hand,%20foot%20-and-%20mouth%20disease
HAND, FOOT & MOUTH DISEASE
Hand, foot and mouth disease (HFMD) is characterized by fever, vesicular stomatitis, and papular/vesicular lesions located peripherally (ie palms of hands, knees, soles of feet, buttocks or genitalia).
Oral vesicular lesions are 1-3 mm, mostly found on the buccal mucosa, tongue and soft palate.
Each oral lesion is surrounded by erythema and is tender to touch.
Patient may complain of sore throat or sore mouth, fever and may be difficult to feed.
Most common cause of HFMD is coxsackievirus A16 (A16).
  1. Change LY, King CC, Hsu KH, et al. Risk factors of enterovirus 71 infection and associated hand, foot, and mouth disease/herpangina in children during an epidemic in Taiwan. Pediatrics. 2002 Jun;109(6):e88. http://www.pediatrics.org/cgi/content/full/109/6/e88. PMID: 12042582
  2. Lin TY, Twu SJ, Ho MS, et al. Enterovirus 71 outbreaks, Taiwan: occurrence and recognition. Emerging Infect Dis. 2003 Mar;9(3):291-293. PMID: 12643822
  3. Wang SM, Lei HY, Huang MC, et al. Therapeutic efficacy of milrinone in the management of enterovirus 71-induced pulmonary edema. Pediatr Pulmonol. 2005 Mar;39(3):219-223. PMID: 15635619
  4. Wang SM, Lei HY, Huang MC, et al. Modulation of cytokine production by intravenous immunoglobulin in patients with enterovirus 71-associated brainstem encephalitis. J Clin Virol. 2006 Sep;37(1):47-52. PMID: 16861032
  5. Gershon AA, Hotez PJ, Katz SL. Coxsackie A virus, coxsackie B virus, echovirus, and enterovirus 68-71 infections. Gershon: Krugman’s infectious diseases of children. 11th ed. Philadelphia, PA: Mosby Inc; 2004.
  6. Mandell GL, Bennett JE, Dolin R. Infections caused by the newer enteroviruses. In: Mandell, Douglas, and Bennett. Principles and Practices of Infectious Diseases. Philadelphia: Elsevier; 2005
  7. MedWormhttp://www.medworm.com/rss/index.php/Pediatrics/33/http://www.medworm.com/rss/medicalfeeds/specialities/Pediatrics.xml
  8. Ministry of Health Malaysia. Hand foot and mouth disease (HFMD) guidelines. MOH (Malaysia) website. http://www.moh.gov.my/. 2007.
  9. National Center for Immunization and Respiratory Diseases. Hand, foot & mouth disease (HFMD). Centers for Disease Control & Prevention. http://www.cdc.gov/ncidod/dvrd/revb/enterovirus/hfhf.htm
  10. Crawford NW, Graham SM. EV71 vaccine: protection from a previously neglected disease. Lancet. 2013 Jun;381(9882):1968-1970. doi: 10.1016/S0140- 6736(13)61124-1. PMID: 23726163
  11. World Health Organization. A guide to clinical management and public health response for hand, foot and mouth disease (HFMD). World Health Organization. http://www.wpro.who.int/publications/docs/ GuidancefortheclinicalmanagementofHFMD.pdf. 2011. Accessed 14 Jan 2016.
  12. Centers for Disease Control and Prevention. Hand, foot, and mouth disease (HFMD): prevention & treatment. CDC website. http://www.cdc.gov/hand-foot-mouth/about/prevention-treatment.html. Aug 2015.
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