Hand, foot and mouth disease

Infectious diseases

Clinicals - History

Fact Explanation
Vesicular erruptions on hands, feet, buttocks, genitalia and mouth This is a viral illness with vesicular eruptions in mouth, hands, foot, buttocks and genitalia. Infection is caused by coxsackievirus A5, A7, A9, A10, B2, B5 strains, polio virus, echovirus and enterovirus 71 (EV-71). Commonly seen in infants and in children less than 5 years but some adults can also get affected. Vesicular erruptions on hands, feet, buttocks, genitalia and mouth
This is a viral illness with vesicular eruptions in mouth, hands, foot, buttocks and genitalia. Infection is caused by coxsackievirus A5, A7, A9, A10, B2, B5 strains, polio virus, echovirus and enterovirus 71 (EV-71). Commonly seen in infants and in children less than 5 years but some adults can also get affected.
Fever Usually fever is the first clinical manifestation. Fever is accompanied by malaise and poor appetite. Fever
Usually fever is the first clinical manifestation. Fever is accompanied by malaise and poor appetite.
Sore throat and oral ulcers Soreness in the throat or mouth is common. Later blisters appear in the oral mucosa and they rupture making ulcers. Sore throat and oral ulcers
Soreness in the throat or mouth is common. Later blisters appear in the oral mucosa and they rupture making ulcers.
Skin rash Flat or raised red spots and blisters usually involves the palms and soles. Skin over the knees, elbows and genitalia can also get affected. Skin rash
Flat or raised red spots and blisters usually involves the palms and soles. Skin over the knees, elbows and genitalia can also get affected.
Vomiting Vomiting is common in EV-71 infection. EV 71 can cause disease outbreaks. Vomiting
Vomiting is common in EV-71 infection. EV 71 can cause disease outbreaks.
Symptoms of dehydration Affected children can get dehydrated due to vomiting, and poor oral intake because of the sore throat and oral ulcers. Symptoms of dehydration
Affected children can get dehydrated due to vomiting, and poor oral intake because of the sore throat and oral ulcers.
Symptoms of meningitis Aseptic meningitis is a rare complication of the disease. Headache, neck pain and stiffness and photophobia are the usual symptoms. Symptoms of meningitis
Aseptic meningitis is a rare complication of the disease. Headache, neck pain and stiffness and photophobia are the usual symptoms.
Symptoms of encephalitis This is an even rare complication of the disease. Affected children have fever, headache, altered consciousness or drowsiness and seizures. Symptoms of encephalitis
This is an even rare complication of the disease. Affected children have fever, headache, altered consciousness or drowsiness and seizures.
Symptoms of myocarditis Myocarditis is also another rare but life threatening complication of the disease. Although most of the patients are asymptomatic, some have chest pain, palpitations due to arrhythmia and even sudden death. Symptoms of myocarditis
Myocarditis is also another rare but life threatening complication of the disease. Although most of the patients are asymptomatic, some have chest pain, palpitations due to arrhythmia and even sudden death.
Involvement of the central nervous system Except from meningitis and encephalitis, hand- foot and mouth disease can result in Guillain-Barré syndrome, acute cerebellar ataxia and acute transverse myelitis. Involvement of the central nervous system
Except from meningitis and encephalitis, hand- foot and mouth disease can result in Guillain-Barré syndrome, acute cerebellar ataxia and acute transverse myelitis.

Clinicals - Examination

Fact Explanation
Fever Affected children are usually febrile, in response to the viremia. Fever
Affected children are usually febrile, in response to the viremia.
Mucosal ulcers Oral vesicles and ulcers are seen. The surrounding skin is erythemic. Mucosal ulcers
Oral vesicles and ulcers are seen. The surrounding skin is erythemic.
Skin lesions First macules appear and they become small flaccid blisters which rupture easily. Lesions can involve palms, soles, buttocks and genital skin. Skin lesions
First macules appear and they become small flaccid blisters which rupture easily. Lesions can involve palms, soles, buttocks and genital skin.
Signs suggestive of myocarditis and heart failure Arrhythmia or tachycardia, low blood pressure and pulmonary edema are suggestive of myocarditis and heart failure. Signs suggestive of myocarditis and heart failure
Arrhythmia or tachycardia, low blood pressure and pulmonary edema are suggestive of myocarditis and heart failure.

Investigations - Diagnosis

Fact Explanation
Detection of the virus Respiratory tract secretions and stool samples can be collected for viral studies and demonstration of the presence of the virus. Polymerase chain reaction can be used to isolate the virus. However investigations are not necessary as this is a clinical diagnosis. Detection of the virus
Respiratory tract secretions and stool samples can be collected for viral studies and demonstration of the presence of the virus. Polymerase chain reaction can be used to isolate the virus. However investigations are not necessary as this is a clinical diagnosis.

Investigations - Management

Fact Explanation
ECG Detects arrhythmia. ECG
Detects arrhythmia.
Echocardiogram Aids in the diagnosis of ventricular dilatation and heart failure secondary to myocarditis. Echocardiogram
Aids in the diagnosis of ventricular dilatation and heart failure secondary to myocarditis.
Chest X-ray Signs of heart failure like cardiomegaly, pulmonary edema, Kerley B lines and upper lobe diversion can be detected. Chest X-ray
Signs of heart failure like cardiomegaly, pulmonary edema, Kerley B lines and upper lobe diversion can be detected.

Management - Supportive

Fact Explanation
Health education The disease is transmitted through infected person's respiratory secretions, blister fluid and feces. Maintenance of good personal hygiene (hand washing, use of handkerchief ) will prevent the disease transmission. Parents are advised to clean their children's toys with disinfectants. Health education
The disease is transmitted through infected person's respiratory secretions, blister fluid and feces. Maintenance of good personal hygiene (hand washing, use of handkerchief ) will prevent the disease transmission. Parents are advised to clean their children's toys with disinfectants.
Maintain adequate hydration Children with dehydration should be given fluids either orally or intravenously. Maintain adequate hydration
Children with dehydration should be given fluids either orally or intravenously.
Antipyeritics Fever should be treated with antipyretics other than non-steroidal anti inflammatory drugs. Antipyeritics
Fever should be treated with antipyretics other than non-steroidal anti inflammatory drugs.
Analgesics Pain in the mouth can be relieved by analgesics. Analgesics
Pain in the mouth can be relieved by analgesics.

Management - Specific

Fact Explanation
Conservative management Hand, foot and mouth disease is often self-limiting and does not require any treatment. Antipyretics and analgesics can be prescribed for the comfort of the patient. Conservative management
Hand, foot and mouth disease is often self-limiting and does not require any treatment. Antipyretics and analgesics can be prescribed for the comfort of the patient.

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