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July 3, 2005
Hand-foot in mouth disease

Hand, foot, and mouth disease (HFMD) is a common illness of infants and children characterized by fever, sores in the mouth, and a rash with blisters. HFMD begins with a mild fever, poor appetite, malaise, and sore throat. One to two days after the fever begins, painful sores develop in the mouth. They begin as small red spots that blister and then often become ulcers. They are usually located on the tongue, gums, and inside of the cheeks. The rash develops over 1 to 2 days with flat or raised red spots. The rash is non-pruritic, and it is usually located on the palms of the hands, soles of the feet, and buttocks. A person with HFMD may have only the rash or the mouth ulcers.

HFMD is caused by enteroviruses. The most common being coxsackievirus A16; sometimes, HFMD is caused by enterovirus 71 or other enteroviruses. The enterovirus group includes polioviruses, coxsackieviruses, echoviruses and other enteroviruses.

HFMD caused by coxsackievirus A16 infection is a mild disease and nearly all patients recover without medical treatment in 7 to 10 days. Complications are uncommon. Rarely, the patient with coxsackievirus A16 infection may also develop viral meningitis. Another cause of HFMD, EV71 may also cause viral meningitis and, rarely, more serious diseases, such as encephalitis, or a poliomyelitis-like paralysis. EV71 encephalitis may be fatal.

HFMD is moderately contagious. Infection is spread from person to person by direct contact with nose and throat discharges, saliva, fluid from blisters, or the stool of infected persons. A person is most contagious during the first week of the illness.

Usually, HFMD can be distinguished from other causes of mouth sores based on the age of the patient, the pattern of symptoms reported by the patient or parent, and the appearance of the rash and sores on examination. A throat swab or stool specimen may be sent to a laboratory to determine which enterovirus caused the illness. Since the testing often takes 2 to 4 weeks to obtain a final answer, the physician usually does not order these tests.

No specific treatment is available for this or other enterovirus infections. Symptomatic treatment is given to provide relief from fever, aches, or pain from the mouth ulcers.

Pictures:

www.info.gov.hk/dh/diseases/CD/HFMDc.htm

http://dermatology.cdlib.org/93/reviews/viral/11.jpg

www.askdrsears.com/html/8/T082902.asp

www.askdrsears.com/html/8/T082902.aspwww.askdrsears.com/html/8/T082902.asp
Posted At : 6:14 PM. | Link | Rotation 6 04-05 | Comments (4)

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Interesting that coxsackie virus is a rare cause of encephalitis because I saw that case last week. The child had general fatigue and malaise symptoms, and then developed an unsteady gait. On physical exam he had a single oral ulcer, which was the clue for coxsackie. Something to be aware of if you're going to work with kids I guess. Thanks for the post.

Posted By Kristen Frank / Posted At 7/8/05 1:12 AM

even though there is no treatment, there are some helpful preventive methods: washing hands well, covering mouth/nose when coughing/sneezing, washing toys and other surfaces that have saliva on them, and excluding children from child care or school settings if there is a fever, or ulcers in the mouth and the child is drooling.

Posted By Scott Um / Posted At 7/9/05 4:25 PM

Hand foot and mouth disease rules!

Posted By Salah Baydoun / Posted At 7/9/05 5:03 PM

We saw a bunch of people into the office whose kids all had cocksackie, and most of them turned out to have it as well, but none of them had the rash on the hands or feet. Too bad, I say.

Posted By Koustav Mukherjee / Posted At 7/10/05 1:54 PM