Hand, Foot, and Mouth Disease

Abbreviated as HFMD, Hand Foot and Mouth Disease is a disease that often impacts children and infants. The clinical features of HFMD include sores in the mouth, blistering rashes, and fever. The disease often starts with a low fever, a sore throat, a lack of appetite, and a general sense of feeling unwell. Approximately two days following, painful sores appear in the patient’s mouth. The sores start out as tiny blistering red spots, progressing into ulcers that are often found on the gums, inner cheeks, and the tongue. Skin rashes may appear following another couple of days, usually on the soles of the feet, palms, or buttocks. Such rashes may be raised with red spots or flat. Rashes may blister. Typically, there is no itching.

HFMD is not to be confused with Foot and Mouth Disease, which impacts swine, sheep, and cattle. The names may be quite alike, but the diseases have no correlation whatsoever because they are caused by entirely different kinds of viruses. HFMD is caused by a group of enteroviruses that includes echoviruses, coxsackieviruses, and polioviruses. The virus known as Coxsackievirus A16 is the usual culprit, though Enterovirus 71 and a few others have been known to cause cases of HFMD.

Fortunately, HFMD is usually not a serious illness and most patients experience a full recovery in a little over a week without medical treatment. Coxsackievirus A16 infection is known to cause a mild illness  unless complications of viral or aseptic meningitis develop. Such complications may require hospitalization and monitoring of symptoms such as headache, fever, back pain, and stiff neck. Instances of HFMD caused by the EV71 virus can also be complicated by viral meningitis. There have been rare reports of more serious complications with encephalitis or poliomyelitis-like paralysis. Complications of encephalitis from the EV71 virus can be fatal and such fatalities were reported in Malaysia during the 1997 outbreaks of HFMD as well as in Taiwan during 1998.

HFMD is contagious through person to person contact. Coming in contact with throat and nose discharges, saliva, blister fluids, and infected stool spreads the disease. A patient is at the most infectious stage during the first seven days of the disease. Fortunately, HFMD is not spread to or from any animals.

From the initial infection, it takes up to a week for symptoms to manifest, with fever being most common first indicator. Anyone can be infected, but not everyone will become ill as a result. Children under the age of ten are in the high risk group because they often lack the antibodies adults have built up from previous exposures to the viruses. Becoming infected by a certain virus will ensure immunity to that virus in the future, but you could get HFMD again from a different enterovirus.

If a pregnant woman gets an enterovirus infection during pregnancy, this may cause very mild illness, but there is no data to clearly suggest that it causes any complications with the pregnancy. Still, there is a chance that the virus may pass on to the newborn child. If newborns become infected, they may experience illness and in rare cases develop complications of infection in the organs. This could be fatal, and the risk is highest during the first two weeks of the newborn’s life. Strict hygienic practice by the expectant mother will help reduce the chances of infection during pregnancy and birth.

HFMD happens all over the world, but is most prevalent during early autumn and the summer season. Recent major outbreaks have occurred in Southeast Asia and have been attributed to the EV71 virus.

Diagnosis of HFMD may be done by examining the mouth sores that manifest. A doctor will typically be able to distinguish the mouth sores caused by HFMD from those caused by a herpevirus infection or stomatitis. The doctor may confirm the diagnosis and determine which enterovirus is the causal agent by a throat swab test or a stool specimen test done in laboratory settings. Often, these tests take nearly a month to get accurate results so are not the best method of diagnosis.

There is no special treatment specifically designed for HFMD. The treatment procedure is to treat the symptoms by providing relief for aches, fevers, and painful mouth ulcers. There is no vaccine against HFMD, but practicing good hygiene on a regular basis is a good prevention method. Wash hands regularly especially after handling diapers. Keep any potentially contaminated surfaces clean using disinfectant solutions. Avoid being in close proximity with children who have HFMD.

Child care facilities may experience outbreaks of HFMD during the autumn and summer season. During such outbreaks, it is advised that the facilities instill strict hygienic practices in the children and thoroughly clean areas with disinfectant. The Center for Disease Control does not deem it necessary to exclude infected children from such facilities or other group environments. However, keeping sick children at home will reduce the risk of transmission, especially if the child has weeping lesions and ulcers. It is difficult to tell if an adult is spreading the virus because adults usually do not display symptoms.

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