Hand Foot & Mouth Disease

Definition..

Hand-foot-and-mouth disease is a mild, contagious viral infection common in young children. Characterized by sores in the mouth and a rash on the hands and feet, hand-foot-and-mouth disease is most commonly caused by a coxsackievirus.

There's no specific treatment for hand-foot-and-mouth disease. You can reduce your risk of infection from hand-foot-and-mouth disease by practicing good hygiene, such as washing your hands often and thoroughly.

Clinical S/Sx

History The usual incubation period of hand-foot-and-mouth

(HFM) disease is 4-6 days. The prodrome is associated with the following:

Low-grade fever Malaise Anorexia Abdominal pain  Sore mouth

The prodrome precedes the development of oral lesions, followed shortly by skin lesions, primarily on the hands and feet and occasionally on the buttocks.

Physical Hand-foot-and-mouth disease is the most

common cause of mouth sores in pediatric patients.

Yellow ulcers surrounded by red halos characterize the oral lesions. These primarily occur on the labial and buccal

mucosal surfaces but may be observed on the tongue, palate, uvula, anterior tonsillar pillars, or gums. Unlike herpetic gingivostomatitis, perioral lesions are uncommon. Coxsackie A virus also causes herpangina, mostly described as palatal and posterior oropharyngeal lesions without any associated exanthem.

The oral ulcers are painful. Children younger than 5 years are predominately more symptomatic than older patients.

The exanthem typically involves the dorsal surfaces but frequently may include the palmar, plantar, and interdigital surfaces of the hands and feet. These lesions may be asymptomatic or pruritic. They usually begin as erythematous macules that

rapidly progress to thick-walled grey vesicles with an erythematous base.

In young infants, these lesions may also be observed on the trunk, thighs, and buttocks.

The rash is usually self-limited, lasting approximately 3-6 days.

Case reports have documented subacute, chronic, and recurring skin lesions.

Causes

The most common cause of hand-foot-and-mouth disease is infection due to the coxsackievirus A16. The coxsackievirus belongs to a group of RNA viruses called enteroviruses. Other enteroviruses sometimes cause hand-foot-and-mouth disease.

Oral ingestion is the main source of coxsackievirus infection and hand-foot-and-mouth disease. The illness spreads by person-to-person contact with nose and throat discharges, saliva, fluid from blisters, or the stool of someone with the infection. The virus can also spread through a mist of fluid sprayed into the air when someone coughs or sneezes.

Hand-foot-and-mouth disease is most common in children in child care settings because of frequent diaper changes and potty training, and because little children often put their hands in their mouths.

Although your child is most contagious with hand-foot-and-mouth disease during the first week of the illness, the virus can remain in his or her body for weeks after the signs and symptoms are gone. That means your child still can infect others

Some people, particularly adults, can pass the virus without showing any signs or symptoms of the disease.

Outbreaks of the disease are more common in summer and autumn in the United States and other temperate climates. In tropical climates, outbreaks occur year-round.

Hand-foot-and-mouth disease isn't related to foot-and-mouth disease (sometimes called hoof-and-mouth disease), which is an infectious viral disease found in farm animals. You can't contract hand-foot-and-mouth disease from pets or other animals, and you can't transmit it to them.

Risk factors..

Hand-foot-and-mouth disease primarily affects children younger than age 10. Children in child care centres are especially susceptible to outbreaks of hand-foot-and-mouth disease because the infection spreads by person-to-person contact, and young children are the most susceptible.

Children usually develop immunity to hand-foot-and-mouth disease as they get older by building antibodies after exposure to the virus that causes the disease. However, it's possible for adolescents and adults to get the disease.

Pathophysiology..

The infection occurs when a susceptible person is exposed to the virus by means of direct contact with nose and throat discharges, saliva, vesicle fluid, or faecal material from an infected person. The virus may persist in faecal material for up to 1 month. After contact, the virus spreads to regional lymph nodes within 24 hours and viraemia rapidly follows, with spread of the virus to the oral mucosa and skin causing the vesicular rash. The incubation period is 4 to 7 days; however, there may be a prodromal period of 3 to 4 days. Lesions in the mouth heal within 1 week, and lesions on the hands and feet may last up to 10 days

Complications.. The most common complication of hand-foot-and-mouth disease is

dehydration. The illness can cause sores in the mouth and throat, making swallowing painful and difficult. Watch closely to make sure your child consumes adequate amounts of fluids during the course of the illness. If dehydration is severe, intravenous (IV) fluids may be necessary.

Hand-foot-and-mouth disease is usually a minor illness causing only a few days of fever and relatively mild signs and symptoms. However, a rare and sometimes serious form of the coxsackievirus can involve the brain and cause other complications: Viral meningitis. This is an infection and

inflammation of the membranes (meninges) and cerebrospinal fluid surrounding the brain and spinal cord. Viral meningitis is usually mild and often clears on its own.

Encephalitis. This severe and potentially life-threatening disease involves brain inflammation caused by a virus. Encephalitis is rare.

Tests and Diagnosis..

Your doctor will likely be able to distinguish hand-foot-and-mouth disease from other types of viral infections by evaluating:

The age of the affected person The pattern of signs and symptoms The appearance of the rash or sores A throat swab or stool specimen may be taken and

sent to the laboratory to determine which virus caused the illness. However, your doctor probably won't need this type of testing to diagnose hand-foot-and-mouth disease.

Treatments and Drugs..

There's no specific treatment for hand-foot-and-mouth disease. Signs and symptoms of hand-foot-and-mouth disease usually clear up in seven to 10 days.

A topical oral anesthetic may help relieve the pain of mouth sores. Over-the-counter pain medications other than aspirin, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) may help relieve general discomfort.

Lifestyle and Home remedies..Certain foods and beverages may irritate blisters on the tongue or in the

mouth or throat. Try these tips to help make blister soreness less bothersome and eating and drinking more tolerable:

Suck on ice pops or ice chips Eat ice cream or sherbet Drink cold beverages, such as milk or ice water Avoid acidic foods and beverages, such as citrus fruits, fruit drinks

and soda Avoid salty or spicy foods Eat soft foods that don't require much chewing Rinse your mouth with warm water after meals If your child is able to rinse without swallowing, rinsing the inside of

his or her mouth with warm salt water may be soothing. Mix 1/2 teaspoon (2.5 milliliters) of salt with 1 cup (240 milliliters) of warm water. Have your child rinse with this solution several times a day, or as often as needed to help reduce the pain and inflammation of mouth and throat sores caused by hand-foot-and-mouth disease.

Prevention..

Certain precautions can help to reduce the risk of infection with hand-foot-and-mouth disease:

Wash hands carefully. Be sure to wash your hands frequently and thoroughly, especially after using the toilet or changing a diaper, and before preparing food and eating. When soap and water aren't available, use hand wipes or gels treated with germ-killing alcohol.

Disinfect common areas. Get in the habit of cleaning high-traffic areas and surfaces first with soap and water, then with a diluted solution of chlorine bleach, approximately 1/4 cup (60 milliliters) of bleach to 1 gallon (3.79 liters) of water. Child care centers should follow a strict schedule of cleaning and disinfecting all common areas, including shared items such as toys, as the virus can live on these objects for days. Clean your baby's pacifiers often.

Teach good hygiene. Be a positive role model by showing your children how to practice good hygiene and how to keep themselves clean. Explain to them why it's best not to put their fingers, hands or any other objects in their mouths.

Isolate contagious people. Because hand-foot-and-mouth disease is highly contagious, people with the illness should limit their exposure to others while they have active signs and symptoms. Keep children with hand-foot-and-mouth disease out of child care or school until fever is gone and mouth sores have healed. If you have the illness, stay home from work.

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