Overview

Hand, Foot, and Mouth Disease (HFMD) is a common viral illness that primarily affects infants and young children, though adults can occasionally be infected. It is characterized by a combination of fever, painful sores inside the mouth, and a rash with red spots or blisters on the hands, feet, and sometimes other areas like the buttocks. HFMD is usually mild and resolves on its own within 7 to 10 days. The disease spreads easily through direct contact with nasal secretions, saliva, fluid from blisters, or feces of an infected person, making it more prevalent in daycare centers and schools.

Causes

HFMD is caused by several types of viruses belonging to the Enterovirus group. The most common culprits include:

• Coxsackievirus A16: The most frequent cause, usually resulting in mild illness.
• Enterovirus 71 (EV-71): Can cause more severe cases and occasionally lead to neurological complications.
• Other enteroviruses: Less commonly, other strains of enteroviruses can also lead to HFMD.

The infection spreads through respiratory droplets, direct contact with infected bodily fluids, or contaminated surfaces, making it highly contagious, especially among young children.

Symptoms

Symptoms of Hand, Foot, and Mouth Disease usually appear 3 to 6 days after exposure and can vary in severity. Common signs include:

• Fever: Often the first symptom, usually mild to moderate in severity.
• Sore throat: Accompanied by discomfort while swallowing.
• Painful mouth sores: Red spots that develop into painful ulcers on the tongue, gums, and inside of the cheeks.
• Skin rash: Flat or raised red spots, sometimes with blisters, appearing on the palms, soles of the feet, and occasionally on the buttocks or groin area.
• General malaise: Fatigue, irritability, and reduced appetite are common, especially in children.
• Drooling: Infants may drool excessively due to painful mouth sores.

Diagnosis

Diagnosis of HFMD is primarily clinical, based on the characteristic combination of symptoms. Typical diagnostic steps include:

• Physical examination: A doctor identifies the distinct pattern of mouth sores and skin rash.
• Medical history: Information about recent contact with infected individuals and symptom onset is useful.
• Laboratory tests (rarely needed): In severe or atypical cases, throat swabs, stool samples, or blister fluid may be tested to identify the virus strain.

In most cases, no specific tests are necessary, and diagnosis is made during a clinical visit.

Treatment

There is no specific antiviral treatment for Hand, Foot, and Mouth Disease. Management focuses on relieving symptoms and ensuring proper hydration:

• Pain relief: Over-the-counter medications like acetaminophen or ibuprofen help reduce fever and ease pain.
• Mouth care: Cold fluids, popsicles, or soothing mouthwashes can reduce mouth discomfort. Spicy or acidic foods should be avoided.
• Hydration: Encouraging plenty of fluids is crucial to prevent dehydration, especially if mouth sores make eating difficult.
• Rest: Adequate rest helps the body recover faster.
• Isolation: To prevent the spread, children should stay home from daycare or school until fever resolves and mouth sores improve.

In rare severe cases, especially with EV-71 infection, hospitalization may be required for supportive care.

Prognosis

The prognosis for Hand, Foot, and Mouth Disease is excellent in most cases. Symptoms usually resolve within a week to ten days without long-term consequences. Complications are rare but can include dehydration, nail shedding, or, in very rare instances, viral meningitis or encephalitis, particularly with EV-71 infection.

Most children recover completely with supportive care. Preventive measures, such as frequent handwashing, disinfecting surfaces, and avoiding close contact during outbreaks, can reduce the risk of infection. Recurrent infections are possible but usually less severe than the first episode.