and feet swelling and redness, red eyes, inflamed lips and mouth, and a rash. In near a quarter of children that do not receive prompt treatment (generally prior to the 10th day of fever), they will develop inflammation in the vessels that provide oxygen to the heart muscle. Treatment reduces this risk near ten-fold.

We see Kawasaki diseases patients in our inpatient consultative service. We have active research studies on Kawasaki disease ongoing in Dr. Mark Hicar’s laboratory. For more information, you can call for a consultation or visit the CDC website: http://www.cdc.gov/kawasaki.

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