Pediatrics

July 26th, 2020

Hand, Foot, And Mouth Disease

Clinicals - History

Introduction

Hand, foot, and mouth disease (HFMD) is an infectious disease often caused by Coxsackie A16 (CV-A16) virus, Coxsackie B2-B5, Enterovirus 71 (EV-71), and other enteroviruses.


Most cases are mild and self-limiting; however, severe multisystem involvement is possible.

Fever

Mild fever can precede the rash. Fever that is >37.5°C or that lasts >3 days may herald severe disease.

Oral lesions

Painful, blister-like oral mucosal lesions appear early in the course of disease, preceding the rash on the hands and feet. The patient may report pain while eating.

Skin rash

A vesicular rash over the hands and feet is classic, but may not always be present. Involvement of other areas such as the hip and buttocks appears to increase the risk for severe disease.

Neurologic symptoms

Rarely, HFMD can involve the central nervous system (CNS), leading to aseptic meningitis, acute flaccid paralysis, and brainstem encephalitis.


The possibility of CNS involvement should be considered in patients with a history of headache, seizures, weakness, paralysis, loss of coordination, or severe nausea.

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