Review Question - QID 221265

This patient who presents with a 1-week history of fever, sore throat, mouth ulcers, and a rash on the palms and soles, most likely has hand, foot, and mouth disease. This disease is caused by coxsackievirus infection.

Coxsackievirus A is an enterovirus that is part of the picornavirus family of positive-sense RNA viruses. This virus is responsible for causing an acute, self-limited viral illness known as hand, foot, and mouth disease. This disease is characterized by a fever and sore throat on days 1-2 followed by oral ulcers and an erythematous, maculopapular rash on days 2-3, most notably involving the hands and feet. The maculopapular rash evolves into a vesicular rash 1-2 days after initiation. This disease usually affects children of preschool age who attend daycare, as the virus is extremely contagious and spread by fecal-oral route or direct contact with the infected patient's saliva or blister fluid; however, it can affect older kids as well. This self-limited viral illness usually lasts between 7-10 days. Treatment is supportive care.

El-Asmar et al. review the case of a coxsackievirus infection in an adult. They found that the patient had received an allogeneic hematopoietic cell transplant, placing him at increased risk for severe viral infections. They recommend that patients should be closely monitored and that careful infection prevention measures should be taken.

Figure/Illustration A is a clinical photograph demonstrating a rash on the palms and soles of the feet (red circles). These findings are consistent with a diagnosis of hand, foot, and mouth disease.

Incorrect Answers:
Answer 2: Herpes simplex virus can present primarily as herpetic gingivostomatitis with painful, yellow ulcers on the oral mucosa. Recurrent disease is characterized by grouped umbilicated vesicles, located primarily on the lips and face.

Answer 3: Parvovirus infection can cause Fifth disease, which has a fever as well as a characteristic slapped cheek rash.

Answer 4: Rubeola virus infection causes measles, which is characterized by a prodrome with a high fever up to 105°F (40.6°C), coryza, cough, and conjunctivitis. On days 3-4 of the illness, white papules on the oral mucosa known as Koplik spots can be seen. A maculopapular rash also develops, beginning on the forehead and behind the ears and eventually spreading in a cephalocaudal progression.

Answer 5: Varicella infections are characterized by a prodrome of fever and myalgias with an initial acute eruption of erythematous macules and papules that start on the face and oral mucosa and spread to the trunk and extremities. Lesions evolve into vesicles on an erythematous base and then to pustules with an overlying crust, but do not affect the palms and soles.

Bullet Summary:
Coxsackievirus presents in children with a fever, sore throat, mouth ulcers, and a rash on the palms and soles.