Makindo Medical Notes

About

• Hand, foot, and mouth disease (HFMD) is a common viral illness affecting both children and adults.
• While usually self-limiting, it can be unpleasant due to painful symptoms.
• It is unrelated to the foot and mouth disease that affects animals.

Aetiology

• Coxsackievirus A16: The most frequent cause of HFMD.
• Enterovirus 71: Linked to more severe complications, such as encephalitis and neurological involvement.
• Other enteroviruses can occasionally cause HFMD.
• Outbreaks are common, particularly in daycare centers, schools, and groups of children.

Clinical Features

• General malaise, fever, and a feeling of being unwell.
• Primarily affects infants and young children, but adults can also be affected during outbreaks.
• Painful vesicles and ulcers in the mouth, particularly on the tongue, gums, and inside of the cheeks.
• Non-itchy spots or blisters on the hands, feet, and sometimes buttocks.
• Occasionally, fingernail and toenail shedding (onychomadesis) may occur after recovery.

Complications

• Dehydration: Oral pain can lead to reduced fluid intake, particularly in young children.
• Secondary bacterial infections: Skin lesions may become infected.
• Neurological complications: Rare but include:
  • Encephalitis
  • Aseptic meningitis
  • Acute flaccid paralysis

Investigations

• Diagnosis is typically clinical, based on characteristic symptoms and appearance.
• No specific investigations are usually required unless complications are suspected.

Management

• Reassure caregivers that HFMD is usually a mild and self-limiting illness.
• Encourage adequate hydration to prevent dehydration.
• Recommend antipyretics, such as paracetamol or ibuprofen, to manage fever and discomfort.
• A soft diet may be required if oral ulcers are painful, especially in young children.
• Avoid antibiotics (oral or topical) unless there is evidence of secondary bacterial infection.
• Do not prescribe antiviral medications; there is no specific antiviral treatment for HFMD.
• Follow-up is generally not needed, but advise seeking medical attention if symptoms worsen or signs of dehydration occur (e.g., reduced urination, lethargy).

Prevention

• Promote good hygiene practices, such as regular handwashing, especially after diaper changes or using the toilet.
• Clean and disinfect frequently touched surfaces and objects, especially in daycare and school settings.
• Encourage individuals with HFMD to stay home until fever resolves and mouth sores are healed to prevent spreading the virus.

Conclusion

HFMD is a common viral illness that typically resolves without complications. While no specific treatment is required, supportive care, including pain management and hydration, is essential. Education on hygiene practices can help prevent transmission in group settings.