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).

Pharmacotherapy

Symptomatic Therapy
Antipyretics

  • May be given if patient is febrile

Analgesics

  • May be given to patients complaining of pain
  • Recommended for patients w/ central nervous system (CNS) involvement suffering from headaches

Anticonvulsants/Sedatives

  • Eg Midazolam, Phenytoin
  • May be considered for patients w/ seizures or frequent myoclonic jerks

Mouthwash/sprays

  • Soothes oral discomfort & pain

Specific Therapy
Intravenous Immunoglobulin (IVIg)

  • Recommended for patients w/ encephalitis, acute flaccid paralysis & autonomic nervous system dysregulation
  • May be considered for patients w/ brainstem encephalitis

Inotropes

  • Eg Dobutamine Dopamine, Epinephrine, Milrinone
  • Decreased left ventricular ejection fraction (EF) & cardiopulmonary failure warrants inotropic agent support
  • Dobutamine
    • Cold sweating, mottled skin, tachycardia, tachypnea, & hypertension
    • Patients should be treated w/ IV immunoglobulin
  • Milrinone
    • Should be given to patients w/ pulmonary edema because of both inotropic & vasodilator properties

Antibiotics

  • May be used for patients w/ suspected bacterial disease until infection has been ruled out
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