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Hand, Foot and Mouth

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What It Is

Hand, foot, and mouth disease is a common viral illness that usually affects infants and children younger than 5 years old. However, it can sometimes occur in adults. Symptoms of hand, foot, and mouth disease include fever, blister-like sores in the mouth, and a skin rash.

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Coxsackie virus

Coxsackie A16 is a frequently encountered pathogen in cases of HFMD occurring throughout the year. course usually uneventful, with full recovery. cases of Cox A16 rare.

Clinical Fatal

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Enterovirus 71 (EV71)

Responsible for sporadic outbreak. More severe course. Maybe complicated by meningitis, encephalitis and neurogenic pulmonary oedema. In Taiwan, based on 1998 epidemic, significant difference between Cox A16 and EV71 are the higher fever >39C and >3 days in EV71

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Mode of transmission
HFMD Most The

is moderately contagious.

contagious during the first week of the illness. virus can be transmitted from person to person via
o direct contact with nose and throat discharges, o saliva, o fluid from blisters o stool of infected persons.

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virus may continue to be excreted in the

Myth

Foot and mouth 7/18/12 disease

Hand, foot and mouth disease

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EMERGENCE IN INDIA

Related to Mass Polio Vaccination?

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Clinical S/Sx
History

The usual incubation period of hand-foot-andmouth (HFM) diseaseis 4-6 days. The prodrome is associated with the following:
o Low-grade fever o Malaise o Anorexia o Abdominal pain o Sore mouth

The prodrome precedes the development of oral lesions, followed shortly by skin lesions, primarily 7/18/12 on the hands and feet and occasionally on the

MOUTH

Oral lesions begin as erythematous macules that evolve into 2-3 mm vesicles on an erythematous base. The vesicles are rarely observed because they rapidly become ulcerated. They are painful and may interfere with eating. The vesicles may involve the palate, buccal mucosa, gingiva, and tongue. The tongue is involved in 44% of the cases, and, in addition 7/18/12 to the ulcers, the tongue may

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Hand and Foot

Cutaneous lesions are characteristic and are present in two-thirds of patients. Typically, the hands, feet, and buttocks are involved. The hands are involved more often than the feet, and the dorsal aspect of the hands and sides of the fingers are more commonly involved than the palmar surfaces. Each lesion begins as a 2-10 mm erythematous macule on which a central, gray, oval vesicle develops.

The lesions are characteristically elliptical; their long axis parallels the skin lines. These lesions are 7/18/12 asymptomatic and resolve in 3-7 days.

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HAND

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FOOT
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Differentials

Aphthous Stomatitis Chickenpox Erythema Multiforme Herpes Simplex

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Laboratory Studies

Generally, no laboratory studies are necessary for handfoot-and-mouth disease (HFMD). Leukocyte counts are 4000-16,000/L. Occasionally, atypical lymphocytes are present. Recent studies show that elevated serum concentration of C-reactive protein (CRP) and fasting and elevated blood glucose were significantly higher in severe cases than in mild ones. CULTURE- The virus can be isolated from swabs of the vesicles or mucosal surfaces or from stool specimens and then inoculated into mice or cultured on viral tissue media. ANTIBODIES- Neutralizing antibodies rapidly disappear; thus, they are usually detectable only in the acute phase.

PCR- Studies have illustrated the usefulness of a molecular 7/18/12 assay using polymerase chain reaction primers to arrive at

Imaging Studies

Acute flaccid paralysis associated with enterovirus 71infected hand-foot-and-mouth disease (HFMD) can be seen in severe cases. MRI is an effective modality to investigate neurological complications associated with the enterovirus 71 epidemics. Involvement of posterior portions of the medulla oblongata and pons, and bilateral anterior horns of the spinal cord, are characteristic findings.

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Histologic Findings

Classic histo-pathologic findings of HFMD include an intra-epidermal vesicle that contains neutrophils and eosinophilic cellular debris. The adjacent epidermis has reticular degeneration, that is, intercellular and intracellular edema. The dermis has a mixed infiltrate. Eosinophilic intranuclear inclusions are observed with electron microscopic studies. Neuropathology in fatal cases of enterovirus 71 infection have shown features of an acute encephalitis involving the brain stem and spinal cord.

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Medication Summary

The topical application of anesthetics is beneficial. Viscous lidocaine, dyclonine solution, or diphenhydramine may be used to treat painful oral ulcers. The application of topical viscous lidocaine with a cottontipped swab several times daily can help in controlling the pain caused by oral ulcers. Antipyretics may be used to manage fever, and analgesics may be used to treat arthralgias. A case report of severe hand-foot-and-mouth disease (HFMD) from enterovirus infection in an immunocompromised patient described a faster resolution of symptoms and lesions with oral acyclovir. Low-level laser therapy has also been shown to shorten the duration of painful oral ulcers. magnesium hydroxide (Mylanta), and sucralfate (Carafate)

Elixirs such as diphenhydramine (Benadryl), aluminum and 7/18/12

Complications..

The most common complication of hand-foot-andmouth disease is dehydration. The illness can cause sores in the mouth and throat, making swallowing painful and difficult. If dehydration is severe, intravenous (IV) fluids may be necessary. However, a rare and sometimes serious form of the enterovirus can involve the brain and cause other complications:
o Viral meningitis. o Encephalitis.

Desquamation of palms and soles. Onychomadesis may develop after the infection.

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Prevention..
Wash

hands carefully. Disinfect common areas.

Teach

good hygiene. contagious people.

Isolate Recent

studies from China have shown that most of the children with hand-footand-mouth disease (HFMD) presented with vitamin A insufficiency, which was associated with their reduced immunity and more severe illness.

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Messa ge

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THANK YOU

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BY NIKHI L.J