US Pharm. 2012;37(3):17-18.
Hand, Foot, and Mouth Disease
Hand, foot, and mouth disease is an early childhood
condition most commonly caused by the coxsackievirus. This viral
infection is named after its classic symptoms: small ulcers on the
inside cheeks, gums, and tongue, and a red rash that can result in
blisters on the palms of the hands and soles of the feet.
Coxsackievirus is easily spread from an infected person
through nasal secretions, saliva, droplets in the air after a cough or
sneeze, fluid from open blisters, or stool contamination. The best
protection against its spread is thorough hand washing, especially after
diaper changes or use of the bathroom. Breakouts of the disease are
common in child care settings, preschools, and elementary schools.
Symptoms begin to appear between 3 and 7 days following
exposure. The initial symptoms include fever, loss of appetite, and sore
throat, followed by small blisters in the mouth and a red skin rash
commonly found on the palms and soles. Treatment is aimed at relieving
symptoms with fever reducers such as acetaminophen or ibuprofen, easing
sore mouths and throats with topical anesthetics, and encouraging fluids
to avoid dehydration.
Hand, foot, and mouth disease is usually mild and lasts no
more than 7 to 10 days. It can cause more serious symptoms in some
children, resulting in dehydration when it is painful to swallow. In
rare cases, this viral infection can lead to inflammation of the brain
lining (meningitis) or of the brain itself (encephalitis). There is no
vaccine available to prevent the disease. The best prevention involves
thorough hand washing, disinfecting areas or objects shared by young
children during an outbreak, and home care until fever is gone and mouth
ulcers have healed.
Young Children Are the Most Vulnerable to Infection
Hand, foot, and mouth disease is a common, contagious,
viral illness in young children. It can occur in older children and
adults, although it is usually very mild. In the United States,
coxsackievirus A16 is the most common cause of this infection, but
enterovirus 71 has also caused outbreaks.
Recognizing the Infection
Symptoms begin to appear within a week of exposure to an
infected person. Fever and sore throat are the initial symptoms,
followed by sores in the mouth and throat about 48 hours later. Finally,
a rash appears after another 48 hours. The rash is typically found on
the palms of the hands and soles of the feet and may form raised
blisters. In some children, the rash may also be seen on the knees,
elbows, buttocks, and genital area. Although this is a common pattern
for the development of symptoms, some children may develop only one or
two of the typical symptoms, while others may become more seriously ill,
having difficulty eating or drinking for an extended period due to
painful ulcers in the mouth and throat. These children may become
extremely dehydrated as a result and require treatment with IV fluids.
Diagnosis is usually made by combining the timing and
appearance of symptoms with the observations made during a physical
examination. Often, there is an outbreak spreading through the day care
center or school the child attends. Laboratory testing for the virus is
not required for diagnosis, although a throat swab or stool sample may
be analyzed to determine the exact virus responsible for the illness.
Treating the Symptoms
There is no specific treatment for hand, foot, and mouth
disease. A virus causes this illness, so antibiotics are not effective.
The aim of treatment is to relieve symptoms and prevent complications
such as dehydration. Fever may be treated with nonprescription medicines
such as acetaminophen or ibuprofen. Aspirin should not be used in young
children due to the risk of Reye syndrome. Mouthwashes and sprays that
contain topical anesthetics help relieve mouth ulcer pain, making it
easier to eat and drink. Children who are having trouble swallowing
liquids may be given frozen pops or ice cream, and they may have an
easier time drinking cold drinks and eating soft foods that do not
The most common complication is dehydration, a result of
fever and difficulty drinking fluids. Rarely, viral meningitis or
encephalitis, two inflammatory brain conditions, can result. Children
with unusual symptoms such as prolonged fever, stiff neck, and headache
should always be evaluated by a doctor.
Children with hand, foot, and mouth disease are highly
contagious and should be kept home for at least the first week of the
illness, until fever is gone and open ulcers in the mouth and on the
body are healed. Viruses that cause this disease can be contagious even
after symptoms have disappeared and can be spread by people who had very
mild symptoms or none at all. Prevention of viral spread is greatly
helped by thorough hand washing and good toilet hygiene. During
outbreaks of the disease, it is important to disinfect surfaces and
objects (such as toys) that may be contaminated with viruses using a
solution of 1 tablespoon of chlorine bleach to 4 cups of water.
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