Can cold symptoms be an indication of the onset of Hand, Foot, and Mouth Disease (HFMD)?

Cold Symptoms as Early Indicators of Hand, Foot, and Mouth Disease (HFMD)

Yes, cold-like symptoms such as fever, cough, and rhinitis are often the initial presentation of Hand, Foot, and Mouth Disease (HFMD) before the characteristic rash appears. 1, 2

Initial Presentation of HFMD

• Fever is typically the first symptom, ranging from low-grade to higher than 102.2°F (39°C), usually appearing 1-2 days before the characteristic rash 1, 2
• Common early symptoms that mimic a cold include:
  • General malaise and discomfort 1
  • Sore throat 1
  • Irritability, especially in young children 1, 2
  • Respiratory symptoms such as cough and rhinitis 1, 2
  • Occasionally gastrointestinal symptoms like nausea, vomiting, and diarrhea 1

Disease Progression After Cold-Like Symptoms

• Oral lesions typically develop first, appearing as small red spots that progress to painful vesicles and ulcers in the mouth (particularly on the tongue, gums, and inside of cheeks) 2
• Characteristic vesicular rash appears 1-2 days after fever onset, typically on hands, feet, and in the mouth 2
• Fever usually subsides within 3-4 days, though oral ulcers may persist for 7-10 days 2

Diagnostic Considerations

• HFMD should be considered in the differential diagnosis when patients (especially children under 5 years) present with cold-like symptoms followed by development of characteristic vesicular lesions 2
• Laboratory confirmation can be achieved through RT-PCR testing of vesicle fluid samples (preferred), respiratory samples, or stool specimens 3
• Unlike common colds, HFMD will progress to develop the characteristic vesicular rash on hands, feet, and in the mouth 4, 5

Important Distinctions from Similar Conditions

• Unlike chickenpox, HFMD vesicles are typically concentrated on hands, feet, and mouth rather than being widely distributed 1
• Unlike Kawasaki disease, HFMD presents with vesicular lesions rather than diffuse erythema and doesn't typically have the persistent high fever characteristic of Kawasaki disease 1, 2

Warning Signs of Complications

• Persistent high fever, lethargy, severe headache, stiff neck, or unusual irritability may indicate potential complications 2
• Neurological complications such as meningitis, encephalitis, and acute flaccid paralysis can occur, particularly with Enterovirus 71 infections 3, 2
• Respiratory distress may indicate rare but serious complications like neurogenic pulmonary edema 2

Prevention and Management

• Hand hygiene is the most important preventive measure, with thorough handwashing with soap and water being more effective than alcohol-based hand sanitizers 3
• Environmental cleaning, particularly of toys and objects that may be placed in children's mouths, is crucial in preventing spread 3
• Supportive care is the mainstay of treatment, including oral analgesics such as acetaminophen or NSAIDs for pain and fever 3
• Mild toothpaste and gentle oral hygiene can help manage oral lesions 3