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Hand, foot and mouth disease

What is foot and mouth disease?

Foot and mouth disease (HFM) is a common, short-lived, mild virus. infection it most often affects young children. It is characterized by blisters on the hands, feet and mouth. The infection can rarely affect adults.

FMD is also called enteroviral vesicular stomatitis.

Hand, foot and mouth disease


Vesicles on the palm of the hand, FMD


Blisters on the foot, hand, foot and mouth disease


Oral hand foot and mouth

See more pictures of hand, foot, and mouth disease.

What is the cause of foot and mouth disease?

FMD is due to an enterovirus infection, usually the Coxsackie virus (CV) A16. Other viruses that cause HFM include:

  • Enterovirus 71, related to serious infections that can affect the nervous system
  • CVA6, which causes an increasingly common and serious infection worldwide
  • CV A5, A7, A9, A10, B2 and B5
  • Ecovirus
  • Coxsackiev virus.

Who gets foot and mouth disease?

HFM most frequently infects children younger than 10 years, and most are younger than 5 years (95%). It can infrequently affect adults and tends to be more severe in the elderly, immunocompromisedand pregnant women.

Foot and mouth disease is very infectious, so several family members or a school class may be affected. Epidemics They are most common during the late summer or fall months.

What are the clinical features of hand, foot, and mouth disease?

Typical causes of HFM:

  • Injuries to the dorsal and palm surfaces of the hands and feet. The progression is from flat pink spots to small elongated grayish blisters and, in a week, they peel off without scarring.
  • Little vesicles and ulcers in and around the mouth, palate, and pharynx. Sometimes they are painful, so the child eats little and becomes restless.
  • Red macules and papules on the buttocks and sometimes on the arms. Injuries can also occur on the genitals.

Atypical FMD results in one more extended eruption. Features may include:

  • Red crusted papules
  • Blistered or very large.
  • Targetoid injuries
  • Involvement of unusual sites such as the ear.
  • In children with atopic dermatitis, lesions can select the skin affected by eczema (eczema coxsackium).

Flat pink spots on the dorsal and palmar surfaces of the hands and feet are soon followed by small, elongated grayish blisters. These are resolved by taking off within a week, without leaving scars.

Usually there are also some small oral vesicles and ulcers. Sometimes they are painful, so the child eats little and becomes restless. There may be some on the skin around the mouth. In young children, a red rash may develop on the buttocks and sometimes on the arms.

Atypical Coxsackie A6 hand, foot, and mouth disease produces a more generalized rash, larger blisters, and subsequent peeling of the skin and / or shedding of nails.

Atypical hand disease, foot and mouth disease


Enteroviral ampoules on the hands


Enteroviral foot blisters


Severe enteroviral stomatitis

How is hand, foot and mouth disease diagnosed?

Diagnosis is generally made clinically, due to the characteristic appearance of blisters at typical sites, i.e., hands, feet, and mouth.

In sick children, blood tests can show:

  • High white blood cell count
  • Atypical lymphocytes
  • High serum C-reactive protein (CRP)
  • Positive serology for the causative virus, which can be isolated from vesicle swabs, mucous membrane stool surfaces or specimens, confirming infection but rarely necessary.

Skin biopsy of an ampoule shows the histopathological findings characteristic of hand, foot and mouth disease.

How is the infection transmitted?

The hand, foot, and mouth are transmitted by direct contact with the skin, nasal and oral secretions of infected individuals, or by faecal contamination.

How is hand, foot and mouth disease treated?

Specific treatment is often not necessary.

  • The blisters should not be broken to reduce the spread.
  • Keep the blisters clean and apply non-stick bandages to erosions.
  • Maintain adequate fluid intake; If oral intake is poor due to painful erosions, intravenous fluids may be indicated.
  • Antiseptic mouthwashes, current and oral pain relievers help ease pain due to oral ulcers.

Intravenous immunoglobulin and milrinone have shown some effectiveness in some reports

No vaccines or specific antiviral Medications are available.

Does the child have to stay out of school?

As in the vast majority of cases, FMD is a mild illness, it is not necessary to keep children out of school once they are well enough to attend.

The blisters remain infectious until they have dried, which usually occurs within a few days. Stool is infectious for up to a month after illness. Thorough hand washing will reduce the spread of the disease.

What are the complications of hand, foot, and mouth disease?

Complications are rare. They include:

  • Dehydration due to inadequate fluid intake.
  • Changes in fingernails and toenails are often seen approximately 2 months after CVA6 infection:
    • Transverse slowly moving lines out
    • Nail detachment (onychomadesis) approximately 2 months after illness.
    • Finally the nail return to normal.

Severe enterovirus infection can lead to:

  • Generalized vesicular rash
  • Enteritis (intestinal infection)
  • Myocarditis (infection of the heart muscle)
  • Meningoencephalitis (brain infection)
  • Acute flaccid paralysis (spinal cable infection)
  • Pulmonary edema and pneumonia (lung infection)
  • In pregnancy, miscarriage in the first trimester or delayed fetal growth.

Neurological Impairment associated with enterovirus 71 infection may include:

  • Aseptic meningitis
  • Encephalitis
  • Encephalomyelitis
  • Acute cerebellar ataxia
  • Acute transverse myelitis
  • Guillain barre syndrome
  • Opsomyoclonus syndrome
  • Benign intracranial hypertension