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]

  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]

  Fever accompanied by sore throat, and general weakness are usually the preliminary signs of hand, foot and mouth disease. [symptoma.com]

• Pallor

  No signs of pallor, icterus, cyanosis and pedal oedema were observed. On examination, the soles and palms of the patient had shown multiple vesicles of varying diameter from 1-2 mm ( Figures 2 and 3 ). The surface of vesicles was erythematous. [omicsonline.org]

• Sore Throat

  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]

  Symptoms Early symptoms may include fever and a sore throat (in younger kids fever and decreased eating or drinking). [webmd.com]

  […] a loss of appetite and a sore throat. [thesun.co.uk]

  Be sure to contact your doctor if mouth sores or a sore throat keep your child from drinking fluids, or if your child’s symptoms worsen. Here are some tips on home treatment: Offer plenty of cool liquids to help soothe a sore throat. [reliantmedicalgroup.org]

  It usually starts with a fever reduced appetite sore throat a feeling of being unwell (malaise) One or two days after the fever starts, painful sores can develop in the mouth (herpangina). [cdc.gov]

• Pneumonia

  The most common presentations among the severe caseswere: seizures (74%), pneumonia (39%), encephalitis (39%), and meningitis (13%). [ncbi.nlm.nih.gov]

  People infected with HFMD usually had minor symptoms, but in serious cases the disease could lead to complications such as encephalitis and pneumonia, he said. [english.peopledaily.com.cn]

• Hypertension

  Neurological involvement associated with enterovirus 71 infection may include: Aseptic meningitis Encephalitis Encephalomyelitis Acute cerebellar ataxia Acute transverse myelitis Guillain-Barré syndrome Opsomyoclonus syndrome Benign intracranial hypertension [dermnetnz.org]

  […] incidence of neurologic involvement, including the following [2] : A poliolike syndrome Aseptic meningitis Encephalitis Encephalomyelitis Acute cerebellar ataxia Acute transverse myelitis Guillain-Barré syndrome Opsomyoclonus syndrome Benign intracranial hypertension [emedicine.medscape.com]

  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]

  Presence of some atypical physical findings like tachycardia, tachypnea, hypotension, hypertension, bleeding in GIT and neurological deficits, elevated leukocyte count, vomiting and absence of mouth ulcers are reported to have some predictive value. [ [oadoi.org]

• Oral Ulcers

  It is marked by fever, oral ulcers, and skin manifestations affecting the palms, soles, and buttocks, with symptoms usually lasting less than 1 week. [ncbi.nlm.nih.gov]

• Sore Mouth

  Check if it's hand, foot and mouth disease The first signs of hand, foot and mouth disease can be: a sore throat a high temperature, above 38C not wanting to eat After a few days mouth ulcers and a rash will appear. [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]

  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]

  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]

• 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]

• Ulcer

  The blisters give way to shallow ulcers that heal in a few days. [medical-dictionary.thefreedictionary.com]

  The symptoms include small, painful blisters on the fingers, palms, toes and soles; and ulcers in the mouth. This photograph shows the small whitish to yellowish mouth ulcers with surrounding redness. [mountsinai.org]

  These can develop quickly into larger yellow-grey mouth ulcers with red edges. They can be painful and make eating, drinking and swallowing difficult. The ulcers usually pass within a week. [thesun.co.uk]

  The ulcerations were tender, the depth of the ulcers was 0.1 mm approximately with a sloping edge and the edge was non-indurated. The ulcer was freely movable over the base and the base was non-indurated. [omicsonline.org]

  Also call if the rash is spreading to your child’s outer lips with sores/ulcers, or your child’s gums are red and swollen. For further information call our office at 303-666-2720. [bouldermedicalcenter.com]

• Skin Rash

  The most common symptoms of HFMD are fever, malaise (feeling unwell or tired), mouth sores and skin rash. Some children may show all these symptoms, while others may just have a mild skin rash. [chla.org]

  Abstract Human enterovirus 71(EV71), one of the major pathogens of the hand, foot and mouth disease (HFMD), causes skin rashes in palms, feet and mouth ulcers and complication in the central nervous system such as aseptic meningitis and acute flaccid [ncbi.nlm.nih.gov]

  A skin rash on the palms of the hands and soles of the feet may also develop over one or two days as flat, red spots, sometimes with blisters. It may also appear on the knees, elbows, buttocks or genital area. [cdc.gov]

  The disease—a viral illness which can result in mouth sores and skin rashes —is the latest unconventional ailment to hit campus in recent years. [thecrimson.com]

  A skin rash with red spots, and sometimes with blisters, may also develop over one or two days on the palms of the hands and soles of the feet; it may also appear on the knees, elbows, buttocks or genital area. [web.archive.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]

  Hand, foot and mouth disease (HFMD) is caused by enteroviruses such as Coxsackie virus A16 (CVA16) and Enterovirus 71 (EV71). The diagnostic hallmarks are oral ulcers and maculo-papular or vesicular rash on the hands and feet. [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]

• Papule

  We describe a 37-year-old immunocompetent man who presented with multiple painful papules and vesicles on his palms and feet together with vesicles inside the mouth. [ncbi.nlm.nih.gov]

  Red macules and papules on the buttocks and sometimes on the arms. Lesions can also occur on the genitalia. Atypical hand foot and mouth disease results in a more widespread rash. [dermnetnz.org]

  Atypical HFMD has 4 distinct presentations: Widespread vesiculobullous lesions Eczema coxsackium with lesions concentrated in areas of eczematous skin Gianotti-Crosti type rash (multiple discrete, erythematous flat-topped papules symmetrically distributed [merckmanuals.com]

• Meningism

  Aseptic meningitis is the most common neurologic complication of EV71-induced HFMD. Lumbar puncture is a crucial procedure in the diagnosis of aseptic meningitis. It is often performed based on physicians' clinical suspicion. [ncbi.nlm.nih.gov]

  Approximately 320 children have been hospitalized with HFMD associated with suspected meningitis, encephalitis, or acute flaccid paralysis (AFP), and at least 55 have died. [web.archive.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]

  […] contentid=29&language=English">headache</a>, sore throat and lack of energy. [aboutkidshealth.ca]

• Flaccid Paralysis

  The initial illness resolves but is sometimes followed by aseptic meningitis, encephalomyelitis, or even acute flaccid paralysis similar to paralytic poliomyelitis. [ncbi.nlm.nih.gov]

  Acute Flaccid Paralysis Four patients had acute flaccid paralysis: one had paralysis of the right arm, and three had paralysis of the legs (unilateral in two patients and bilateral in one). [doi.org]

• Neurologic Manifestation

  Infection with EV-71 may be accompanied by severe neurologic manifestations (eg, meningitis, encephalitis, polio-like paralysis). Morbidity and mortality are significantly higher with EV-71 than with coxsackievirus A16 or other enteroviruses. [merckmanuals.com]

  At three major hospitals we identified 41 children with culture-confirmed enterovirus 71 infection and acute neurologic manifestations. [ncbi.nlm.nih.gov]

  Symptoms Prodromal symptoms were defined as systemic symptoms that occurred before the onset of neurologic manifestations. [doi.org]

  Neurological manifestations of enterovirus 71 infection in children during an outbreak of hand, foot, and mouth disease in Western Australia. Clin Infect Dis. 2001 Jan 15. 32(2):236-42. [Medline]. Ooi MH, Wong SC, Mohan A, et al. [emedicine.medscape.com]

• Ataxia

  Twenty patients had grade I rhombencephalitis (54 percent), defined as generalized myoclonic jerks with tremor, ataxia, or both. [doi.org]

  In 20 patients with rhombencephalitis, the syndrome was characterized by myoclonic jerks and tremor, ataxia, or both (grade I disease). Ten patients had myoclonus and cranial-nerve involvement (grade II disease). [ncbi.nlm.nih.gov]

  Tremors, ataxia and cranial nerve palsies can occur. Cardiorespiratory failure can occur in severe cases. Prognosis [ 1 ] This is generally excellent with a full recovery in the vast majority people. [patient.info]

  Neurological involvement associated with enterovirus 71 infection may include: Aseptic meningitis Encephalitis Encephalomyelitis Acute cerebellar ataxia Acute transverse myelitis Guillain-Barré syndrome Opsomyoclonus syndrome Benign intracranial hypertension [dermnetnz.org]

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].

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].

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].

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].

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].

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].

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].

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].

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.

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.