Hand, foot and mouth disease occurs in children in epidemic proportions, especially in autumn. Though rare, there have been a few reports of outbreaks in adults as well. The causative virus of hand, foot and mouth (HFM) disease is coxsackie virus types A16, A5, A10 and rarely human enterovirus 71.
What are the Signs and Symptoms of Hand, Foot and Mouth Disease?
Hand, foot and mouth disease usually has a mild course in most children. The infected child may develop mild fever and body pain after an incubation period of 3–7 days. The incubation period is the time taken for signs and symptoms to appear after the germ gets into the body of an individual.
Systemic signs are usually absent or mild. Generalized weakness, irritability, loss of appetite and fever are the common symptoms in severe attacks. Some children may complain of abdominal pain and sore throat.
Small, oval, fluid filled blisters with a small red halo appear on the hands and feet, and, at times, on the face, groin and buttocks. They are commonly seen on the sides of the fingers, toes and heel, as well as the palms and soles. The blisters are deep seated and painful, but dry up and heal within 5–10 days. Usually they are few in number, though 50 or more may appear in some patients.
Painful, shallow ulcers develop in the mouth. When severe, this may resemble herpangina, which is also caused by coxsackie viruses.
In children with a history of atopy (allergic tendency), the blisters may be extensive.
Infection usually occurs through the feco-oral route, and, less commonly, through inhalation.
Is the Hand, Foot and Mouth Disease Seen in Children Dangerous Like the Foot and Mouth Disease in Cattle?
No. Foot and mouth disease, caused by picorna virus, is a lethal epidemic among cattle in many countries. This virus very rarely causes disease in humans. Both viruses belong to a group called the enteroviruses, however.
Very rarely, hand, foot and mouth virus can affect the brain, heart and nervous system, causing inflammation of the brain (encephalitis), meningitis, myocarditis, left ventricular failure, paralysis and Guillain–Barré syndrome, a type of peripheral neuropathy. Such complications are more common with HFM disease caused by enterovirus 71.
Which Other Diseases Resemble Hand, Foot and Mouth Disease?
Generalized eruption of HFM disease may mimic Kaposi’s varicelliform eruption, which is a generalized form of herpes simplex infection in immunocompromised children.
Fire ant bites and other insect bite allergies may mimic hand, foot and mouth disease. Chickenpox, when localized to the extremities and face, may be mistaken for hand, foot and mouth disease. Likewise, generalized hand, foot and mouth disease may be mistaken for chickenpox. Comparative lack of systemic manifestations such as fever and body aches, and a predilection for acral areas is typical of hand, foot and mouth disease. The blisters of HFM disease are oval or triangular compared to the round blisters of chickenpox. The early lesions of hand, foot and mouth disease, when the number is limited, may also be mistaken for molluscum contagiosum.
At times, drug eruptions and erythema multiforme may mimic hand, foot and mouth disease. The primary attack of herpes simplex, known as herpetic gingivostomatitis, has to be ruled out in all cases of HFM disease.
How is Hand, Foot and Mouth Disease Treated?
Hand, foot and mouth disease in children is a self-limiting disease and requires no treatment in the normal course of the disease. Very severe attacks are treated with a course of oral antiviral medications. Calamine lotion is applied to the blisters to speed up drying and healing. Allopurinol mouthwashes are useful to reduce the pain of the oral ulcers.
Affected children should be kept away from other children to avoid infection, though the virus may be transmitted through, for example, fomites, door handles and towels.
References
- Leah Belazarian et al. Exanthematous Viral Diseases. Fitzpatrick’s Dermatology in General Medicine, 7th Ed: 1851-1872, 2008
- Faulkner CF, Godbolt AM, De Ambrosis B, Triscott J. Hand, foot and mouth disease in an immunocompromised adult treated with aciclovir. Australas J Dermatol 2003; 44: 203–6.
- Sasidharan CK, Sugathan P, Agarawal R et al. Hand-foot-and-mouth disease in Calicut. Indian J Pediatr 2005; 72: 17–21.
Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
Hanish Babu - Dr.Hanish Babu, MD is a dermatologist and a feature writer on Suite101.com with more than 200 articles related to skin diseases on the ...
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