Can hand, foot, and mouth disease (HFMD) occur in adults?

Hand, Foot, and Mouth Disease in Adults

Yes, hand, foot, and mouth disease (HFMD) can definitely occur in adults, although it is less common than in children and often presents with some atypical features. 1, 2

Epidemiology in Adults

• HFMD predominantly affects children under 5 years of age, but cases in adults are increasingly being reported 3
• Adult HFMD may be underdiagnosed or misdiagnosed due to its relative rarity in this population 4
• Having a child recently diagnosed with HFMD is a significant risk factor for adults developing the disease 4
• Close contact with HFMD patients and poor personal hygiene are risk factors for adult HFMD 2

Clinical Presentation in Adults

• Adults may present with the classic triad of oral lesions and rashes on hands and feet, similar to children 1
• Atypical presentations are more common in adults, including:
  • Vesiculobullous exanthema on the trunk or extremities 5
  • Perioral zone involvement 5
  • More widespread exanthema beyond the classic distribution 2
• Fever is a common constitutional symptom in adult HFMD patients 1
• The disease typically follows a benign and self-limiting course in immunocompetent adults 5

Causative Agents

• Enterovirus 71 (EV-A71) is a primary cause of HFMD and is associated with more severe outbreaks, especially in Asia 1, 6
• Coxsackievirus A6 has been increasingly identified in adult HFMD cases and is often associated with atypical presentations 5
• EV71 subgenotype C4a has been identified as the most common pathogen in some adult HFMD populations 2

Transmission and Contagious Period

• The virus spreads through direct contact with respiratory secretions, saliva, or fluid from blisters 6
• The contagious period begins 1-2 days before symptoms appear and continues until all blisters have dried and crusted over (generally 7-10 days from symptom onset) 6
• Viral shedding can continue in stool for several weeks after symptoms resolve 6
• Adults may act as the main infectious source for trans-regional spread of HFMD 4

Complications

• While most adult cases are mild, severe complications can occur, including:
  • Neurological manifestations such as encephalitis/meningitis 1, 7
  • Acute flaccid myelitis (AFM) 1
  • Acute flaccid paralysis (AFP) 1
  • Cardiopulmonary complications (rare) 3
• Severe complications are more commonly associated with EV-A71 infections 7

Diagnosis

• Clinical diagnosis based on characteristic lesions, especially in the context of known exposure or outbreak 1
• Laboratory confirmation can be achieved through:
  • Reverse transcriptase PCR (RT-PCR) of vesicle fluid samples (ideal specimen) 1
  • Testing of respiratory samples or stool specimens 1
  • Virus isolation assay for confirmation 2

Prevention and Management

• Practice thorough handwashing with soap and water (more effective than alcohol-based sanitizers) 1, 6
• Avoid close contact with others during the contagious period (at least 10-14 days) 6
• Treatment is primarily supportive:
  • Oral analgesics such as acetaminophen or NSAIDs for pain and fever 1
  • Mild toothpaste and gentle oral hygiene for oral lesions 1
  • Moisturizing creams, particularly urea-containing products, for skin lesions 1
• Adults should avoid returning to work until fever has resolved and mouth sores have healed 1, 6

Important Considerations

• Adults may be subclinical carriers or misdiagnosed patients who can serve as latent infectious sources 4
• Environmental cleaning is crucial as enteroviruses can remain viable on surfaces for up to 28 days 6
• The geographic and gender distribution of adult HFMD may differ from that of childhood HFMD 2
• Keeping pets has been identified as a potential protective factor against HFMD in some studies 4