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

The outbreaks of hand foot mouth disease occur during the period of warm temperatures of spring, summer, and fall, showing a strong seasonal pattern. 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. It typically occurs in small epidemics in nursery schools or kindergartens, usually during the summer and autumn months.The symptoms appear within 3 days to 1 week after the infection with mild fever, poor appetite, malaise and sore throat, followed by development of painful sores develop in the mouth. The mouth ulcers are usually seen on the tongue, gums, and inside of the cheeks. The skin rash develops over 1 to 2 days as a flat red patch with blisters on the palms and foot. Hand foot mouth disease usually resolves in a week to 10 days, but very rarely complications such as meningitis and acute flaccid paralysis can occur.

Complications

Complications of hand foot and mouth disease include:

• Viral or aseptic meningitis, it presents with fever, headache, stiff neck, or back pain.
• Encephalitis
• A polio-like paralysis
• Fingernail and toenail loss, usually 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.
• Acute flaccid paralysis)
• Cardiopulmonary failure
• Pulmonary edema or pulmonary hemorrhage.

Prognosis

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