Tomato Flu Virus in Children: Symptoms, Treatment and Prevention

Tomato flu is a highly contagious disease that has been appeared from an unknown viral infection. It was first recognized as a viral disease on May 6, 2022, in the state of Kerala, India. The disease is called Tomato flu because it’s characterized by red colour, painful blisters on the body that look like a tomato. The infection mostly affects children under the age of five years. Tomato flu is believed to be related to hand, foot and mouth disease. This is commonly caused by the Coxsackievirus. The coxsackie virus A16 type generally causes only mild illness. Even without special medical treatment, most patients recover naturally within 7-10 days.

Infection is transmitted from one person to another person by direct contact with the infectious virus, which is present in the saliva, blister fluid, nose and throat secretions, and stool of those who are infected. The virus is most frequently transferred by people’s hands, mites, and by contact with surfaces that have been exposed to the virus. There is currently no definite evidence that maternal enterovirus infection can cause untoward pregnancy outcomes such as abortion, stillbirth, or congenital abnormalities².

Tomato flu could be an after- effect of chikungunya or dengue fever in children rather than a viral infection. The virus could also be a new variant of the viral hand, foot, and mouth disease, a common infectious condition targeting major children aged 1-5 years and immune-compromised adults, and a few case studies have even shown HFMD in immunocompetent adults³.

Figure A: Tomato flu on hands    Figure B: Tomato flu on face

Figure C: Tomato flu on the feet.        Figure D: Tomato flu on the mouth

Symptoms⁴:

Primary symptoms:

Fever

Nausea and vomiting

Dehydration

Running nose

Frequent cough

Secondary symptoms:

High-grade fever

Skin rash and skin irritation

Large, spherical, reddish blisters

Patches and dis colouration on hands, buttocks and knees

EPIDEMIOLOGY^5,6:

The first case of tomato flu was identified in the Indian state of Kerala on 6^th may 2022. In that time, 82 cases have been reported from Kerala in children under 6 years and 26 cases from Tamil Nadu in children less than 9 years, both states located in the south of India. 100 children with tomato flu, no other complications were reported. None of the children with tomato flu was admitted to the hospital, and self-recovery was reported. The government mandated isolation for infected individuals for 5-7 days with proper symptom guidance; the general public was encouraged to practise good hygiene and sanitation and to confine the infected persons and their possessions.

MANAGEMENT^7,8:

The management of HFMD is mainly supportive, as the disease is self- limiting and usually resolves within 7-10 days. Patients are advised to take adequate rest and maintain proper fluid intake to prevent dehydration, particularly in young children. Fever and body pains are controlled using medications like paracetamol or ibuprofen, while the use of aspirin is avoided. Painful mouth ulcers can be managed with soothing oral preparations, salt water rinses, and by consuming soft and non-spicy foods. Skin rashes and blisters usually heal without specific treatment, but cleanliness should be maintained to avoid secondary infection.

 There is specific antiviral therapy approved for HFMD; however, drugs like acyclovir and oseltamivir may be used in severe cases, although their effectiveness is limited. Patients with severe symptoms such as persistent fever, dehydration, and neurological complications require hospitalization and intensive care management. Isolation of the patient for 5-7 days, maintaining proper hygiene, and avoiding close contact are important preventive measures to control the spread of infection. Drug re-purposing and vaccination are the most efficacious and cost-effective approaches to ensure public health safety from viral infections, in children and older people.

TREATMENT^9,10,11:

Tomato flu is caused by CV-A16 (Coxsackievirus A16). There is no specific antiviral treatment for HFMD. Only the symptoms are managed like any other flu with antipyretic and analgesics accordingly; ibuprofen or acetaminophen can be used to treat the fever. The infection is presented with usual symptoms of flu, such as fever, fatigue and body aches. It seemed like red, painful blisters that grew to the size of a tomato.

Treatment is divided into 2 types. They are;

1. Allopathic treatment
2. Herbal treatment

Allopathic treatment:

Antipyretic: used to control high temperature. It helps prevent complications like dehydration, weakness, and febrile discomfort.

Examples: Paracetamol, Ibuprofen.

Analgesics: used to relieve body pains, headaches, and inflammation. It works by inhibiting prostaglandins, thereby reducing pain signals and swelling in tissues.

Examples: Paracetamol, Ibuprofen

Antihistamines: used to control itching and allergic- type reactions caused by skin lesions. They block histamine release, reducing irritation and improving patient comfort.

Example: Cetirizine

Hydration therapy: used to maintain fluid and electrolyte balance, especially in children who may lose fluids due to fever. It prevents dehydration, fatigue, and complications like electrolyte imbalance.

Example: ORS solution, water.

Skin care: the purpose is to soothe skin irritation, reduce itching, and protect blisters from secondary infection. It also provides a cooling effect.

Example: Calamine lotion.

Herbal treatment:

Method 1:

Boil leaves in water for 10-15 min, cool the water and use for bathing or washing affected skin 1-2 times daily. It may prevent the infection and reduce itching.

 Method 2: