Hand, foot, and mouth disease

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Hand, foot, and mouth disease
Other namesEnteroviral vesicular stomatitis with exanthem
Hand Foot Mouth Disease.png
Small reddish spots and bumps around mouth in HFMD
Specialty Infectious disease
Symptoms Fever, flat discolored spots or bumps that may blister [1] [2]
Complications Temporary loss of nails, viral meningitis [3]
Usual onset3–6 days post exposure [4]
Duration1 week [5]
Causes Coxsackievirus A16, Enterovirus 71 [6]
Diagnostic method Based on symptoms, viral culture [7]
Prevention Handwashing [8]
Treatment Supportive care [5]
Medication Pain medication such as ibuprofen [9]
FrequencyAs outbreaks [1]

Hand, foot, and mouth disease (HFMD) is a common infection caused by a group of enteroviruses. [10] It typically begins with a fever and feeling generally unwell. [10] This is followed a day or two later by flat discolored spots or bumps that may blister, on the hands, feet and mouth and occasionally buttocks and groin. [1] [2] [11] Signs and symptoms normally appear 3–6 days after exposure to the virus. [4] The rash generally resolves on its own in about a week. [5]

Contents

The viruses that cause HFMD are spread through close personal contact, through the air from coughing, and via the feces of an infected person. [8] Contaminated objects can also spread the disease. [8] Coxsackievirus A16 is the most common cause, and enterovirus 71 is the second-most common cause. [6] Other strains of coxsackievirus and enterovirus can also be responsible. [6] [12] Some people may carry and pass on the virus despite having no symptoms of disease. [10] Other animals are not involved. [8] Diagnosis can often be made based on symptoms. [7] Occasionally, a throat or stool sample may be tested for the virus. [7]

Most people with hand, foot, and mouth disease get better on their own in 7 to 10 days. [8] Most cases require no specific treatment. [5] No antiviral medication or vaccine is available, but development efforts are underway. [13] [14] For fever and for painful mouth sores, over-the-counter pain medications such as ibuprofen may be used, though aspirin should be avoided in children. [9] The illness is usually not serious. Occasionally, intravenous fluids are given to children who are dehydrated. [15] Very rarely, viral meningitis or encephalitis may complicate the disease. [3] Because HFMD is normally mild, some jurisdictions allow children to continue to go to child care and schools as long as they have no fever or uncontrolled drooling with mouth sores, and as long as they feel well enough to participate in classroom activities. [8]

HFMD occurs in all areas of the world. [16] It often occurs in small outbreaks in nursery schools or kindergartens. [1] Large outbreaks have been occurring in Asia since 1997. [16] It usually occurs during the spring, summer and fall months. [16] Typically it occurs in children less than five years old but can occasionally occur in adults. [1] [10] HFMD should not be confused with foot-and-mouth disease (also known as hoof-and-mouth disease), which mostly affects livestock. [17]

Signs and symptoms

Common constitutional signs and symptoms of the HFMD include fever, nausea, vomiting, feeling tired, generalized discomfort, loss of appetite, and irritability in infants and toddlers. Skin lesions frequently develop in the form of a rash of flat discolored spots and bumps which may be followed by vesicular sores with blisters on palms of the hands, soles of the feet, buttocks, and sometimes on the lips. [18] The rash is rarely itchy for children, [4] but can be extremely itchy for adults. Painful facial ulcers, blisters, or lesions may also develop in or around the nose or mouth. [1] [19] [20] HFMD usually resolves on its own after 7–10 days. [19] Most cases of the disease are relatively harmless, but complications including encephalitis, meningitis, and paralysis that mimics the neurological symptoms of polio can occur. [21]

Cause

The viruses that cause the disease are of the Picornaviridae family. Coxsackievirus A16 is the most common cause of HFMD. [6] Enterovirus 71 (EV-71) is the second-most common cause. [6] Many other strains of coxsackievirus and enterovirus can also be responsible. [6] [12]

Transmission

HFMD is highly contagious and is transmitted by nasopharyngeal secretions such as saliva or nasal mucus, by direct contact, or by fecal–oral transmission. It is possible to be infectious for days to weeks after the symptoms have resolved. [8]

Child care settings are the most common places for HFMD to be contracted because of toilet training, diaper changes, and children's propensity to put their hands into their mouths. [20] HFMD is contracted through nose and throat secretions such as saliva, sputum, nasal mucus and as well as fluid in blisters, and stool. [22]

Diagnosis

A diagnosis usually can be made by the presenting signs and symptoms alone. [19] If the diagnosis is unclear, a throat swab or stool specimen may be taken to identify the virus by culture. [19] The common incubation period (the time between infection and onset of symptoms) ranges from three to six days. [4] Early detection of HFMD is important in preventing an outbreak in the pediatric population. [23]

Prevention

Preventive measures include avoiding direct contact with infected individuals (including keeping infected children home from school), proper cleaning of shared utensils, disinfecting contaminated surfaces, and proper hand hygiene. These measures have been shown to be effective in decreasing the transmission of the viruses responsible for HFMD. [19] [24]

Protective habits include hand washing and disinfecting surfaces in play areas. [22] Breast-feeding has also shown to decrease rates of severe HFMD, though does not reduce the risk for the infection of the disease. [22]

Vaccine

A vaccine known as the EV71 vaccine is available to prevent HFMD in China as of December 2015. [25] No vaccine is currently available in the United States. [24]

Treatment

Medications are usually not needed as hand, foot, and mouth disease is a viral disease that typically resolves on its own. Currently, there is no specific curative treatment for hand, foot and mouth disease. [19] Disease management typically focuses on achieving symptomatic relief. Pain from the sores may be eased with the use of analgesic medications. Infection in older children, adolescents, and adults is typically mild and lasts approximately 1 week, but may occasionally run a longer course. Fever reducers can help decrease body temperature.[ citation needed ]

A minority of individuals with hand, foot and mouth disease may require hospital admission due to complications such as inflammation of the brain, inflammation of the meninges, or acute flaccid paralysis. [12] Non-neurologic complications such as inflammation of the heart, fluid in the lungs, or bleeding into the lungs may also occur. [12]

Complications

Complications from the viral infections that cause HFMD are rare, but require immediate medical treatment if present. HFMD infections caused by Enterovirus 71 tend to be more severe and are more likely to have neurologic or cardiac complications including death than infections caused by Coxsackievirus A16. [19] Viral or aseptic meningitis can occur with HFMD in rare cases and is characterized by fever, headache, stiff neck, or back pain. [12] [19] The condition is usually mild and clears without treatment; however, hospitalization for a short time may be needed. Other serious complications of HFMD include encephalitis (inflammation of the brain), or flaccid paralysis in rare circumstances. [18] [19]

Fingernail and toenail loss have been reported in children 4–8 weeks after having HFMD. [4] The relationship between HFMD and the reported nail loss is unclear; however, it is temporary and nail growth resumes without treatment. [4] [26]

Minor complications due to symptoms can occur such as dehydration, due to mouth sores causing discomfort with intake of foods and fluid. [27]

Epidemiology

Hand, foot and mouth disease most commonly occurs in children under the age of 10 [4] [19] and more often under the age of 5, but it can also affect adults with varying symptoms. [20] It tends to occur in outbreaks during the spring, summer, and autumn seasons. [6] This is believed to be due to heat and humidity improving spread. [22] HFMD is more common in rural areas than urban areas; however, socioeconomic status and hygiene levels need to be considered. [28] Poor hygiene is a risk factor for HFMD. [29] [ better source needed ]

Outbreaks

India 2022

An outbreak of an illness referred to as tomato fever or tomato flu was identified in the Kollam district on May 6, 2022. [53] The illness is endemic to Kerala, India and gets its name because of the red and round blisters it causes, which look like tomatoes. [53] The disease may be a new variant of the viral HFMD or an effect of chikungunya or dengue fever. [53] [54] [55] Flu may be a misnomer. [54] [56]

The condition mainly affects children under the age of five. [53] [57] An article in The Lancet states that the appearance of the blisters is similar to that seen in Mpox, and the illness is not thought to be related to SARS-CoV-2. [53] Symptoms, treatment and prevention are similar to HFMD. [53]

History

HFMD cases were first described clinically in Canada and New Zealand in 1957. [19] The disease was termed "Hand Foot and Mouth Disease", by Thomas Henry Flewett, after a similar outbreak in 1960. [58] [59]

Research

Novel antiviral agents to prevent and treat infection with the viruses responsible for HFMD are currently under development. Preliminary studies have shown inhibitors of the EV-71 viral capsid to have potent antiviral activity. [13]

Related Research Articles

<span class="mw-page-title-main">Coxsackie A virus</span> Virus that causes digestive upset and sometimes heart damage

Coxsackie A virus (CAV) is a cytolytic Coxsackievirus of the Picornaviridae family, an enterovirus.

<span class="mw-page-title-main">Measles</span> Viral disease affecting humans

Measles is a highly contagious, vaccine-preventable infectious disease caused by measles virus. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days. Initial symptoms typically include fever, often greater than 40 °C (104 °F), cough, runny nose, and inflamed eyes. Small white spots known as Koplik's spots may form inside the mouth two or three days after the start of symptoms. A red, flat rash which usually starts on the face and then spreads to the rest of the body typically begins three to five days after the start of symptoms. Common complications include diarrhea, middle ear infection (7%), and pneumonia (6%). These occur in part due to measles-induced immunosuppression. Less commonly seizures, blindness, or inflammation of the brain may occur. Other names include morbilli, rubeola, red measles, and English measles. Both rubella, also known as German measles, and roseola are different diseases caused by unrelated viruses.

<span class="mw-page-title-main">Mumps</span> Human disease caused by paramyxovirus

Mumps is a highly contagious viral disease caused by the mumps virus. Initial symptoms of mumps are non-specific and include fever, headache, malaise, muscle pain, and loss of appetite. These symptoms are usually followed by painful swelling around the side of the face, which is the most common symptom of a mumps infection. Symptoms typically occur 16 to 18 days after exposure to the virus. About one third of people with a mumps infection do not have any symptoms (asymptomatic).

<span class="mw-page-title-main">Bornholm disease</span> Medical condition

Bornholm disease, also known as epidemic pleurodynia, is a condition characterized by myositis of the abdomen or chest caused by the Coxsackie B virus or other viruses. The myositis manifests as an intermittent stabbing pain in the musculature that is seen primarily in children and young adults.

<span class="mw-page-title-main">Scarlet fever</span> Infectious disease caused by Streptococcus pyogenes

Scarlet fever, also known as scarlatina, is an infectious disease caused by Streptococcus pyogenes, a Group A streptococcus (GAS). It most commonly affects children between five and 15 years of age. The signs and symptoms include a sore throat, fever, headache, swollen lymph nodes, and a characteristic rash. The face is flushed and the rash is red and blanching. It typically feels like sandpaper and the tongue may be red and bumpy. The rash occurs as a result of capillary damage by exotoxins produced by S.pyogenes. On darker-pigmented skin the rash may be hard to discern.

<span class="mw-page-title-main">Mpox</span> Viral disease of humans and animals

Mpox is an infectious viral disease that can occur in humans and other animals. Symptoms include a rash that forms blisters and then crusts over, fever, and swollen lymph nodes. The illness is usually mild, and most infected individuals recover within a few weeks without treatment. The time from exposure to the onset of symptoms ranges from three to seventeen days, and symptoms typically last from two to four weeks. However, cases may be severe, especially in children, pregnant women, or people with suppressed immune systems.

<span class="mw-page-title-main">Coxsackievirus</span> Virus that causes digestive upset and sometimes heart damage

Coxsackieviruses are a few related enteroviruses that belong to the Picornaviridae family of nonenveloped, linear, positive-sense single-stranded RNA viruses, as well as its genus Enterovirus, which also includes poliovirus and echovirus. Enteroviruses are among the most common and important human pathogens, and ordinarily its members are transmitted by the fecal–oral route. Coxsackieviruses share many characteristics with poliovirus. With control of poliovirus infections in much of the world, more attention has been focused on understanding the nonpolio enteroviruses such as coxsackievirus.

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<span class="mw-page-title-main">Enterovirus 71</span> Species of virus

Enterovirus 71 (EV71), also known as Enterovirus A71 (EV-A71), is a virus of the genus Enterovirus in the Picornaviridae family, notable for its role in causing epidemics of severe neurological disease and hand, foot, and mouth disease in children. It was first isolated and characterized from cases of neurological disease in California in 1969. Enterovirus 71 infrequently causes polio-like syndrome permanent paralysis.

<span class="mw-page-title-main">Chickenpox</span> Human viral disease

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<span class="mw-page-title-main">Foot-and-mouth disease</span> Infectious disease affecting cattle

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<span class="mw-page-title-main">Enterovirus 68</span> Species of virus

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Beginning in January 2018, an outbreak of hand, foot, and mouth disease (HFMD) occurred among children nationwide across Malaysia. Nearly 38,000 cases were recorded between January 1 and July 26, and by August 14 the total number of cases had risen to 51,000. Among the states and federal territories affected by the outbreak, Selangor recorded the highest cases with 11,349, Kuala Lumpur with 4,428 and Sarawak with 4,412 cases as reported in July 2018. At least two children in Sarawak and Penang died from complications caused by the virus.

The 1997 Sarawak HFMD outbreak is a hand, foot, and mouth disease (HFMD) outbreak from April until June caused by the Enterovirus 71 (EV-71) affecting 600 children in the state of Sarawak in Malaysia. Sarawak is the first state in Malaysia that reported HFMD outbreak. An estimated 28 to 31 of the infected children died as a result. The affected children are aged between five months to six years.

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