Hand Foot and Mouth Disease

Common viral illness characterized by vesicular eruptions on the hands, feet, and oral mucosa, often accompanied by fever

Aetiology

• Coxsackievirus A16 (most typical, mild)

• Enterovirus 71 (EV71) (more severe; neurological complications possible)

• Coxsackie A6 (can cause atypical more severe rash)

• Fecal-oral route (most common)

• Respiratory droplets

• Contact with vesicle fluid or contaminated surfaces

Pathophysiology

• Virus enters via oropharyngeal mucosa.

• Replicates in lymphoid tissue of the GI/respiratory tract.

• Viremia → dissemination to skin and mucosa.

• Produces vesicular lesions and sometimes systemic complications.

Clinical Presentation

• Low-grade fever 1-2 days

• Malaise

• Sore throat

• Decreased appetite

• Vesicles on palms and soles, sometimes buttocks and extremities

• Non-pruritic, may be tender

• Lesions progress from macules → papules → vesicles → crust

• Painful vesicles/ulcers on tongue, buccal mucosa, hard & soft palate

• Causes drooling, refusal to eat or drink

Investigations

• PCR from throat/stool/vesicle fluid (when needed in severe/atypical cases)

• Serology not routinely used

Management

• Adequate hydration (important due to painful oral ulcers)

• Antipyretics (paracetamol/ibuprofen)

• Topical oral anesthetics for mouth ulcers (avoid benzocaine in young children)

• Good hygiene to prevent spread

• Dehydration

• Neurological complications

• Severe pain or inability to swallow

• Signs of respiratory/cardio instability