infectious diseases
Hand Foot and Mouth Disease (HFMD)
Introduction
Hand-foot-and-mouth disease (HFMD) is a febrile disorder usually caused by coxsackievirus A16, enterovirus 71, or other enteroviruses. Infection causes a vesicular eruption on the hands, feet, and oral mucosa. Atypical HFMD due to coxsackievirus A6 often causes high fever with papulovesicular lesions progressing to vesicobullous lesions and bullae that are widely distributed on the body. The disease is most common among young children. The course is similar to that of Herpangina . (See also Children have a sore throat or mouth pain and may refuse to eat. Fever is common. Vesicles are distributed over the buccal mucosa and tongue, the palms of the hands and soles of the feet, and, occasionally, the buttocks or genitals; usually, the vesicles of typical HFMD are benign and short-lived. This photo shows vesicles on the tongue and around the mouth in a patient with hand-foot-and-mouth disease. DR P. MARAZZI/SCIENCE PHOTO LIBRARY This photo shows oral lesions that appear as various-sized erosions and ulcerations on an erythematous base after vesicles have opened. © Springer Science+Business Media This photo shows vesicles on the palm surrounded by erythema. © Springer Science+Business Media This photo shows vesicles and erythematous papules on the sole of a patient with hand-foot-and-mouth disease. SCIENCE PHOTO LIBRARY This image shows a clear-filled vesicle on the toe of a child with hand-foot-and-mouth disease. DR P. MARAZZI/SCIENCE PHOTO LIBRARY Atypical HFMDhas 4 distinct presentations: Widespread vesiculobullous lesions Eczema coxsackium with lesions concentrated in areas of eczematous skin Gianotti-Crosti type rash (multiple discrete, erythematous flat-topped papules symmetrically distributed on the face, buttocks, and extensor surface of the extremities) Purpuric lesions Onychomadesis (painless nail shedding) is common during convalescence. Aseptic meningitis may complicate atypical HFMD, but most patients recover uneventfully. Infection with EV-71 may be accompanied by severe neurologic manifestations (eg, Overview of Meningitis , Thediagnosisof HFMD is usually made clinically. of HFMD is symptomatic. It includes meticulous oral hygiene (using a soft toothbrush and salt-water rinses), a soft diet that does not include acidic or salty foods, and topical measures (see Treatment ). Three inactivated EV-71 vaccines are currently available in China, but none are yet approved for use in the United States. Coxsackie A16 vaccines are also in preclinical development. 