HAND, FOOT AND MOUTH DISEASE
Hand, foot, and mouth disease (HFMD) is a mild, contagious and common viral illness in infants and children. The disease causes fever and blister-like eruptions in the mouth and/or skin rash. HFMD is often confused with foot-and-mouth (hoof-and-mouth) disease, a disease of cattle, sheep, and swine; however, the two diseases are not related. HFMD occurs mainly in children under 10 years old but can also occur in adults. Children are more likely to be at risk for infection and illness because they are less likely than adults to have antibodies to protect them. HFMD occur worldwide and cases occur more often in summer and early autumn.
Hand Foot and Mouth Disease is caused by viruses that belong to the enterovirus group. This group of viruses includes polioviruses, coxsackieviruses, echoviruses, and enteroviruses. Coxsackievirus A16 is the most common cause of HFMD in the United States, but other coxsackieviruses have been associated with the illness like A5, 7, B2 and 5. Enteroviruses, including enterovirus 71, have also been associated with HFMD and with outbreaks of the disease (Taiwan, Jepan and Malaysia).
The disease usually begins with a fever, poor appetite, feeling vaguely unwell, irritability in infants and toddlers and often with a sore throat. One or 2 days after fever onset, painful sores usually develop in the mouth. They begin as small red spots that blister and then often become ulcers. The sores are usually located on the tongue, gums, and inside of the cheeks. A non-itchy skin rash develops over 1–2 days. The rash has flat or raised red spots, sometimes with blisters. The rash is usually located on the palms of the hands and soles of the feet; it may also appear on the buttocks and/or genitalia. A person with HFMD may have only the rash or only the mouth sores.
Oral ingestion is the main source of coxsackievirus infection and hand-foot-and-mouth disease. The illness spreads by person-to-person contact with nose and throat discharges, saliva, fluid from blisters, or the stool of someone with the infection. The virus can also spread through a mist of fluid sprayed into the air when someone coughs or sneezes. Hand-foot-and-mouth disease is most common in children in child care settings because of frequent diaper changes and potty training, and because little children often put their hands in their mouths. Although your child is most contagious with hand-foot-and-mouth disease during the first week of the illness, the virus can remain in his or her body for weeks after the signs and symptoms are gone. That means your child still can infect others. Some people, particularly adults, can pass the virus without showing any signs or symptoms of the disease. HFMD is not transmitted to or from pets or other animals.
Diagnosis of HFMD is not so difficult, althought Hand Foot and Mouth Disease is one of many infections that result in mouth sores. However, health care providers can usually tell the difference between HFMD and other causes of mouth sores by considering the patient’s age, the symptoms reported by the patient or parent, and the appearance of the rash and sores. Samples from the throat or stool may be sent to a laboratory to test for virus and to find out which enterovirus caused the illness. However, it can take 2–4 weeks to obtain test results, so health care providers usually do not order tests.
There is no specific treatment for HFMD. However symptoms can be treated to provide relief from pain from mouth sores and from fever and aches: pain and fever can be treated with paracetamol or ibuprofen, but should be cautious for aspirin which can cause Reye’s syndrome in children. Mouthwashes or sprays that numb pain can be used to lessen mouth pain. Fluid intake should be enough to prevent dehydration (lack of body fluids). If moderate-to-severe dehydration develops, it can be treated medically by giving fluids through the veins. Offer your child plenty of cool fluids. Your child may also have Popsicles and ice cream. Do not give your child acidic or spicy foods and drinks, such as salsa or orange juice. These foods can make mouth sores more painful. Avoid salty or spicy foods. Eat soft foods that don't require much chewing.
A specific preventive for HFMD is not available, but the risk of infection can be lowered by following good hygiene practices. Good hygiene practices that can lower the risk of infection include: Washing hands frequently and correctly and especially after changing diapers and after using the toilet. Cleaning dirty surfaces and soiled items, including toys, first with soap and water and then disinfecting them by cleansing with a solution of chlorine bleach (made by adding 1 tablespoon of bleach to 4 cups of water). Avoiding close contact (kissing, hugging, sharing eating utensils or cups, etc.) with persons with HFMD. No vaccine is available to protect against the enteroviruses that cause HFMD.
Complications from the virus infections that cause HFMD are not common, but if they do occur, medical care should be sought. The most common complication of hand-foot-and-mouth disease is dehydration. The illness can cause sores in the mouth and throat, making swallowing painful and difficult. Make sure your child consumes adequate amounts of fluids during the course of the illness. If dehydration is severe, intravenous (IV) fluids may be necessary. HFMD caused by enterovirus 71 has shown a higher incidence of neurologic (nervous system) involvement. And fatal cases of encephalitis (swelling of the brain) caused by enterovirus 71 have occurred during outbreaks. However, these serious outcomes are still very rare. Viral meningitis causes fever, headache, stiff neck, or back pain. The condition is usually mild and clears without treatment; however, some patients may need to be hospitalized for a short time. Other more serious diseases, such as a polio-like paralysis, result even more rarely. There have been reports of fingernail and toenail loss occurring mostly in children within 4 weeks of their having hand, foot, and mouth disease (HFMD). At this time, it is not known whether the reported nail loss is or is not a result of the infection.
Presented by dr. Johnny Nurman, SpA
(Pediatrician at Brawijaya Women and Children Hospital)