Overview
Hand, foot, and mouth disease (HFMD) is a very contagious, acute viral infection most commonly caused by coxsackie A16 and enterovirus 71 characterised by vesicular eruptions in the mouth and papulovesicular lesions of the distal limbs.
Pathophysiology
HFMD is spread by direct contact with respiratory secretions, fluid from blisters, or faecal-oral transmission. The virus replicates in the lymphoid tissue of the intestines and pharynx before spreading to regional lymph nodes.
Epidemiology
- Most common in late summer and early autumn
- Most common in children <10 years old
- Outbreaks are common in schools, nurseries, and other childcare-related settings
Presentation
HFMD presents with:
- A non-specific prodrome:
- Fever, malaise, anorexia, cough, sore mouth, abdominal pain
- Oral ulcers – within 1-2 days
- Macules and papules on the hands and feet – soon after the oral lesions
HFMD is diagnosed clinically.
Management
Overview
Treatment is supportive with simple analgesia and rest. School exclusion is not necessary unless the child is too unwell to attend.
Complications
- Dehydration – due to reduced oral fluid intake secondary to oral pain
- Secondary bacterial infection – rare
Prognosis
- HFMD is generally self-limiting
- If due to coxsackie A16, it resolves within 7-10 days
- If due to enterovirus 71, the incidence of neurological complications is higher, although these are still rare
