Hand, Foot, and Mouth Disease – Handle It Well to Avoid the Swell


Oftentimes, diseases are eponymously classified with the name of the scientist who discovered the syndrome (e.g. Crohn’s Disease), yet, in the case of Hand, Foot, and Mouth Disease (HFMD), the illness was appropriately named after the most prominently affected features upon physical examination. It is a viral illness typically seen in children less than 5 years of age, with outbreaks appearing in schools, camps, and daycare during the spring and fall months. HFMD is a common disease, but because clinicians are not required to officially report the cases to public health authorities, the exact prevalence is unknown. Fortunately, in the majority of cases, HFMD is a benign self-limiting illness, but serious complications such as meningitis (an inflammation of the brain and spinal cord tissue) do occur. Although there are no vaccines to prevent it, engaging in some simple hygienic practices may help decrease the spread of disease.

There are two main viruses that cause HFMD, coxsackievirus A16 (belonging to the polio family) and enterovirus 71. HFMD is transmitted via contact of either infected fecal material or respiratory secretions. Once the virus gains access to the oral cavity, it moves into the intestinal region. At this site, it undergoes replication, with subsequent invasion of the lymph nodes and organ systems. The incubation period (length of time between acquisition of the virus to manifestation of disease) is 3-5 days. Patients with HFMD present with fevers, throat pain, and small red sore lesions that occur in the mouth, hands, and feet [hence the name of the disease]. The diagnosis is based on the patient’s history and a physical examination; however, in children, if experiencing a more severe form of the illness, specialized viral testing can be obtained. The treatment is supportive and involves hydration with intravenous fluids as well as medications such as Tylenol for fever and throat pain. On occasion, patients with HFMD may become critically ill, and they may develop meningitis, myocarditis (inflammation of the heart muscle, potentially leading to heart failure), and paralysis. These complications are more common with enterovirus 71.

Studies have delineated a number of risk factors that predispose patients to the severe form of disease, and they include: fever for more than three consecutive days, vomiting, young age, and lethargy. However, despite the potentially hazardous side effects, children generally do well, enjoying symptom resolution within a week. If your child has been diagnosed with HFMD, make sure that they are drinking plenty of fluids, and treat their sore throat with over-the-counter medications. These viruses are ubiquitous, but we can all play a role in disease prevention by adhering to the following recommendations: frequent hand washing, especially after changing diapers; disinfecting surfaces and toys on a regular basis; allowing your children to stay home when ill; and avoiding close contact with those who are infected. If we participate in these practices, we will lower the risk of disease dissemination. This is especially important if we have contact with young children, as this particular age group is more susceptible to serious complications.

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