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Hand, Foot and Mouth Disease

Hand Foot and Mouth Disease

Hand, foot and mouth disease is a mild, contagious viral infection, which is most commonly caused by coxsackievirus A type 16. Symptoms include fever, exanthem and macular or vesicular lesions of the oral cavity.


Presentation

The incubation period for the virus to present signs and symptoms is 3 to 6 days from the day of initial infection. Fever accompanied by sore throat, and general weakness are usually the preliminary signs of hand, foot and mouth disease. After about 1 to 2 days, painful sores begin to appear in the throat and mouth, making eating and drinking difficult for children. Soon after that, rashes develop on the hands, feet and buttocks.

Infants and toddlers who develop this disease usually become cranky and irritable. They also experience loss of appetite due to development of painful sores inside the mouth and throat [6].

Fever
  • Fever is often the first sign of hand-foot-and-mouth disease, followed by a sore throat and sometimes a poor appetite and the feeling of being sick (malaise). One or two days after fever begins, painful sores may develop in the mouth or throat.[web.archive.org]
  • Fever accompanied by sore throat, and general weakness are usually the preliminary signs of hand, foot and mouth disease.[symptoma.com]
  • To relieve symptoms, the following home care can be used: Over-the-counter medicines, such as acetaminophen (Tylenol) or ibuprofen can be used to treat fever. Aspirin should not be given for viral illnesses in children under age 18.[nlm.nih.gov]
Nail Abnormality
  • abnormalities and peeling Chang et al.[doi.org]
Bradypnea
  • Majority Rashes and fever 38.5 C 100 % 100 % CNS involvement (lethargy 84.4 %, myoclonus 51.7 %, drowsiness 23.1 %), tachypnea 76.2 %, bradypnea 14.3 %, hypertension 15.5 %, increased chest 51.7 %, consolidation of the thorax 29.9 %, hyperglycemia 86.4[doi.org]
Sore Mouth
  • To help with the symptoms: drink fluids to prevent dehydration – avoid acidic drinks such as fruit juice eat soft foods like soup – avoid hot and spicy foods take paracetamol or ibuprofen to help ease a sore mouth or throat A pharmacist can help with[nhs.uk]
  • There may be a sore mouth or throat, cough or abdominal pain. EV71 can occasionally cause vomiting. Mouth lesions : after the prodrome, lesions develop in the mouth. These may be on the buccal mucosa, tongue and hard palate.[patient.info]
  • Signs and symptoms The history in patients with HFMD is as follows: Sore mouth or throat Malaise Rarely, vomiting occurs in HFMD cases caused by EV-71 Physical findings include the following: Initially, macular lesions appear on the buccal mucosa, tongue[emedicine.medscape.com]
  • One of the most important steps parents can take is to keep their kids hydrated – something that's not always easy when they have sore mouths or throats. That's why Roth resorted to juice.[aol.com]
Aphthous Stomatitis
  • In the differential diagnosis of lesions on the oral mucosa, the lesions that should be considered are primary herpetic gingivostomatitis, herpangina, erythema multiforme, aphthous stomatitis and chickenpox.[doi.org]
Back Pain
  • It causes fever, headache, stiff neck, or back pain and may require the infected person to be hospitalized for a few days. Encephalitis (inflammation of the brain) or polio-like paralysis can occur, but this is even rarer.[web.archive.org]
  • Viral or aseptic meningitis can occur with HFMD in rare cases and is characterized by fever, headache, stiff neck, or back pain. The condition is usually mild and clears without treatment; however, hospitalization for a short time may be needed.[en.wikipedia.org]
Rash of the Hands and Feet
  • Rash on the hands and feet can follow within one or two days, and may also appear on the buttocks. Hand-foot-and-mouth disease may cause all of the above signs and symptoms or just a few of them.[web.archive.org]
  • The diagnostic hallmarks are oral ulcers and maculo-papular or vesicular rash on the hands and feet. Severe form of this disease can lead to death due to neurological and cardiopulmonary complications.[ncbi.nlm.nih.gov]
  • Usually, a diagnosis can be made from asking about the symptoms and the rash on the hands and feet. There is no specific treatment for the infection other than symptom relief. Antibiotics do not work because the infection is caused by a virus.[nlm.nih.gov]
Vesicular Rash
  • The diagnostic hallmarks are oral ulcers and maculo-papular or vesicular rash on the hands and feet. Severe form of this disease can lead to death due to neurological and cardiopulmonary complications.[ncbi.nlm.nih.gov]
  • On June 8, she was admitted to a local hospital for suspected aseptic meningitis with a temperature of 102.6 F (39.2 C), nuchal rigidity, tonsilar enlargement, and a vesicular rash on the soles of her feet.[web.archive.org]
  • Serious enteroviral infection can lead to: Widespread vesicular rash Enteritis (gut infection ) Myocarditis (heart muscle infection ) Meningoencephalitis (brain infection ) Acute flaccid paralysis (spinal cord infection ) Pulmonary oedema and pneumonia[dermnetnz.org]
Exanthema
  • Atypical HFMD manifestations including vesiculobullous exanthema, often on the trunk or extremities, and perioral zone involvement were often caused by Coxsackievirus A6 infections.[ncbi.nlm.nih.gov]
  • […] exanthem (disorder), Enteroviral vesicular stomatitis with exanthem, Hand foot and mouth disease, Vesicular stomatitis with xanthem, Hand foot and mouth disease (disorder), Hand, foot and mouth disease, disease (or disorder); hand-, foot and mouth disease, exanthema[fpnotebook.com]
  • In the most common manifestation which gives the syndrome its name, children typically present with vesicular exanthema on the soles of their feet, the palms of their hands and in their mouths, causing discomfort and feeding difficulties.[dx.doi.org]
Eczema
  • Features may include: Red, crusted papules No blisters or very large ones Targetoid lesions Involvement of unusual sites such as the ear In children with atopic dermatitis, lesions may select skin affected by eczema.[dermnetnz.org]
  • "Eczema coxsackium" and unusual cutaneous findings in an enterovirus outbreak. Pediatrics. 2013 Jul. 132(1):e149-57. [Medline]. Yu JG, Liu YD, Qiao LY, Wang CJ.[emedicine.com]
  • How to treat your baby's rash Could your baby's rash be eczema, impetigo or meningitis? Find out more with this video on baby rashes. More baby videos Should I take my baby to the doctor for HFMD? You shouldn't need to take your baby to the doctor.[babycentre.co.uk]
Hyperkeratosis
  • Histological examination of the skin biopsy from a palmar papule showed orthokeratotic hyperkeratosis with areas of confluent parakeratosis and presence of singular basal and suprabasal keratinocyte necrosis.[doi.org]
Headache
  • It causes fever, headache, stiff neck, or back pain and may require the infected person to be hospitalized for a few days. Encephalitis (inflammation of the brain) or polio-like paralysis can occur, but this is even rarer.[web.archive.org]
  • Symptoms include; fever, sore throat, ulcers in the throat, headache, and a rash with blisters on the palms of the hands and soles of the feet. Hand, foot, and mouth disease is cause by a coxsackie virus.[mountsinai.org]

Workup

A careful physical examination of the sores, and the signs and symptoms of the disease would help in diagnosis of the condition. In addition, a throat swab and stool culture would also be carried out to analyze the presence of the viral agent [7].

Lymphocytopenia
  • A complete blood count revealed lymphocytopenia (1.29 g/l), and the erythrocyte sedimentation rate was increased to 26 mm/h. Blood chemistry tests showed an elevated CRP level (56 mg/l).[doi.org]
Lymphocytic Infiltrate
  • Oedema with increase in macroglia and astrocytic proliferation were seen in the cerebral tissue, but no lymphocytic infiltration was evident.[ncbi.nlm.nih.gov]

Treatment

Hand, foot and mouth disease has no specific treatment regime. So far, no antiviral medications have been developed against this virus. Symptoms usually clear up within 7 to 10 days. Over the counter medications for pain relief and fever are given, such as acetaminophen, ibuprofen and aspirin. These help relieve the pain and discomfort caused due to the sores and rashes.

Children are also given topical oral anesthetic to decrease the pain, caused due to development of sores inside mouth and throat. Analgesic agents can also be applied directly on the affected area through mouthwashes or sprays. In some instances, administration of intravenous immunoglobulin and milirone has proved to be effective [8].

Prognosis

In rare cases the disease can turn fatal. Individuals usually begin to show signs of recovery after 5 to 7 days. Chances of reinfection from the same virus are pretty impossible, as the body develops immunity against the virus that has been the cause of infection [5].

Etiology

The disease is caused by coxsackievirus A16. This virus belongs to a group of viruses known as nonpolio enteroviruses. Hand, foot and mouth disease is an infectious disease caused due to contact with infected persons. The disease spreads when children are exposed to nasal secretions, saliva or feces of infected individuals [2].

Epidemiology

Children less than 10 years fall easy prey to the disease due to poor immunity. However, the disease can even strike the adult population with compromised immunity profile. There has been considerable number of outbreaks of hand, foot and mouth disease reported worldwide. In the year 2012, about 1,520,274 cases of the disease were reported in China. In the same year, the disease also struck Alabama, United States, affecting majorly the teenagers and adult population. In Taiwan, the year 1998 witnessed 1.5 million cases of hand, foot and mouth disease [3].

Sex distribution
Age distribution

Pathophysiology

Hand, foot and mouth disease is infectious in nature, and is spread through the fecal-oral route, and contact with the lesions that develop on the hands and feet. Such a kind of disease is easily spread through oral secretions as well. Such sequence of events causes development of viremia, followed by occurrence of invasions governing the mucous membranes and skin.

The virus can continue to stay inside the body even after the signs and symptoms of the disease have subsided. As a result, the child who has once contracted the disease can continue its spread even after several weeks [4].

Prevention

There are several precautions that individuals can take to avoid spread of the disease. The following measures can be employed to prevent the disease:

  • Hand washing: The practice of washing hands frequently, after using toilet or changing diapers, helps in keeping the virus away. In situations when soap and water are unavailable, it is necessary to keep sanitizer gel and wipes handy.
  • Good hygiene: Good hygiene comes with practice. Parents and teachers should educate the children about good hygienic practices, so that the children can safeguard themselves against the virus [9].
  • Cleaning and disinfection: It is necessary that common surfaces, such as table tops and cooking platforms, be thoroughly cleaned and disinfected prior to use. It is also necessary to appropriately clean and disinfect baby’s pacifiers.
  • Isolation: It is one of the best methods to prevent the spread of the disease. Children who have active signs of the disease should not be sent to school, until the fever has subsided and the sores healed. Adults should also avoid going to their workplace when they have the disease.
  • Vaccination: A new vaccine has been developed that promises to prevent against the hand, foot and mouth disease [10].

Summary

Hand, foot and mouth disease (HFMD) is a viral infection characterized by development of sores inside the mouth and rashes in the hand and foot. It is more common in young children and with less chances of occurrence amongst the adult population. Children less than 5 years are more prone to develop such a kind of condition. The disease is highly contagious in nature and children who visit day care centres are at an increased risk. The development of sores inside the mouth makes eating and drinking difficult for the affected children. No specific treatment regime exists for treating hand, foot and mouth disease. The disease resolves by itself and medications are employed for symptomatic relief [1].

Patient Information

Definition

Hand, foot and mouth disease is a viral infection characterized by development of sores inside the mouth, and throat and rashes in the hands and feet. It is a contagious disease, and therefore is required that affected individuals be kept in isolation until they completely recover. Children below 10 years of age fall easy prey to this disease due to low immunity. Immunocompromised adults also are at an increased risk of developing such a disease.

Cause

The virus Coxsackie A 16 is known to cause hand, foot and mouth disease. This virus belongs to the group of non polio enteroviruses. It is an infectious disease, and is easily spread by contact with infected person through saliva or oral secretion, stool, fluid discharge from sores, and respiratory droplets that are shed off during coughing and sneezing.

Symptoms

Symptoms of hand, foot and mouth disease begin with development of fever followed by appearance of sores inside the mouth and throat. Affected individuals then gradually develop rashes in the hands, feet and buttocks.

Diagnosis

Diagnosis of hand, foot and mouth disease is made by careful examination of the sores and other signs. In addition, stool samples and throat swabs are tested for the presence of virus.

Treatment

There is no specific treatment regime for this disease. The symptoms are managed, and brought under control, with medications such as acetaminophen and aspirin, to relieve fever and pain due to sores. Oral analgesic are also given to be applied on the sores.

References

Article

  1. Thomas I, Janniger CK. Hand, foot, and mouth disease. Cutis. Nov 1993;52(5):265-6. 
  2. Osterback R, Vuorinen T, Linna M, et al. Coxsackievirus A6 and hand, foot, and mouth disease, Finland. Emerg Infect Dis 2009; 15:1485.
  3. Chen SC, Chang HL, Yan TR, Cheng YT, Chen KT. An eight-year study of epidemiologic features of enterovirus 71 infection in Taiwan. Am J Trop Med Hyg. Jul 2007;77(1):188-91 
  4. Wang SM, Liu CC. Enterovirus 71: epidemiology, pathogenesis and management. Expert Rev Anti Infect Ther. Aug 2009;7(6):735-42.
  5. Yin XG, Yi HX, Shu J, et al. Clinical and epidemiological characteristics of adult hand, foot, and mouth disease in northern Zhejiang, China, May 2008-November 2013. BMC Infect Dis 2014; 14:251.
  6. Whiting DA, Smith MB. The clinical appearance of hand, foot and mouth disease. S Afr Med J 1969; 43:575.
  7. Miller GD, Tindall JP. Hand-foot-and-mouth disease. JAMA. Mar 4 1968;203(10):827-30.
  8. Cherry JD, Jahn CL. Hand, foot, and mouth syndrome. Report of six cases due to coxsackie virus, group A, type 16. Pediatrics 1966; 37:637
  9. Fang Y, Wang S, Zhang L, et al. Risk factors of severe hand, foot and mouth disease: a meta-analysis. Scand J Infect Dis 2014; 46:515.
  10. Boughton B. EV71: Vaccine Prevents Hand-Foot-Mouth, Associated Disease. Medscape Medical News.

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Last updated: 2019-07-11 20:23