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Internal Medicine

Hand-Foot-Mouth Disease (HFMD)

Common viral illness primarily affecting children below 5 yr.


Aetiology

Causative organisms:

Viruses of genus Enterovirus belonging to family Picornaviridae
  • Coxsackievirus A16
  • Enterovirus 71
  • Less common: Polio virus, ECHO virus
  • Transmission: Direct contact or infected fomites

Clinical features

Prodrome

  • Low-grade fever
  • Feeling of being unwell
  • Sore throat

Disease

  • Ulcers or blisters in the oral cavity
    • Mostly on the posterior aspect
  • Papulovesicular skin rash
    • Palms and soles and less commonly, on buttocks, knees, elbows and genital area
  • Illness resolves quickly over 4-5 days

Complications

  • Temporary loss of toe/fingernails
    • 4 weeks after onset of disease
  • Rare:
    • Aseptic meningitis
    • Encephalitis
    • Polio-like paralysis
    • Myocarditis
    • Respiratory distress syndrome

Diagnosis

Diagnosis is clinical

Differential diagnosis:

Other illnesses causing oral ulcers:
  • Herpangina
  • Herpetic gingivostomatitis
  • Aphthous ulcers
  • Chickenpox

Management

Symptomatic treatment

  • Analgesics
  • Soft diet

Prevention:

No vaccine is available against this disease
  • Isolation of affected children at home
  • Hand hygiene

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