Hand Foot and Mouth Disease


Hand Foot and Mouth Disease, Hand-Foot-Mouth Disease, Coxsackie Virus A Virus

  • See Also
  • Epidemiology
  1. Typically occurs in outbreaks
  2. Most common under age 10 years old (esp. under age 5 years old)
  • Etiology
  1. Typical childhood presentation
    1. Coxsackie Virus A16 (Enterovirus)
    2. Enterovirus 71
      1. Has been associated with Encephalitis, Myocarditis
  2. Atypical presentation seen in adults and teenagers
    1. Coxsackie Virus A6
    2. Affects teens and adults and is highly contagious via droplets, fecal oral route
    3. More severe presentation with fever, Arthralgias, flu-like symptoms
    4. Diffuse Vesicles and erosions affect the nose, cheeks, extensor arms, elbows, thighs, buttocks, groin
  • Pathophysiology
  1. Fecal-oral transmission
  2. Enteroviral exanthem
  • Symptoms
  1. Upper Respiratory Infection symptoms precede oral and skin lesions by days
  2. Fever
  3. Malaise
  4. Pharyngitis
  5. Rash on palms, soles and buttocks
  • Signs
  1. Oral Lesions
    1. Football shaped, painful Vesicles
    2. Involves Buccal mucosa, Gingiva and Tongue
      1. Spares the posterior pharynx
      2. Contrast with Herpangina which spares the anterior pharynx
  2. Skin lesions
    1. Red Papules transition to gray Vesicles (may appear as targets)
    2. Distribution: Palms, soles and buttocks
  • Differential Diagnoses
  1. See Hand Dermatitis or Foot Dermatitis
  2. See Oral Ulcer
  3. Aphthous Ulcer
  4. Varicella Virus
  5. Rickettsial Pox (East Coast, U.S.)
  6. Primary Herpetic Gingivostomatitis (Oral Herpes Simplex Virus)
    1. Diffuse involvement seen with Eczema herpeticum (ill patients that typically require admission)
    2. External Vesicles were only typically seen with HSV and varicella
      1. Not seen with Herpangina or Hand Foot and Mouth Disease in past
      2. However, Coxsackie Virus A6 is associated with more diffuse vessicles
  7. Herpangina
    1. Vesicles in posterior pharynx, sparing anterior pharynx
  • Management
  1. Symptomatic therapy
  2. Maintain hydration
  3. Severe illness has occurred (esp. Coxsackie Virus A6, Enterovirus 71) with significant morbidity and mortality
    1. Consider hospital observation stay in severe cases
  • References
  1. Swadron and DeClerck in Herbert (2017) EM:Rap 17(8): 10-1