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).

Etiology

  • Most common cause of hand, foot & mouth disease (HFMD) is coxsackievirus A16 (CA16)
    • Other possible causes are group A & B coxsackieviruses, & enterovirus 71
    • Enterovirus 71 infection may be accompanied by neurologic complications & has been associated w/ disease outbreaks

Pathophysiology

  • Infection may spread to household member & close contacts
    • Person to person spread by direct contact w/ unwashed contaminated hands, nasal & throat discharge, saliva, fluid from blisters, stool, or contact w/ contaminated surfaces
    • The 1st week of illness is the most contagious period

Signs and Symptoms

  • Characterized by fever, vesicular stomatitis, & papular/vesicular lesions located peripherally (eg palms of hands, knees, soles of feet, buttocks or genitalia)
    • Hand, foot & mouth disease may present as solely peripheral or oral, or both
  • Oral vesicular lesions are 1-3 mm, mostly found on the buccal mucosa, tongue & soft palate
    • Vesicles may have ulcerated at the time of examination
  • Each oral lesion is surrounded by erythema & is tender to touch
    • Oral lesions commonly develop 1-2 days after onset of fever
  • Patient may complain of sore throat or sore mouth, fever & may be difficult to feed
    • Skin lesions begin as non-itchy rash that develops over 1-2 days

Risk Factors

  • Age may determine susceptibility to the disease & protective antibody levels
  • Close contact (eg household, daycare)
    • Patient may be asymptomatic & may serve as reservoir for spread of infection
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