Hand-foot-and-mouth disease
Hand-foot-and-mouth disease is a coxsackievirus A (most often A16) or enterovirus 71 exanthem of infants and young children producing oral vesicles/ulcers with oval vesicles on the palms and soles. It is a clinical diagnosis managed with supportive care; enterovirus 71 disease carries the highest risk of neurologic and cardiopulmonary complications.
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What this article covers
- Overview
A coxsackievirus (usually A16) or enterovirus 71 exanthem of young children: hand-foot-and-mouth disease is an acute, self-limited enteroviral illness of infants and young children producing…
- Epidemiology
Infants and young children are the primary population: the disease is most common in children under 5 years old, especially in day care and school settings where close contact spreads the virus efficiently.
- Risk factors
Age under 5 years: immature mucosal and humoral immunity to enteroviruses concentrates disease in this age group.
- Pathophysiology
Fecal-oral and oral-oral transmission: the virus is shed in saliva, vesicle fluid, and stool, and spreads through direct contact with secretions, contaminated hands, or fomites.
- Clinical features
Oral vesicles/ulcers as the earliest and most consistent finding: shallow, painful ulcers appear on the buccal mucosa and anterior tongue, often preceding or accompanying the skin lesions, and are…
- Differential diagnosis
Herpangina: posterior oropharyngeal vesicles/ulcers on the soft palate, tonsillar pillars, and uvula without hand or foot lesions; same viral family and season.
- Diagnosis
This is a clinical diagnosis confirmed on inspection: the combination of low-grade fever, painful oral ulcers, and oval vesicles on the palms and soles in a young child during enterovirus season is…
- Management
First, assess hydration and oral intake: offer frequent cool liquids or an oral rehydration solution and soft, bland, non-acidic foods; inability to maintain adequate oral intake because of oral pain…
- Complications
Dehydration: the most common complication, from reduced oral intake due to painful mouth ulcers; it is the usual reason for medical evaluation and, occasionally, admission for intravenous fluids.
- Prognosis
Excellent in typical disease: most children recover fully within 7 to 10 days without sequelae, and treatment is supportive only.
- Prevention
No vaccine exists against coxsackievirus or enterovirus 71, so prevention relies entirely on hygiene and isolation measures.
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