Hand-foot-mouth disease

Hand-foot-and-mouth disease is a viral infection caused by Coxsackievirus that usually begins in the throat. Symptoms include; fever, sore throat, ulcers in the throat, headache, and a rash with blisters on the palms of the hands and soles of the feet.

Also known as: Coxsackievirus infection

Definition

Hand-foot-mouth disease is a relatively common infection viral infection that usually begins in the throat.

A similar infection is herpangina.

Causes, incidence, and risk factors

Hand-foot-and-mouth disease (HFMD) is most commonly caused by coxsackievirus A16, a member of the enterovirus family.

The disease is not spread from pets, but it can be spread by person to person. You may cacth it if you come into direct contact with nose and throat discharges, saliva, fluid from blisters, or the stools of an infected person. You are most contagious the first week you have the disease.

The time between infection and the development of symptoms is about 3 - 7 days.

The most important risk factor is age. The infection occurs most often in children under age 10, but can be seen in adolescents and occasionally adults. The outbreaks occur most often in the summer and early fall.

Symptoms

Fever
Headache
Loss of appetite
Rash with very small blisters on hands, feet, and diaper area; may be tender or painful if pressed
Sore throat
Ulcers in the throat (including tonsils), mouth, and tongue

Signs and tests

A history of recent illness and a physical examination, demonstrating the characteristic vesicles on the hands and feet, are usually sufficient to diagnose the disease.

Treatment

There is no specific treatment for the infection other than relief of symptoms.

Treatment with antibiotics is not effective, and is not indicated. Over-the-counter medicines, such as Tylenol (acetaminophen) can be used to treat fever. Aspirin should not be used in viral illnesses in children under age 12 years.

Salt water mouth rinses (1/2 teaspoon of salt to 1 glass of warm water) may be soothing if the child is able to rinse without swallowing. Make sure your child gets plenty of fluids. Extra fluid is needed when a fever is present. The best fluids are cold milk products. Many children refuse juices and sodas because their acid content causes burning pain in the ulcers.

Expectations (prognosis)

Generally, complete recovery occurs in 5 to 7 days.

Complications

Dehydration
Febrile seizures

Calling your health care provider

Call your doctor if there are signs of complications, such as pain in neck or arms and legs. Emergency symptoms include convulsions.

You should also call if:

A high fever is not reduced by medication
Signs of dehydration occur:
- Dry skin and mucus membranes
- Weight loss
- Irritability
- Lethargy
- Decreased or dark urine.

Prevention

Avoid contact with people with known illness. Practice strict hand washing if in contact with infected children.

References

Abzug MJ. Nonpolio enteroviruses. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 247.

Losi-Sasaki JM, Moore AY. Viral diseases of the skin. In: Rakel P, Bope ET, eds. Conn’s Current Therapy 2008. 60th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 209.

Review date:: August 8, 2009
Reviewed by:: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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