HFMD: causes, transmission, pathophysiology, symptoms, diagnosis and treatment. For patient education.
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Hand, foot and mouth disease is a common viral infection that affects mostly infants and young children. Infection is characterized by a rash on the hands and feet, and painful blisters inside the mouth. Outbreaks typically occur in daycare setting, during summer and early fall.
Most cases are caused by coxsackievirus A, serotype 16, but other enteroviruses can also be the cause. Notably, enterovirus 71, EV-71, is responsible for a more severe form of the disease. The viruses are non-enveloped, and contain a single plus-strand RNA.
An infected person may shed virus in respiratory droplets, oral and nasal secretions, blister fluid, and stool. The disease can spread through direct or indirect contacts with the infected. Patients are most contagious during the first week of illness, but can remain infectious for several weeks, even without symptoms.
After being inhaled or ingested, the virus replicates in the throat, tonsils, and lymphoid tissue of the small intestine. From there, it spreads to regional lymph nodes, and then further to various organs including the skin, heart, liver, and central nervous system.
Incubation period is 3 to 6 days. Infection typically starts with a low-grade fever and flu-like symptoms. Painful mouth sores appear a couple of days after the onset of fever, most often in the back of the throat. Skin rash commonly occurs on the hands, soles of the feet, and around the mouth, but can be anywhere on the body. The rash can be flat, raised or vesicular. Skin lesions are typically not itchy or painful.
Rarely, complications involving the central nervous system such as aseptic meningitis, encephalitis, or polio-like paralysis, may occur, especially with enterovirus 71, which has a significantly higher mortality rate.
Diagnosis is usually made based on symptoms. Antibody or PCR tests may be used to differentiate between coxsackievirus and enterovirus 71.
Hand, foot and mouth disease is usually mild and resolves on its own within 7 to 10 days. Treatment is supportive and includes pain and fever reducers, hydration, oral hygiene and a soft diet. Antiviral drugs may be used to treat infections by EV-71.