Viral Fever

We often hear people say that they were down with a viral fever, very often called a “viral”. The viral fever is not a single disease entity caused by a specific type of virus. It rather refers to several febrile infections caused by viruses. We tend to treat them as one and the same because the symptoms and management are similar irrespective of the causative virus.  Viral fevers occur in all parts of the world and affect people of all ages. Thankfully, most of these infections are self-limiting, i.e. they will go away on their own. By this we do not mean to say that viruses cannot cause serious febrile illnesses. In fact, Dengue fever, Chinkungunya fever, and Japanese encephalitis are all caused by viruses. However, the typical set of symptoms that we call the “viral” can be managed with some self-care at home.

What are the Symptoms of a Viral Fever?

The earliest recognizable symptoms of a viral infection are often fatigue and body ache. This may be followed by the onset of fever. In most cases the fever is accompanied by respiratory symptoms such as sore throat, running nose, nasal stuffiness and red eyes. Headache is also a common symptom of viral infection. Severe fatigue and body ache even with a relatively low grade fever is a characteristic feature. Vomiting and diarrhea may be present in some cases. These symptoms usually resolve in three to seven days, though the fatigue may persist for a couple of weeks. If the fever does not resolve within this time frame, or other associated symptoms such as rashes, jaundice or joint pain appear, it is advisable to see a doctor. Such symptoms that require immediate medical attention are discussed later in more detail.

How is a Viral Diagnosed?

Most of the time your doctor will diagnose the fever to be of  a viral origin based on symptoms alone and no   specific tests will be required. Sometimes, some blood tets, a sputum culture etc may be required in order to rule out a bacterial infection. In most cases it is not necessary to determine which virus has caused the infection because management is targeted at symptoms rather than the organism itself. Sometimes when a viral fever outbreak is accompanied by atypical symptoms, unusually serious illness or fatality,  doctors and hospitals may order specific tests to determine the underlying virus. Such virus cultures are available at a limited number of laboratories.

How is a Viral Fever Treated?

Treatment of viral fever is targeted at relieving the body ache and fever and alleviating other associated symptoms:

1. For fever and body ache: Any non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen or acetaminophen (paracetamol) can be used to relieve fever and pain. Sometimes a combination of both may be needed to bring down the fever. Aspirin is not a good choice for bringing down the fever. These medicines are available over-the-counter, but children, the elderly or those with any chronic illness are advised not to take them unless prescribed by a doctor. Side effects of ibuprofen include nausea and vomiting, which may be prevented if the medication is taken with food. Rare side effects include diarrhea, constipation, heartburn, and stomach pain. People with stomach ulcers or kidney disease, pregnant women, and those with an aspirin allergy should avoid ibuprofen. People with liver disease and chronic alcohol users should avoid acetaminophen.
2. Stay hydrated:A fever can be very dehydrating, which only worsens your fatigue. Stay hydrated with plenty of water and clear soup. If your fever is accompanied by vomiting and diarrhea it is all the more important to drink enough fluids. Replenish your electrolytes by adding a pinch of salt and a spoonful of sugar to the water. If you are unable to drink fluids because of repeated vomiting it is advisable to seek medical attention as intravenous fluids may be required.
3. For the Cough and Cold:Warm saline gargle and steam inhalation are the most helpful measures for relieving the cough and cold that accompanies a viral fever. A very stuffy nose may need some nasal decongestant. You can use saline nasal drops available over the counter. Preparations containing xylometazoline (Otrivin) or oxymetazoline (Nasivion) should be used only if recommended by your doctor.  Repeated use of these nasal decongestants causes rebound congestion and should be avoided. Use combination products for cold and fever with caution as they may contain sedating antihistamines.
4. What about Antibiotics?Since antibiotics are medicines that fight bacteria and not viruses they will not help you feel any better if you have a viral fever. There is a common misconception that if you have a cough with sputum it indicates a bacterial infection. People tend to self-medicate with antibiotics because of such notions or if their fever does not resolve in three to four days. This approach can do a lot of harm by making your body resistant to potentially life-saving antibiotics.

How to Prevent Viral Fever?

Unfortunately, viral fevers are not easy to prevent. Most of them are highly contagious and once a wave starts a large number of people tend to contract the infection. You cannot get yourself vaccinated against them, because as we have already mentioned they are not caused by a specific type of virus.  Overall hygienic practices and a good immune system is the key to protecting yourself from repeated viral infections. Here we list some measures that you will find useful:

Cover your mouth and nose with a handkerchief or tissue when you cough or sneeze. It’s not only good manners but a very crucial step in protecting your friend and neighbor from getting infected.

• Likewise, try to avoid close contact with people with an obvious cough, cold or fever.
• Frequent hand washing is one of the most important infection control measures.
• Well ventilated homes and offices hinder the spread of infections.
• Schools and offices should advise sick individuals to stay at home till their symptoms resolve. This is particularly important at the onset of symptoms when they are most infectious.
• Some of the more serious viral infections such as Dengue, Chikungunya and Japanese encephalitis spread by mosquito bites. Keeping your environment free from mosquito breeding grounds helps in their prevention.
• A robust immune system is your best bet against viral infections. It comes with an overall healthy diet and lifestyle. Excessive stress is known to weaken the immune system.

When to see a Doctor?

While most viral fevers can be expected to go away with the need for hospitalization or even a visit to the doctor, it should be recognized that some viral infections can cause serious complications and sometimes can even be fatal. In general, children below the age of five, the elderly (>65 years of age), those with any chronic illness, and pregnant women should see a doctor in case of a fever. Some warning signs that indicate the need for medical attention are listed below.

• Confusion or excessive sleepiness
• Stiff neck
• Skin rash
• Chest pain
• Trouble breathing
• Repeated vomiting
• Abdominal pain
• Blood in stool
• Swollen joints
• Jaundice
• Bleeding from skin