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.
Pictures..