Hand-foot-and-mouth Disease

The viruses that cause HFM disease are easily spread from person to person. The viruses produce a characteristic rash. Most of the time, HFM disease is caused by the virus called Coxsackievirus A16. This is a member of a viral subgroup known as enteroviruses. It has no relation to foot-and-mouth disease, a viral infection often found in farm animals.

Hand-foot-and-mouth disease produces a characteristic rash inside the mouth and on the hands and feet. In younger children, the rash may also occur on the thighs, buttocks, and trunk. The lesions inside the mouth are usually mildly painful yellow ulcers with a red halo. The lesions on the skin usually start as red areas that may or may not be itchy. The lesions may change to gray blisters with thick walls.

Before the rash develops, the person may have other symptoms, including:

• fatigue
• fever that ranges from about 100 to 102 degrees F
• headache
• irritability in younger children
• loss of appetite
• malaise, or a vague feeling of illness

HFM disease is usually a minor illness with only a few days of fever and relatively mild symptoms. Rarely, a severe form of HFM disease caused by enterovirus 71 can involve the brain. Viral meningitis, encephalitis, or paralysis can result.

HFM disease is more common in the summer and fall months. The viruses infect humans only and are passed in feces. They can be spread when a person with contaminated hands touches food or objects that are put into the child's mouth. Less commonly, the viruses are passed through respiratory secretions or mouth-to-mouth contact.

Factors that put a person at risk for the disease include:

• age less than 5 years
• crowded living conditions
• poor sanitation

HFM disease is a contagious infection. Careful hand washing after using the toilet or changing a diaper can decrease the spread of the infection. Hands should also be washed well before food preparation. Children and toddlers should be taught good hygiene. Children with HFM disease are contagious for about a week. They should be kept out of day care or school until the fever is gone and the mouth ulcers have healed.

Diagnosis of HFM disease begins with a medical history and physical exam. HFM disease is diagnosed by observing the characteristic rash. There are no commonly used tests to identify the virus. In rare cases, a test may be ordered to look for the virus in fluid from the skin lesions.

HFM disease is almost always a mild illness without major long-term effects. If the brain is affected in the severe form of the disease, serious neurologic or developmental problems can result.

HFM is a contagious disease that is easily passed from one person to another. The virus may be found in the person's respiratory secretions for up to 2 weeks. It may also be found in the stool for up to a month after the disease starts.

Since HFM disease is caused by a virus, antibiotics are of no use. Since it is a mild illness, treating symptoms to make the child more comfortable is usually all that is necessary. Medicines such as ibuprofen (i.e., Advil, Motrin) or acetaminophen (i.e., Tylenol) may be given for fever. Occasionally, intravenous fluids are needed to prevent dehydration.

The mouth ulcers will be less painful if the child avoids:

• citrus fruits and fruit drinks such as orange juice
• foods that require a lot of chewing
• salty foods or beverages such as sports drinks
• spicy foods

Cold drinks and frozen desserts are often well liked and well tolerated by an individual with this condition. The person should drink plenty of fluids and rinse the mouth with warm water after meals.

Acetaminophen or ibuprofen may cause stomach upset or allergic reactions.

The individual can return to normal activities once he or she feels better.

Any new or worsening symptoms should be reported to the healthcare professional.