Hand foot and mouth disease (HFMD)

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In children who present with, an acute onset of fever and a vesicular rash , it is common practice to first think of Chicken pox , which is a primary infection with the Varicella Zoster virus. However, it is important to consider other viral infections also which have a similar presentation. In this context , Hand foot and mouth disease needs to be considered in the differential diagnosis of chicken pox especially in children.

What is hand foot and mouth (HFMD) disease?
Hand foot and mouth disease (HFMD) is a viral infection characterized by fever and a typical rash most frequently seen on the palms of the hands, soles of the feet, and inside the mouth.


What are the symptoms and signs of hand foot and mouth disease?Hand foot and mouth disease (HFMD)

  • The disease usually begins with a fever, poor appetite, malaise and often with a sore throat.
  • One or 2 days after fever onset, painful sores usually develop in the mouth. They begin as small red spots that blister and then often become ulcers. The sores are usually located on the tongue, gums, and inside of the cheeks.
  • A non-itchy skin rash develops over 1-2 days. The rash has flat or raised red spots, sometimes with blisters. The rash is usually located on the palms of the hands and soles of the feet; it may also appear on the buttocks and/or genitalia.
  • A person with HFMD may have only the rash or only the mouth sores.

What causes hand foot and mouth disease?
HFMD is caused by several members of the enterovirus family of viruses. The most common cause is Coxsackie virus A-16; less frequently enterovirus 71 is the infectious agent..

How is hand foot and mouth disease spread?

  • Infection is spread from person to person by direct contact with infectious virus. Infectious virus is found in the nose and throat secretions, saliva, blister fluid, and stool of infected persons. The virus is most often spread by persons with unwashed, virus-contaminated hands and by contact with virus-contaminated surfaces.
  • Infected persons are most contagious during the first week of the illness.
  • The viruses that cause HFMD can remain in the body for weeks after a patient’s symptoms have gone away. This means that the infected person can still pass the infection to other people even though he/she appears well. Also, some persons who are infected and excreting the virus, including most adults, may have no symptoms.
  • HFMD is not transmitted to or from pets or other animals.

Hand foot and mouth disease (HFMD)What is the incubation period for hand foot and mouth disease?
There is a short four- to six-day incubation period between exposure and development of initial symptoms . A person is most contagious during the first week of illness.

When does hand foot and mouth disease occur?
Spring and fall are the most frequent seasons for community epidemics of HFMD. While anyone exposed to the viral causes of HFMD may develop disease, not everyone infected will develop symptoms.

How does hand foot and mouth disease affect pregnancy and the baby?
Commonly HFMD is an illness of children less than 10 years of age; adults generally were exposed during childhood and maintain a natural immunity. Information regarding fetal exposure to HFMD during pregnancy is limited. No solid evidence exists that maternal enterovirus infection is associated with complications such as spontaneous abortion or congenital defects. However, should a baby be born to a mother with active HFMD symptoms, the risk of neonatal infection is high. Typically, such newborns have a mild illness. Rarely, overwhelming infection involving vital organs such as liver, heart, and brain can be lethal.

What is the course of hand foot and mouth disease?
The illness is characteristically self-limited and is usually resolved within a week, particularly when due to its most common cause, Coxsackie virus A-16. As a rule, HFM is generally a mild and self-limited illness.

How is hand foot and mouth disease diagnosed?
Usually, the diagnosis of HFM is made on a combination of clinical history and characteristic physical findings. Laboratory confirmation is rarely necessary unless severe complications develop.

What is the treatment for hand foot and mouth disease?

  • There is no specific treatment for HFMD.
  • Symptoms can be treated to provide relief from pain from mouth sores and from fever and aches:
    • Pain and fever can be treated with paracetamol
    • Mouthwashes or sprays that numb pain can be used to lessen mouth pain.
  • Fluid intake should be enough to prevent dehydration . If moderate-to-severe dehydration develops, it can be treated medically by giving intra venous fluids.

Prevention
A specific preventive for HFMD is not available, but the risk of infection can be lowered by following good hygiene practices.
Good hygiene practices that can lower the risk of infection include

  • Washing hands frequently and correctly especially after changing diapers and after using the toilet
  • Cleaning dirty surfaces and soiled items, including toys, first with soap and water and then disinfecting them by cleansing with a solution of chlorine bleach
  • Avoiding close contact (kissing, hugging, sharing eating utensils or cups, etc.) with persons with HFMD

Vaccination Recommendations

  • No vaccine is available to protect against the enteroviruses that cause HFMD.

Complications

  • Complications from the virus infections that cause HFMD are not common, but if they do occur, medical care should be sought.
  • Viral or “aseptic meningitis” can rarely occur with HFMD. Viral meningitis causes fever, headache, stiff neck, or back pain. The condition is usually mild and clears without treatment; however, some patients may need to be hospitalized for a short time.
  • Other more serious diseases, such as encephalitis or a polio-like paralysis, result even more rarely. Encephalitis can be fatal.
  • There have been reports of fingernail and toenail loss occurring mostly in children within 4 weeks of their having hand, foot, and mouth disease (HFMD). At this time, it is not known whether the reported nail loss is or is not a result of the infection. However, in the reports reviewed, the nail loss has been temporary and nail growth resumed without medical treatment

References

  • medicinenet.com/handfoot-and-mouth disease
  • nlm.nih.gov/medlineplus/ency/article/000965


Dr. Irene Nirmala Thomas
,MD
Associate Professor , Dept of Dermatology,
GMC hospital,Ajman, UAE.

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