Hand-foot-mouth disease

Definition

Hand-foot-mouth disease is an infection of young children in which characteristic fluid-filled blisters appear on the hands, feet, and inside the mouth.

Description

Coxsackie viruses belong to a family of viruses called enteroviruses. These viruses live in the gastrointestinal tract and are, therefore, present in feces. They can be spread easily from one person to another when poor hygiene allows the virus within the feces to be passed from person to person. After exposure to the virus, development of symptoms takes only four to six days. Hand-foot-mouth disease can occur year-round, although the largest number of cases are in summer and fall months.

An outbreak of hand-foot-mouth disease occurred in Singapore in 2000, with more than 1,000 diagnosed cases, all in children, resulting in four deaths. A smaller outbreak occurred in Malaysia in 2000. In 1998, a serious outbreak of enterovirus in Taiwan resulted in more than 1 million cases of hand-foot-and-mouth disease. Of these, there were 405 severe cases and 78 deaths, 71 of which were children younger than five years of age.

Hand-foot-mouth should not be confused with foot and mouth disease, which infects cattle but is extremely rare in humans. An outbreak of foot and mouth disease swept through Great Britain and into other parts of Europe and South America in 2001.

Demographics

Hand-foot-mouth disease is very common among young children and often occurs in clusters of children who are in daycare together.

Causes and symptoms

Hand-foot-mouth disease is spread when poor hand washing after a diaper change or contact with saliva allows the virus to be passed from one child to another.

Within about four to six days of acquiring the virus, an infected child may develop a relatively low-grade fever , ranging from 99 to 102°F (37.2–38.9°C). Other symptoms include fatigue, loss of energy, decreased appetite, and a sore sensation in the mouth that may interfere with feeding. After one to two days, fluid-filled bumps (vesicles) appear on the inside of the mouth, along the surface of the tongue, on the roof of the mouth, and on the insides of the cheeks. These are tiny blisters, about 3–7 mm in diameter. Eventually, they may appear on the palms of the hands and on the soles of the feet. Occasionally, these vesicles may occur in the diaper region.

The vesicles in the mouth cause the majority of discomfort, and the child may refuse to eat or drink due to pain . This phase usually lasts for an average of a week. As long as the bumps have clear fluid within them, the disease is at its most contagious. The fluid within the vesicles contains large quantities of the causative viruses. Extra care should be taken to avoid contact with this fluid.

Diagnosis

Diagnosis is made by most practitioners solely on the basis of the unique appearance of blisters of the mouth, hands, and feet, in a child not appearing very ill.

Treatment

As of 2004, there were no treatments available to cure or decrease the duration of the disease. Medications like acetaminophen or ibuprofen may be helpful for decreasing pain and helping the child to eat and drink. It is important to try to encourage the child to take in adequate amounts of fluids, in the form of ice chips or Popsicles if other foods or liquids are too uncomfortable. There is a risk of developing dehydration .

Prognosis

The prognosis for a child with hand-foot-mouth disease is excellent. The child is usually completely recovered within about a week of the start of the illness.

Prevention

Prevention involves careful attention to hygiene. Thorough, consistent hand-washing practices and discouraging the sharing of clothes, towels, and stuffed toys are all helpful. Virus continues to be passed in the feces for several weeks after infection, so good hygiene should be practiced long after all signs of infection have passed.

Prevention

Parents should be aware of the characteristic rash of hand-foot-mouth disease and monitor their children, especially if they are in a child care setting. Good hygiene practices should be strictly followed to prevent the spread of the disease.

KEY TERMS

Enterovirus —Any of a group of viruses that primarily affect the gastrointestinal tract. The coxsackie-virus and the poliovirus are both enteroviruses.

Vesicle —A bump on the skin filled with fluid.

Resources

BOOKS

Abzug, Mark J. "Nonpolio Enteroviruses." In Nelson Textbook of Pediatrics. Edited by Richard E. Behrman et al. Philadelphia: Saunders Company, 2004.

PERIODICALS

Hairston, B. R. "Viral diseases of the oral mucosa." Dermatology Clinics 21 (January 2003): 17–32.

Purdon, M. "Pediatric viral skin infections." Clinical Family Practice 5 (September 2003): 589.

Sy, Man-Sun, et al. "Human Prion Diseases." Medical Clinics of North America 5 (September 2003): 557.

Wolfrey, J. "Pediatric exanthems." Clinical Family Practice 86 (May 2002): 551–571.

Rosalyn Carson-DeWitt, MD Ken R. Wells

Hand-foot-mouth disease

Hand-foot-mouth disease is a contagious illness that strikes predominantly infants and children that is characterized by fever, mouth sores, and a rash with blistering. Two types of viruses cause the disease. The majority of cases are due to several members of the Coxsackie virus group (subtypes A16, A5, and A10). A type of enterovirus designated as enterovirus 71 also causes the disease, but is of minor importance.

The name of the disease has caused confusion with the well-known hoof and mouth disease. However, hand-foot-mouth disease is entirely different from hoof and mouth disease that strikes cattle, sheep, and swine, causes entirely different symptoms, and which is caused by a different virus.

The disease was initially described and the viral agents determined in 1957.

Hand-foot-mouth disease begins with a general feeling of being unwell. A mild fever, poor appetite, and sore throat leads within a few days to the appearance of sores in the mouth. The blister-like rash develops soon thereafter on the palms of the hands, soles of the feet, on the inside of the mouth, and sometimes on the buttocks. The hands tend to be involved more than the other regions of the body. These symptoms are more inconvenient than threatening to health. Recovery is typically complete within a week or two. Rarely, a stiff neck and back pain reminiscent of meningitis can lead to hospitalization. This precaution is prudent, since one of the enteroviruses that causes hand-foot-mouth disease, enterovirus 71, can also cause viral meningitis. During outbreaks of hand-foot-mouth disease, cases of viral meningitis can concurrently appear.

Children fewer than ten years of age are most susceptible. However, the disease can occur in adults as well. In children the fever, which can peak in the range of 103 to 104° F (39.4 to 39.9° C), is a concern. Also, the sores in the mouth can discourage children from eating and drinking. Thus, an important aspect of managing the disease is the maintenance of a sufficient diet.

The disease is contagious and can be spread from person to person by direct contact with nose or throat fluids. There is no geographic restriction on the occurrence of the disease. There is some seasonal distribution, with the majority of cases being reported during the summer and early fall.

Treatment of hand-foot-mouth disease is confined to the relief of the symptoms, and observance of good hygienic practices to minimize the spread of the virus. Antibiotics are useless, given the viral nature of the disease. An actual cure, such as a vaccine , does not yet exist. Even if specific immunity to one episode of the disease has been produced, a subsequent infection with a different subtype of Coxsackie virus can cause another bout of the disease. In this sense, hand-foot-mouth disease is similar to the immune variation that is the hallmark of influenzae viruses.