Hand-foot-and-mouth disease natural history

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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], Aravind Kuchkuntla, M.B.B.S[3]

Natural History, Complications and Prognosis

Natural History

Hand foot mouth disease begins with a mild fever, poor appetite, malaise ("feeling sick"), and sore throat. One to two days after the fever, painful sores develop in the mouth as small red spots that blister and become ulcers, they are usually seen on the tongue, gums, and inside of the cheeks. The skin rash develops over 1 to 2 days a flat red patch with blisters. The rash does not itch, and it is usually located on the palms of the hands and soles of the feet. Hand foot mouth disease 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. Transmission is by direct contact with nose and throat discharges, saliva, fluid from blisters, or stools of an infected person. Most of the transmission occurs in the first week of illness. It typically occurs in small epidemics in nursery schools or kindergartens, usually during the summer and autumn months. Hand foot mouth disease usually resolves in a week to 10 days, but very rarely complications such as meningitis can occur.

Complications

Complications of hand-foot and mouth disease include:

• Viral or aseptic meningitis

• Can rarely occur with HFMD
• Viral meningitis causes fever, headache, stiff neck, or back pain. The condition is usually mild and clears without treatment; however, some patients may need to be hospitalized for a short time.

• Encephalitis (swelling of the brain) which can be fatal
• A polio-like paralysis is rare but a possible complication.
• Fingernail and toenail loss

• Occurs mostly in children within 4 weeks of having hand, foot, and mouth disease. However, the nail loss has been temporary and nail growth resumed without medical treatment.

Other complications include:

• Meningitis
• Acute flaccid paralysis)
• Pulmonary edema or pulmonary hemorrhage.

Prognosis

Hand foot mouth disease is a self limiting disease and complete recovery occurs in 5 to 7 days.