Hand, foot, and mouth disease  

Age Group Affected:

• Primarily affects children under the age of 10
• Can also affect adolescents

Transmission:

• HFMD spreads easily from person to person.
• It is possible to contract the virus more than once, with less severe symptoms upon re-infection.

Causative Agents:

• Coxsackie A Virus
• Coxsackie B Virus
• Enterovirus 71: Can cause more serious diseases such as meningoencephalitis and myocarditis.

Modes of Transmission:

• Direct contact with blister fluid or droplets from the mouth.
• Highly infectious in children until blisters disappear.
• Rapid spread among family members and within schools.
• Virus can be shed in feces and saliva for several weeks.

Signs and Symptoms:

• Initial Symptoms:
  • Fever
  • Sore throat
  • Loss of appetite
  • Lethargy
• Blisters:
  • Appear 1–2 days after the fever.
  • Incubation period: 3–6 days.
  • Children remain infectious until blisters rupture and heal (7–10 days).
  • Location: Tops of hands, feet, palms, and soles.
  • Characteristics:
    • Tender, non-itchy
    • Evolve from flat pink macules to red-greyish blisters
    • Often oval-shaped
    • Peel off within a week without leaving scars.
  • Oral Lesions:
    • Small blisters and ulcers around lips, mouth, and throat
    • Can be painful and impact oral intake, especially in infants and young children.
• Eczema:
  • HFMD can exacerbate eczema and potentially cause bacterial infection.

Duration:

• HFMD is usually mild with complete resolution in 7–10 days.

Complications:

• Common Complications:
  • Dehydration due to inadequate fluid intake.
  • Fingernail and toenail changes (commonly noted two months after HFMD infection due to Coxsackie A6 infection).
  • Onychomadesis (nail shedding) may occur about two months after the illness but nails eventually return to normal.
• Severe Complications (Uncommon):
  • Widespread blistering
  • Enteritis
  • Myocarditis
  • Meningoencephalitis
  • Acute flaccid paralysis (loss of nerve function in a limb)
  • Pulmonary edema and pneumonia
  • Hemorrhagic conjunctivitis

Complications in Pregnancy:

• Can cause first-trimester spontaneous miscarriage or intrauterine growth restriction.

Complications in Newborns:

• Meningoencephalitis
• Thrombocytopenia
• Disseminated intravascular coagulation
• Cardiomyopathy
• Hepatitis

Rare Complication: Reye Syndrome

• Although not commonly associated with HFMD, Reye Syndrome can develop as a complication following a viral infection.
• Characterized by acute encephalopathy and fatty liver degeneration.
• Typically associated with aspirin use in children with viral infections.

Management

Pain Relief for HFMD

Simple Analgesia:

• Paracetamol or Ibuprofen: Use as needed for pain relief.

Oral Ulcers:

• Antiseptic Mouthwashes or Topical Soothing Agents:
  • Examples: Lignocaine
  • Used for painful oral/palatal ulcers in children.

Aspirin:

• Contraindicated:
  • Risk of Reye Syndrome: A rare form of acute encephalopathy and fatty infiltration of the liver that tends to occur after some acute viral infections, particularly when salicylates are used.
  • Diagnosis: Clinical.
  • Treatment: Supportive.

Hydration

Prevention of Dehydration:

• Constantly offer the child sips of water or juice.
• If Oral Intake is Poor:
  • Consider nasogastric or intravenous fluids.

Blister Care

Management of Blisters:

• Natural Drying: Leave blisters to dry naturally.
• Do Not Pierce/Rupture: To reduce contagion.
• Hygiene: Keep blisters clean and apply non-adherent dressings to erosions.

Staying Home and Preventing Spread

Home Care:

• Mild Cases: Children do not need to stay home once well enough to attend school.
• Infectivity of Blisters: Remain infective until they dry, usually within a few days.
• Fecal Shedding: Virus sheds through fecal stools and remains infective for up to a month after the illness.

Practicality:

• Keeping well children home from school is impractical.

Preventing Spread:

• Hand Hygiene: Wash hands thoroughly after touching child’s bodily fluids (blisters, nose blowing, changing nappies, toileting).
• Minimize Sharing:
  • Avoid sharing personal items such as cutlery, drinking cups, towels, toothbrushes, and clothing.
• Stay Home Policy:
  • Keep the child home from school, kindergarten, or childcare until all the fluid in their blisters has dried.