Hand-foot-and-mouth disease overview

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[2]; Jesus Rosario Hernandez, M.D. [3]

Overview

Hand, foot, and mouth disease (HFMD) is a common illness of infants and children. It is is caused by a number of enteroviruses in the family Picornaviridae. It is characterized by fever, sores in the mouth, and a rash with blisters. HFMD is often confused with foot-and-mouth disease of cattle, sheep, and swine. Although the names are similar, the two diseases are not related at all and are caused by different viruses.

Historical Perspective

Notable outbreaks have occured in Malaysia, Taiwan and China in the past. Hand, foot and mouth disease infected 1 520 274 people with 431 deaths reported up to end of July in 2012 in China. .

Pathophysiology

HFMD usually affects infants and children, and is quite common. It is highly contagious and is spread through direct contact with the mucus or feces of an infected person. It typically occurs in small epidemics in nursery schools or kindergartens, usually during the summer and autumn months.

Differentiating Hand-foot-and-mouth disease from other Diseases

Herpes simplex virus infections, chicken pox and measles present similar to hand-foot-and-mouth disease, and needs to be differentiated from each other clinically using appropriate diagnostic tests.

Epidemiology and Demographics

Individual cases and outbreaks of HFMD occur worldwide, more frequently in summer and early autumn. In the recent past, major outbreaks of HFMD attributable to enterovirus 71 have been reported in some South East Asian countries (Malaysia, 1997; Taiwan, 1998)

Risk Factors

Pregnant women, especially during summer and fall months are susceptible to acquire the infection. It can result in adverse pregnancy outcomes like abortion, still birth or congenital defects.

Diagnosis

History and Symptoms

It is characterized by fever, sores in the mouth, and a rash with blisters. HFMD begins with a mild fever, poor appetite, malaise ("feeling sick"), and frequently a sore throat.

Physical Examination

HFMD is one of many infections that result in mouth sores. Another common cause is oral herpesvirus infection, which produces an inflammation of the mouth and gums (sometimes called stomatitis). Usually, the physician can distinguish between HFMD and 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.

Laboratory Findings

Physical examination is usually diagnostic for hand foot and mouth disease. However, throat swabs, swabs from the lesion and Tzanck test can be used in diagnosing HFMD.

Treatment

Medical Therapy

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.

Primary Prevention

Specific prevention for HFMD or other non-polio enterovirus infections is not available, but the risk of infection can be lowered by good hygienic practices. Preventive measures include frequent handwashing, especially after diaper changes, cleaning of contaminated surfaces and soiled items first with soap and water, and then disinfecting them by diluted solution of chlorine-containing bleach (made by mixing approximately ¼ cup of bleach with 1 gallon of water. Avoidance of close contact (kissing, hugging, sharing utensils, etc.) with children with HFMD may also help to reduce of the risk of infection to caregivers.