Hand, foot, and mouth disease

This article is about viral disease. For the chemotherapy-induced condition, see Chemotherapy-induced acral erythema. For the animal disease, see Foot-and-mouth disease. For the card game, see Canasta § Hand and Foot Canasta.

Hand, foot, and mouth disease
Other namesEnteroviral vesicular stomatitis with exanthem
Small reddish spots and bumps around mouth in HFMD
SpecialtyInfectious disease
SymptomsFever, flat discolored spots or bumps that may blister[1][2]
ComplicationsTemporary loss of nails, viral meningitis[3]
Usual onset3–6 days post exposure[4]
Duration1 week[5]
CausesCoxsackievirus A16, Enterovirus 71[6]
Diagnostic methodBased on symptoms, viral culture[7]
PreventionHandwashing[8]
TreatmentSupportive care[5]
MedicationPain medication such as ibuprofen[9]
FrequencyAs outbreaks[1]

Hand, foot, and mouth disease (HFMD) is a common infection caused by a group of enteroviruses.[10] It typically begins with a fever and feeling generally unwell.[10] This is followed a day or two later by flat discolored spots or bumps that may blister, on the hands, feet and mouth and occasionally buttocks and groin.[1][2][11] Signs and symptoms normally appear 3–6 days after exposure to the virus.[4] The rash generally resolves on its own in about a week.[5]

The viruses that cause HFMD are spread through close personal contact, through the air from coughing, and via the feces of an infected person.[8] Contaminated objects can also spread the disease.[8] Coxsackievirus A16 is the most common cause, and enterovirus 71 is the second-most common cause.[6] Other strains of coxsackievirus and enterovirus can also be responsible.[6][12] Some people may carry and pass on the virus despite having no symptoms of disease.[10] Other animals are not involved.[8] Diagnosis can often be made based on symptoms.[7] Occasionally, a throat or stool sample may be tested for the virus.[7]

Most people with hand, foot, and mouth disease get better on their own in 7 to 10 days.[8] Most cases require no specific treatment.[5] No antiviral medication or vaccine is available, but development efforts are underway.[13][14] For fever and for painful mouth sores, over-the-counter pain medications such as ibuprofen may be used, though aspirin should be avoided in children.[9] The illness is usually not serious. Occasionally, intravenous fluids are given to children who are dehydrated.[15] Very rarely, viral meningitis or encephalitis may complicate the disease.[3] Because HFMD is normally mild, some jurisdictions allow children to continue to go to child care and schools as long as they have no fever or uncontrolled drooling with mouth sores, and as long as they feel well enough to participate in classroom activities.[8]

HFMD occurs in all areas of the world.[16] It often occurs in small outbreaks in nursery schools or kindergartens.[1] Large outbreaks have been occurring in Asia since 1997.[16] It usually occurs during the spring, summer and fall months.[16] Typically it occurs in children less than five years old but can occasionally occur in adults.[1][10] HFMD should not be confused with foot-and-mouth disease (also known as hoof-and-mouth disease), which mostly affects livestock.[17]

  1. ^ a b c d e Kaminska, K; Martinetti, G; Lucchini, R; Kaya, G; Mainetti, C (2013). "Coxsackievirus A6 and Hand, Foot, and Mouth Disease: Three Case Reports of Familial Child-to-Immunocompetent Adult Transmission and a Literature Review". Case Reports in Dermatology. 5 (2): 203–209. doi:10.1159/000354533. PMC 3764954. PMID 24019771.
  2. ^ a b Ooi, MH; Wong, SC; Lewthwaite, P; Cardosa, MJ; Solomon, T (2010). "Clinical features, diagnosis, and management of enterovirus 71" (PDF). Lancet Neurology. 9 (11): 1097–1105. doi:10.1016/S1474-4422(10)70209-X. PMID 20965438. S2CID 17505751.
  3. ^ a b "HFMD Symptoms and Complications". CDC. May 7, 2024. Retrieved July 7, 2024.
  4. ^ a b Hoy, NY; Leung, AK; Metelitsa, AI; Adams, S (2012). "New concepts in median nail dystrophy, onychomycosis, and hand, foot and mouth disease nail pathology". ISRN Dermatology. 2012 (680163): 680163. doi:10.5402/2012/680163. PMC 3302018. PMID 22462009.
  5. ^ a b c d Longo, Dan L. (2012). Harrison's Principles of Internal Medicine (18th ed.). New York: McGraw-Hill. ISBN 978-0-07174889-6.
  6. ^ a b c Repass GL, Palmer WC, Stancampiano FF (September 2014). "Hand, foot, and mouth disease: Identifying and managing an acute viral syndrome". Cleve Clin J Med. 81 (9): 537–43. doi:10.3949/ccjm.81a.13132. PMID 25183845.
  7. ^ a b c "Diagnosis". CDC. August 18, 2015. Archived from the original on May 14, 2016. Retrieved May 15, 2016.
  8. ^ a b c d e f "Causes & Transmission". CDC. August 18, 2015. Archived from the original on May 14, 2016. Retrieved May 15, 2016.
  9. ^ a b "Treat Hand, Foot, and Mouth Disease". CDC. February 2, 2021. Retrieved October 9, 2021.
  10. ^ a b c d "Hand Foot and Mouth Disease". CDC. August 18, 2015. Archived from the original on May 16, 2016. Retrieved May 14, 2016.
  11. ^ Frydenberg, A; Starr, M (August 2003). "Hand, foot and mouth disease". Australian Family Physician. 32 (8): 594–5. PMID 12973865.
  12. ^ Li, Y; Zhu, R; Qian, Y; Deng, J (2012). "The characteristics of blood glucose and WBC counts in peripheral blood of cases of hand foot and mouth disease in China: a systematic review". PLOS ONE. 7 (1): e29003. Bibcode:2012PLoSO...729003L. doi:10.1371/journal.pone.0029003. PMC 3250408. PMID 22235257.
  13. ^ Pourianfar HR, Grollo L (February 2014). "Development of antiviral agents toward enterovirus 71 infection". J Microbiol Immunol Infect. 48 (1): 1–8. doi:10.1016/j.jmii.2013.11.011. PMID 24560700.
  14. ^ Fang, Chih-Yeu; Liu, Chia-Chyi (2018). "Recent development of enterovirus A vaccine candidates for the prevention of hand, foot, and mouth disease". Expert Review of Vaccines. 17 (9): 819–831. doi:10.1080/14760584.2018.1510326. ISSN 1744-8395. PMID 30095317. S2CID 51952220.
  15. ^ "Hand-foot-and-mouth disease – Symptoms and causes". Mayo Clinic. Retrieved October 9, 2021.
  16. ^ a b c "Outbreaks". CDC. August 18, 2015. Archived from the original on May 17, 2016. Retrieved May 15, 2016.
  17. ^ "Foot and Mouth Disease update: further temporary control zone established in Surrey". Defra. August 14, 2007. Archived from the original on September 27, 2007. Retrieved August 14, 2007.