There are several illnesses found more commonly in the summer that share the symptoms of fever and headache. The most common of these are viruses of the enterovirus family. Enteroviruses cause highly contagious epidemics of illnesses that often have fever, headache, sores in the mouth or on the tongue, sometimes vomiting or respiratory symptoms, sometimes a rash on the palms, soles or buttocks that may look like chickenpox and sometimes a rash on the trunk reminiscent of roseola. Usually the rash comes after the fever is gone. Examples of enteroviral illnesses are hand, foot and mouth disease (sometimes called hoof and mouth), herpangina, a roseola like illness, summer flu, and viral meningitis. Although the word meningitis is frightening, it is a viral meningitis that requires no treatment and generally patients with enteroviral illness are only mildly to moderately ill for 3 to 5 days. Infant and young children tend to be more ill that older children and adults. There are about 68 viruses in this family with about 12 commonly causing illness–hence theoretically a person could be ill 68 times from enterovirus. If you have ever had a fever, headache and stiff neck in the late summer months you may have had enteroviral meningitis. There are no antibiotics that will help and in fact antibiotics may make the diagnosis more difficult. Complications are rare, however, at times a patient may be ill enough that the possibility of the more serious bacterial meningitis needs to be ruled out by a spinal tap or lumbar puncture. If this is the case, being on antibiotics may make it difficult to quickly rule out bacterial meningitis by clouding the picture. Because of this, if an enteroviral illness is suspected it is best to avoid antibiotics unless absolutely necessary.

There are other illnesses that may have fever and headache early on in their illness and look exactly like enteroviral illnesses. These are the tick borne illnesses of Rocky Mountain Spotted Fever and Ehrlichiosis and the mosquito related illnesses like West Nile Disease.

Fortunately, West Nile Disease tends to be rare and milder in children. The initial symptoms can be the same as in Enteroviruses, Rocky Mountain Spotted Fever and Ehrlichiosis. Muscle weakness is suggestive of West Nile Disease. Generally worry about West Nile Disease only if a patient is sick enough with encephalitis. There are no antibiotics for West Nile Disease and there is not a rapid test to diagnosis West Nile Disease. The treatment is supportive –i.e. give the patient what is needed until it passes.

Rocky Mountain Spotted fever and Ehrlichiosis are transmitted only by ticks, usually within the first week of the bite . Unfortunately at least a third of people with these illnesses do not remember a tick bite. One does not have to go to Colorado to get Rocky Mountain Spotted Fever. In fact Missouri is one of the most common states for a person to get either one of these illnesses. Like Enteroviruses, common symptoms are fever and headache. At times light will make the headache worse or bother a person’s eyes–some Enteroviruses also do this as can West Nile disease. Muscle aches, particularly calf ache and neck ache are more common in tick born and mosquito born illness but these also can be seen in Enteroviruses. A rash on the palms, soles and extremities that is petechial (small broken blood vessels) at the time of high fever is often found with Rocky Mountain Spotted Fever but not always. There are antibiotics for Rocky Mountain Spotted Fever and Ehrlichiosis that are more effective if used early in the illness, unfortunately, there is no rapid test available in Washington to diagnose either one.

If there are no antibiotics for two of the illnesses above and no quick way to diagnose any of the four what does a patient do? When should I be concerned about these?

The bottom line is that you and your doctor should always be aware of the possibility of tick and mosquito borne illnesses or complications of enteroviral illnesses. You should become concerned if the illness does not follow the typical enteroviral course, especially if your child seems progressively sick instead of better 3 days into his illness, develops rash with the fever still high , has severe muscle or neck aches, or weaknesses. If you child is unable to walk, or doesn’t seem "right" mentally it is a medical emergency.