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Updated: Dec 25 2021

Hand-Foot-and-Mouth Disease

  • Snapshot
    • A 2-year-old girl is brought to her pediatrician’s office for a new rash on the palms and soles that developed yesterday. For the past few days, she has had low-grade fevers and a slight cough, and of note, her 6-year-old sister had similar symptoms. Upon further questioning, she and her sister have had all routine childhood vaccinations. On physical exam, there are multiple 2-3-mm grey vesicular lesions on the bilateral palms and soles and several vesicles and ulcers on the oral mucosa. The physician informs her parents that this disease typically resolves spontaneously and to keep the patient hydrated.
  • Introduction
    • Classification
      • coxsackievirus
        • an enterovirus that belongs to the picornavirus family
        • non-enveloped, icosahedral capsid, linear, single-stranded, positive-sense RNA virus
        • transmission via oral secretions or feces
        • coxsackievirus type A
          • hand, foot, and mouth disease
          • herpangina
        • coxsackievirus type B
          • most commonly causes a nonspecific prodrome
          • myocarditis
          • pericarditis
  • Epidemiology
    • Incidence
      • common among children
    • Demographics
      • more common in children than adults
    • Risk factors
      • exposure to others with the virus
      • daycare centers
      • poor hygiene
      • finger sucking
    • Pathogenesis
      • once infected, the virus will travel to the lymph nodes and incubate, causing a prodrome
  • Presentation
    • Symptoms
      • prodrome
        • flu-like illness
        • low-grade fevers
        • may have a cough
        • malaise
      • painful oral lesions
      • skin rash may be painful
    • Physical exam
      • greyish-yellow vesicles or erythematous papules on the palms and soles
      • vesicles and ulcers in oral mucosa and around the mouth
  • Studies
    • Labs
      • coxsackievirus-specific immunoglobulin A
      • viral culture
  • Differential
    • Rickettsia rickettsii infection
      • distinguishing factor
        • presents with rash on palms and soles but is often not macular and vesicular in nature
    • Chickenpox
      • distinguishing factor
        • pruritic,vesicular rash that typically does not occur on the palms, soles, and oral mucosa
    • Making the diagnosis
      • based on clinical presentation but may be confirmed with laboratory studies
  • Treatment
    • Management approach
      • mainstay of treatment is supportive care
    • Conservative
      • supportive care
        • indication
          • all patients
        • modalities
          • antipyretics
          • analgesics
          • hydration
  • Complications
    • Aseptic meningitis
    • Guillain-Barre syndrome
  • Prognosis
    • Spontaneously resolves
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