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Hand-Foot-and-Mouth Disease (HFMD)

By Mary T. Caserta, MD, Professor of Pediatrics, Division of Infectious Diseases; Attending Physician, University of Rochester School of Medicine and Dentistry; Golisano Children’s Hospital at Strong, University of Rochester Medical Center

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Hand-foot-and-mouth disease is a febrile disorder usually caused by coxsackievirus A16, enterovirus 71, or other enteroviruses. Infection causes a vesicular eruption on the hands, feet, and oral mucosa. Atypical hand-foot-and-mouth disease due to coxsackievirus A6 often causes high fever with papulovesicular lesions progressing to vesicobullous lesions and bullae that are widely distributed on the body.

The disease is most common among young children. The course is similar to that of herpangina

Large outbreaks of disease due to enterovirus 71 (EV-71) have occurred in the Asia-Pacific region since 1997. Disease due to EV-71 is more serious than that due to other enteroviruses.

Children have a sore throat or mouth pain and may refuse to eat. Fever is common. Vesicles are distributed over the buccal mucosa and tongue, the palms of the hands and soles of the feet, and, occasionally, the buttocks or genitals; usually, the vesicles of typical HFMD are benign and short-lived.

Atypical HFMD has 4 distinct presentations:

  • Widespread vesiculobullous lesions

  • Eczema coxsackium with lesions concentrated in areas of eczematous skin

  • Gianotti-Crosti type rash (multiple discrete, erythematous flat-topped papules symmetrically distributed on the face, buttocks, and extensor surface of the extremities)

  • Purpuric lesions

Onychomadesis (painless nail shedding) is common during convalescence. Aseptic meningitis may complicate atypical HFMD, but most patients recover uneventfully.

Infection with EV-71 may be accompanied by severe neurologic manifestations (eg, meningitis, encephalitis, polio-like paralysis). Morbidity and mortality are significantly higher with EV-71 than with coxsackievirus A16 or other enteroviruses.

The diagnosis of HFMD is usually made clinically.

Treatment of HFMD is symptomatic. It includes meticulous oral hygiene (using a soft toothbrush and salt-water rinses), a soft diet that does not include acidic or salty foods, and topical measures (see Stomatitis : Treatment).

Three inactivated EV-71 vaccines are currently under development; they appear safe and efficacious in preventing HFMD due to EV-71.

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