Hand,%20foot%20-and-%20mouth%20disease Diagnosis

• Has caused disease outbreaks in Taiwan, Singapore & Malaysia
• Infection usually causes fever w/ temperature >39°C & for >3 days
• Causes a more severe infection
• May be accompanied by complications:
  
  • Meningitis
  • Encephalitis
  • Neurogenic pulmonary edema
  • Myocarditis
  • Acute flaccid paralysis

Stage I

• Manifestations:
  
  • Oral ulcers
  • Vesicles on palms, soles, knees &/or buttocks
  • Herpangina w/ oral ulcers over anterior tonsils, soft palate, buccal mucosa, or uvula
• Systemic symptoms are generally brief & the patient recovers within 7 days
• Infection is self-limited & patients spontaneously recover

Stage II (CNS Involvement)

• Manifestations:
  
  • May be confirmed w/ cerebrospinal fluid (CSF) analysis & isolation in cell culture or polymerase chain reaction (PCR)
  • Disturbances in motor function may persist for weeks but will slowly resolve
  • Viral meningitis does not lead to long-term neurologic or cognitive sequelae; however, viral encephalitis may lead to neurologic sequelae & deaths are rare but may occur
  • Acute motor neuron disease may occur
    
    • Transient muscle weakness is more common than flaccid paralysis
    • Temporary paresis
    • Cranial nerve involvement may result in complete unilateral occulomotor palsy

Stage IIIa [Autonomic Nervous System (ANS) Dysregulation]

• Manifestations:
  
  • Cold sweating, mottled skin, tachycardia, tachypnea, & hypertension
  • Patients should be treated w/ intravenous (IV) immunoglobulin

Stage IIIb (Cardiopulmonary Failure)

• Manifestations:
  
  • Pulmonary edema
  • Decreased ejection fraction (EF) of left ventricle
  • Noninvasive hemodynamic monitoring provides information while under intensive care

Stage IV

• Convalescence/recovery phase from cardiopulmonary failure

• Swab specimens
  
  • Throat & vesicle swabs are the most recommended samples for virus detection &/or isolation
  • Stool samples/rectal swab may also be used

• Cerebrospinal fluid (CSF) examination
  
  • Used for patients w/ hand, foot & mouth disease (HFMD) w/ suspected central nervous system (CNS) involvement
  • May be used for EV71 & CA16 virus detection; also used for detection &/or isolation of enteroviruses
    
    • Has <5% virus detection rate

• Blood examinations:
  
  • Complete blood count (CBC), blood glucose
  • Blood culture - used to rule out septicemic shock in HFMD w/ cardiopulmonary failure

• Indirect immunofluorescence assay (IFA)
  
  • A rapid but expensive test used for EV71 identification

• Echocardiography
  
  • May be considered for patients w/ HFMD w/ suspected CNS & autonomic nervous system involvement (ANS) involvement

• Magnetic Resonance Imaging (MRI)
  
  • Used for patients w/ HMFD w/ suspected CNS involvement

• Patient is clinically very ill or toxic-looking
• Temperature >38^oC for >48 hours
• High suspicion of cardiac or neurologic complications
  • Guardian is unable to cope & care for the patient
  • Intravenous (IV) rehydration is warranted