What is hand-foot-and-mouth disease?

Causes and Symptoms

Hand-foot-and-mouth disease is usually caused by coxsackievirus A16, but it may also be associated with a number of other coxsackieviruses and enterovirus 71. Outbreaks of the disease are most common in the summer and early fall. Infants and young children ages one to five years are most commonly infected because they have not had previous exposure to the virus and, therefore, have less immunity than adults. They often become infected through contact with the nasal and oral secretions of infected children, and nursery school outbreaks may occur. Skin
lesions
and fecal material may also contribute to the spread of the virus. The incubation period is three to six days.

The illness commences with a low-grade fever (100 to 101 degrees Fahrenheit) and a sore mouth. Oral lesions begin as small, red macules and evolve rapidly into fragile vesicles that rupture, leaving painful ulcers. Any part of the mouth may be involved, but the hard palate buccal mucosa and tongue are mainly affected with an average of five to ten lesions. Similar lesions develop on the skin over the next one to two days; they usually number twenty to thirty, but there may be as many as one hundred. Discrete macular lesions, about 4 millimeters in diameter, appear on the hands and feet and sometimes the buttocks. These lesions often occur along skin lines and progress to become papules and white or gray flaccid vesicles containing infective virus. The lesions may be painful or tender. The fever occurs during the first one to two days of the illness, which resolves in seven to ten days. Rarely, the viral infection is complicated by meningoencephalitis, carditis, or pneumonia.

Treatment and Therapy

There is no specific treatment for hand-foot-and-mouth disease. The infection usually resolves without complications in about one week. Topical anesthetic agents, such as viscous lidocaine, may be used to soothe the discomfort of the mouth lesions. Popsicles and cool sherbets may be given to young children to help soothe a sore mouth. Acetaminophen given at an appropriate dosage for the body weight of the child may also help to relieve the pain of this condition. Some pediatricians recommend a blend of Benadryl and liquid antacid to relieve the stinging sensation of the mouth lesions.

Perspective and Prospects

The first described outbreak of this disease occurred in Toronto, Canada, in 1957. British authors first coined the term “hand-foot-and-mouth disease” when they reported an outbreak in Birmingham, England, in 1959. While there currently are no medications available for treating enteroviral infections, a number of antiviral agents are being studied and might be useful for complicated forms of this disease, such as meningoencephalitis.

Bibliography

Barnhill, Raymond, and A. Neil Crowson, eds. Textbook of Dermatopathology. 3d ed. New York: McGraw-Hill, 2010.

Belshe, Robert B., ed. Textbook of Human Virology. 2d ed. St. Louis, Mo.: Mosby Year Book, 1991.

Goldsmith, Lowell, et al., eds. Fitzpatrick’s Dermatology in General Medicine. 8th ed. 2 vols. New York: McGraw-Hill, 2012.

"Hand, Foot, and Mouth Disease (HFMD)." Centers for Disease Control and Prevention, April 27, 2012.

Mandell, Gerald L., John E. Bennett, and Raphael Dolin, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 7th ed. New York: Churchill Livingstone/Elsevier, 2010.

McCoy, Krisha. "Hand, Foot, and Mouth Disease." Health Library, November 26, 2012.

Vorvick, Linda J., and David Zieve. "Hand-Foot-Mouth Disease." Medline Plus, August 10, 2012.