Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease (HFMD) is a common viral infection caused by various enteroviruses. It predominantly affects children under the age of five but can also occur in adults. The disease is characterised by fever, malaise, and a distinctive rash involving the hands, feet, and mouth.

Signs and Symptoms

Hand, foot, and mouth disease begins with nonspecific symptoms such as fever, nausea, vomiting, fatigue, loss of appetite, and irritability in infants and toddlers. Within a day or two, a rash develops, presenting as flat, discoloured spots and bumps that may blister. The rash typically appears on the palms, soles, buttocks, and sometimes around the mouth and lips. In adults, the rash can be extremely itchy, whereas children usually do not experience itching. Painful ulcers and blisters may also form in or around the mouth and nose.

Cause

HFMD is caused by viruses from the Picornaviridae family, with Coxsackievirus A16 being the most common pathogen, followed by Enterovirus 71 (EV-71). Other strains of coxsackievirus and enterovirus can also cause the disease.

Transmission

The disease is highly contagious and spreads through direct contact with infected bodily fluids, including saliva, nasal mucus, and stool. It can also be contracted through contact with contaminated surfaces. HFMD is particularly prevalent in child care settings due to close contact and poor hygiene practices among young children. The virus can be infectious for days to weeks even after symptoms have resolved.

Diagnosis

Diagnosis is primarily based on clinical presentation, including the characteristic rash and other symptoms. If the diagnosis is uncertain, laboratory tests such as throat swabs or stool samples may be conducted to identify the virus through culture. The incubation period ranges from three to six days, making early detection very important to prevent outbreaks.

Prevention

Preventive measures include maintaining good hygiene, such as regular handwashing, disinfecting contaminated surfaces, and avoiding direct contact with infected individuals. Proper cleaning of shared utensils and toys is also important. Breastfeeding has been shown to decrease the severity of the disease but does not prevent infection. In China, a vaccine for EV71 has been available since December 2015, but no vaccine is currently available in the United States.

Treatment

There is no specific antiviral treatment for HFMD, and management primarily focuses on symptomatic relief. Pain and fever can be managed with over-the-counter medications such as ibuprofen, but aspirin should be avoided in children. In rare cases, intravenous fluids may be necessary for severe dehydration. Hospitalisation may be required for complications such as encephalitis, meningitis, or acute flaccid paralysis.

Complications

Complications from HFMD are rare but can be severe. Enterovirus 71 infections are more likely to lead to serious complications, including viral or aseptic meningitis, encephalitis, and flaccid paralysis. Minor complications include dehydration due to painful mouth sores. Fingernail and toenail loss may occur weeks after infection but is temporary, with nails regrowing without intervention.

Epidemiology

HFMD is prevalent worldwide, with outbreaks commonly occurring in nursery schools and kindergartens. It is most frequent during spring, summer, and autumn and more common in rural areas. Major outbreaks have been reported in Asia, with significant cases in Malaysia, Taiwan, China, and Vietnam. Poor hygiene and socioeconomic factors contribute to the spread of the disease.

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Self-assessment MCQs (single best answer)

What age group is predominantly affected by Hand, Foot, and Mouth Disease (HFMD)?

Which of the following is NOT a common symptom of HFMD?

Which virus is most commonly associated with causing HFMD?

How is HFMD primarily transmitted?

What is the primary method for diagnosing HFMD?

Which preventive measure is NOT recommended for reducing the spread of HFMD?

Which medication is recommended for managing pain and fever in HFMD patients?

Which of the following complications is associated with Enterovirus 71 (EV-71) infections in HFMD cases?

Which of the following regions has reported major outbreaks of HFMD?

What is a potential minor complication of HFMD that can occur weeks after infection?