What is the treatment for hand, foot, and mouth disease (HFMD) caused by Coxsackievirus?

Treatment of Hand, Foot, and Mouth Disease (HFMD)

Treatment for hand, foot, and mouth disease is primarily supportive care focused on symptom management, as there is no specific antiviral therapy available for this self-limiting viral illness. 1

Disease Overview

• HFMD is a common viral illness caused by enteroviruses, primarily coxsackieviruses (most commonly coxsackievirus A16) and enterovirus 71 1, 2
• In recent years, coxsackievirus A6 has emerged as a major cause of outbreaks in the United States and worldwide, often causing more severe disease with unique clinical manifestations 3
• The disease predominantly affects children under 5 years of age but can also affect adults, particularly when caused by coxsackievirus A6 3
• Transmission occurs through fecal-oral, oral-oral, and respiratory droplet contact 1
• Outbreaks typically occur during spring to fall months in North America 1

Clinical Presentation

• Low-grade fever is often the initial symptom 1
• Characteristic maculopapular or papulovesicular rash on the hands and soles of the feet 1
• Painful oral ulcerations that can affect eating and drinking 1
• Lesions typically resolve in 7-10 days without scarring 1, 3
• Coxsackievirus A6 infections may present with more severe manifestations:
  • Higher fever and longer duration of illness 3
  • More extensive skin involvement beyond the typical distribution 3
  • Nail dystrophies (e.g., Beau's lines or nail shedding) may occur weeks after initial symptoms 2

Diagnosis

• Diagnosis is primarily clinical, based on the characteristic distribution of lesions 1
• For atypical or severe cases, laboratory confirmation may be helpful:
  • Vesicle fluid samples have high viral loads and are ideal for testing 4
  • Respiratory samples and/or stool specimens can also be used 4
  • Reverse transcriptase PCR (RT-PCR) targeting the 5′ non-coding region is the preferred diagnostic method due to its sensitivity and specificity 4

Treatment Recommendations

Supportive Care

• Ensure adequate hydration: Painful oral lesions may decrease oral intake, so encourage fluid intake and offer cold, soft foods that are easy to swallow 1
• Pain management:
  • Acetaminophen or ibuprofen for fever and pain relief 1
  • Avoid oral lidocaine solutions as they are not recommended 1

Important Considerations

• No specific antiviral treatment is available for HFMD 1
• Severe complications are rare but can include:
  • Neurologic complications (e.g., aseptic meningitis, encephalitis)
  • Cardiopulmonary complications
  • Acute kidney injury (particularly with enterovirus A71 infections) 5
• Monitor for signs of dehydration, especially in young children with painful oral lesions 1

Prevention Measures

• Hand hygiene is the most important preventive measure:
  • Thorough handwashing with soap and water, especially after diaper changes, using the toilet, and before preparing or eating food 4
  • Alcohol-based hand sanitizers may not be as effective against enteroviruses as handwashing with soap and water 4
• Environmental cleaning:
  • Disinfect potentially contaminated surfaces and fomites 1
  • Pay particular attention to toys and objects that may be placed in children's mouths 4
• Isolation precautions:
  • Children with HFMD should avoid close contact with others until fever resolves and mouth sores heal 4
  • In healthcare settings, standard precautions and good hand hygiene practices should be followed 4

Special Populations

• Adults with HFMD: May experience more severe and atypical presentations, especially with coxsackievirus A6 infections 3, 6
• Immunocompromised patients: May experience more severe disease and should be monitored closely 4

When to Seek Medical Attention

• Persistent high fever (>101°F or 38.3°C) 1
• Signs of dehydration (dry mouth, decreased urination, lethargy) 1
• Neurological symptoms (headache, stiff neck, irritability, altered consciousness) 1
• Respiratory distress or rapid breathing 1

By following these supportive care measures and preventive strategies, most patients with HFMD will recover completely within 7-10 days without complications.