Hand-foot-and-mouth Disease

Background

• Hand-foot-and-mouth disease (HFMD) is a highly contagious enteroviral infection primarily affecting infants and children that is marked by a characteristic rash and oral lesions.
• HFMD usually occurs in infants and children < 10 years old and may have a seasonal variation in temperate climates, being more common in warmer months.
• HFMD is usually caused by Coxsackie virus A16 or enterovirus 71, but may also be caused by many Coxsackie A and B viruses.
• The virus is acquired by direct inoculation of oral, nasal, or conjunctival tissue by oral secretions or feces of an infected person, or by indirect exposure to contaminated surfaces. Infected individuals are most contagious during the first week of illness.

Evaluation

• Patients usually present with a maculopapular/vesicular rash on the extremities (predominantly the hands and to a lesser extent the feet) and painful oral lesions, which is often preceded by a 12-36 hour prodrome that may include fever > 39 degrees C [102.2 degrees F]. The rash may also involve the knees, elbows, buttocks, and/or genital area.
• The diagnosis of hand-foot-and-mouth disease (HFMD) can usually be made in the presence of a maculopapular and/or vesicular rash on the palms of the hands and/or the soles of the feet, and oral ulcers. The oral lesions may occasionally be absent.
• Conversely, the clinical presentation of these same viral illnesses may be limited to fever and painful oral lesions, in which case it is clinically referred to as herpangina.
• A laboratory analysis of throat or stool samples for identification of the causative virus is usually not needed, but may help confirm the diagnosis in patients with severe symptoms or an unusual presentation.

Management

• No effective antiviral therapy is available for hand-foot-and-mouth disease (HFMD) and the illness typically resolves spontaneously within 5-10 days.
• Supportive treatment may be used to alleviate symptoms and includes over-the-counter medications to reduce fever, pain, and inflammation, and IV fluids in patients with dehydration and/or are unable to swallow liquids.
• Children should be kept home if they are unwell or have blisters, and should not return to school or childcare until all of the blisters have dried.