Dear Dr Nina: My son hasn't been the same since nasty stomach bug
Q. My 11-year-old son has been having some terrible health problems over the past three or four months. He had a bad stomach virus last year while we were on holidays in Tunisia, and he hasn't been the same since. My younger son, age nine, had the same bug, as did their father, and they both recovered fine, so I'm bit unsure if the two are related. My GP is quite good but is struggling with the symptoms. He thinks it might be something called post-viral syndrome. What is this? Is it the same as ME or chronic fatigue? I have been reading up on the symptoms online and it sounds like it could be. It also sounds similar to Lyme disease, but we don't have any history of tick bites that we know of. Can you help?
Gastrointestinal viruses cause inflammation of the stomach, intestines, or both. This results in abdominal pain, nausea, vomiting and diarrhoea. Diarrhoea may come on quite suddenly and be explosive. There may also be an associated fever, headache or body aches and pains. Most cases are short-lived and recovery occurs within one to three days.
The main danger with profuse vomiting and diarrhoea, or prolonged symptoms, is dehydration. Children and the elderly, or those with other illness, are especially at risk. It is important to watch out for dark or reduced urine, dry mouth and lips, dizziness when standing, headache, and unusual tiredness, as these are tell-tale signs that the body's fluid reserves are low.
Viral gastroenteritis is extremely contagious and spreads easily among those in close contact. Infection is passed either through direct contact with someone who has the virus or by touching a surface, which has become infected. The virus can live on surfaces for several days, so once again strict hygiene is one of the best ways to avoid its spread.
It is unfortunate your family got sick while travelling abroad, but these episodes are quite common when travelling to less developed countries where food hygiene might not be as advanced, and where the gut is exposed to bugs and viruses it has not encountered before.
It is essential when travelling to check what vaccinations are required and to have this done in advance of your trip. Hepatitis A is a viral illness that can cause a diarrhoeal illness and exists in developing countries with poor sanitation. Ingesting food and drink in restaurants and hotels can put you at risk. The virus can also spread through close physical contact with another infected individual.
It sounds like your doctor feels your son may have post viral irritable bowel syndrome. This is a very well documented phenomenon and is thought to have an incidence of 5pc to 32pc in those who experience an infectious gastrointestinal upset. This is not ME or chronic fatigue. The exact cause isn't clear, but it is thought to be a combination of ongoing inflammation and changes in gut microbes and permeability. Females and those under the age of six are at higher risk. The risk of post-infectious IBS also correlates with the severity of the initial illness, increasing two-fold if diarrhoea lasted more than a week. There is no doubt that on-going stomach upset can cause some stress and it is important to address any psychological upset as this too can prolong symptoms.
Post-infectious lactose intolerance is well documented and so in those with on-going gastrointestinal upset it may be worth trying a low-lactose diet. There are no other specific dietary recommendations, but if diarrhoea predominates a lower residue diet may help. Whatever the cause, it's important to note that the outlook is good overall.
The large majority of people recover within two years with only a small percentage having longer-term problems. If stomach upset is accompanied by fever, passing blood, severe abdominal pain or weight loss, then referral for further investigation is warranted.
Q. My four-year-old daughter complains of a pain in her ear - but the GP said it looked fine. Any ideas?
A. Earache with a normal ear exam may be due to congestion in the Eustachian tube. This tube runs from the back of the nose to the middle ear. If this is congested, pressure builds up, potentially causing an earache.
Allergic rhinitis is associated with this. It causes a sensation of blocked nose, congestion and can cause sneezing, itchy eyes and nasal drip. Other symptoms include reduced taste, red eyes, mouth breathing, snoring, reduced sleep and fatigue. Most associate rhinitis with summer grasses and pollens, but symptoms can occur seasonally for some or all-year-round or others. Common triggers in winter months are house dust mite, moulds, fungal spores, and animal dander.
Treatment aims at reducing congestion. Firstly reduce exposure to triggers. Carpets and blow heaters will harbour and circulate dust and spores and should be avoided.
If it is impossible to avoid your triggers, then using a daily nasal rinse may help. There are many available over the counter in pharmacies. Used correctly these can flush dust, spores and irritating mucus form the nasal passages, helping to keep them clear.
Medication can help. Antihistamines reduce the body’s allergic response helping to limit the congestion, swelling and nasal drip associated with rhinitis. Steroid nasal sprays are essentially the mainstay of treatment for rhinitis whenever it occurs. They help reduce swelling in the nasal passages thus reducing congestion and blockage.
If spray rinses and antihistamines aren’t working, there are other prescription options, and it is worth talking to your doctor or attending an allergy specialist for these.
Health & Living