What are the diagnosis and treatment options for hand, foot, and mouth disease (HFMD)?

Diagnosis and Management of Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease (HFMD) is a highly contagious viral illness that is typically self-limiting and can be diagnosed clinically by its characteristic presentation of fever followed by vesicular rashes on hands, feet, and oral mucosa. 1, 2

Clinical Presentation and Diagnosis

• HFMD primarily affects children under 5 years of age but can occasionally affect adults 2, 3
• The disease typically begins with fever, sore throat, and malaise, followed by development of characteristic lesions 1-2 days later 1, 2
• Diagnostic features include:
  • Maculopapular or vesicular eruptions on palms of hands and soles of feet 2
  • Oral ulcers/sores (often painful) 1
  • Lesions may also appear on buttocks and occasionally spread beyond these classic distributions 1
• Laboratory confirmation is not routinely required but can be achieved through:
  • Reverse transcriptase PCR (RT-PCR) of vesicle fluid samples (preferred specimen due to high viral loads) 1
  • RT-PCR of respiratory samples or stool specimens as alternatives 1

Causative Agents

• Multiple enteroviruses can cause HFMD, including:
  • Coxsackievirus A16 (traditionally most common in US) 4
  • Enterovirus 71 (associated with more severe outbreaks, especially in Asia) 1, 2
  • Coxsackievirus A6 (increasingly common cause with potentially more severe presentations) 1, 4
  • Coxsackievirus A10 5

Treatment

Treatment of HFMD is primarily supportive as the disease is usually self-limiting with symptoms resolving within 7-10 days. 1, 6

Supportive Care Measures

• Oral analgesics such as acetaminophen or NSAIDs for pain relief and fever reduction 1
• Adequate hydration, especially if oral lesions make drinking painful 1
• For oral lesions:
  • Mild toothpaste and gentle oral hygiene 1
  • Cold liquids, ice chips, or popsicles to soothe mouth pain 1
  • Avoiding spicy, acidic, or hot foods that may irritate oral lesions 1
• For skin manifestations:
  • Moisturizing creams (particularly urea-containing products) for hands and feet 1
  • Avoiding friction and heat exposure to affected areas 1

Management of Complications

• Most cases resolve without complications 2, 6
• Monitor for rare but serious complications, particularly with EV-71 infections:
  • Neurological complications (encephalitis, meningitis, acute flaccid myelitis) 1
  • Respiratory complications (pulmonary edema) 2
• Severe cases may require hospitalization for supportive care 2
• Treatment of any secondary bacterial infections that may develop 1

Prevention and Control

• Hand hygiene is the most important preventive measure:
  • Thorough handwashing with soap and water (more effective than alcohol-based sanitizers) 1
  • Particularly after changing diapers, using the toilet, or contact with lesions 1
• Environmental cleaning of toys and objects that may be placed in children's mouths 1
• Avoid sharing utensils, cups, or food 1
• Children with HFMD should avoid close contact with others until:
  • Fever resolves 1
  • Mouth sores heal 1
  • Note: Children may return to daycare once fever has resolved and mouth sores have healed, even if skin rash is still present 1

Special Considerations

• Immunocompromised patients may experience more severe disease and should be monitored closely 1
• Nail dystrophies (including nail shedding) may occur weeks after initial symptoms, particularly with coxsackievirus A6 infections 2, 4
• Outbreaks tend to occur during summer and autumn months in the United States 4