Hand, Foot, and Mouth Disease Can Cause Diarrhea
Yes, hand, foot, and mouth disease (HFMD) can cause diarrhea as one of its symptoms, though it is not among the primary defining characteristics of the disease.
Clinical Presentation of HFMD
HFMD is a viral illness primarily caused by enteroviruses and coxsackieviruses with the following typical presentation:
- Low-grade fever
- Maculopapular or papulovesicular rash on hands and feet
- Painful oral ulcerations/vesicles
- Symptoms typically resolve in 7-10 days 1
Common Gastrointestinal Symptoms
While the hallmark symptoms involve the characteristic rash and oral lesions, gastrointestinal symptoms can occur:
- Nausea and vomiting are frequently reported, especially early in the disease course 2
- Diarrhea may occasionally occur 2
- Abdominal pain may be present, particularly in children 2
Transmission and Prevention
HFMD is highly contagious and spreads through:
- Fecal-oral route
- Oral-oral route
- Respiratory droplets 1
The presence of diarrhea can increase the risk of transmission through the fecal-oral route, making proper hygiene especially important.
Prevention Measures
To prevent spread of HFMD, especially when diarrhea is present:
- Hand hygiene should be performed after using the toilet, changing diapers, before and after preparing food, and before eating 2
- Infection control measures including gloves and gowns should be used when caring for people with diarrhea 2
- Ill people with diarrhea should avoid swimming, water-related activities, and sexual contact with others 2
- Surfaces contaminated by feces or vomitus should be promptly cleaned and disinfected 2
Management of HFMD with Diarrhea
Treatment is primarily supportive:
- Focus on hydration and pain relief with acetaminophen or ibuprofen as needed 1
- Antimotility drugs (e.g., loperamide) should not be given to children <18 years of age with acute diarrhea 2
- Antinausea and antiemetic medications (e.g., ondansetron) may be considered for children >4 years with vomiting to facilitate oral rehydration 2
- Probiotic preparations may be offered to reduce symptom severity and duration 2
Special Considerations
High-Risk Groups
Healthcare providers should direct educational efforts particularly toward:
- Parents of young children
- People with immune deficiencies
- Elderly individuals
- Pregnant women 2
These groups have increased risk of complications from diarrheal disease.
Warning Signs of Severe Disease
While most cases of HFMD resolve without complications, clinicians should monitor for:
- Persistent high fever
- Neurological symptoms (seizures, altered mental status)
- Worsening respiratory rate and rhythm
- Signs of dehydration from diarrhea and decreased oral intake 3
In rare cases, HFMD can lead to serious neurological or cardiopulmonary complications 4, 5.
Conclusion
While not the defining feature of HFMD, diarrhea can occur as part of the symptom complex. The disease is primarily managed with supportive care, with special attention to hydration when diarrhea is present. Proper hygiene and infection control measures are essential to prevent spread, particularly when gastrointestinal symptoms are present.