Can adults get hand, foot, and mouth disease?

Can Adults Get Hand, Foot, and Mouth Disease?

Yes, adults can definitely get hand, foot, and mouth disease (HFMD), though it is less common than in children and may present with atypical symptoms. 1, 2

Epidemiology and Transmission

• HFMD is primarily caused by human enteroviruses, particularly coxsackieviruses, with coxsackievirus A6 emerging as an important causative agent in adults 1
• Transmission occurs through fecal-oral, oral-oral, and respiratory droplet contact 3
• Adults are most infectious during the first week of illness, with viral shedding continuing for up to five days after symptom onset 4
• Close contact with infected individuals, particularly children, is a common source of adult infection 5

Clinical Presentation in Adults

• Adult cases often present with atypical skin manifestations compared to the classic presentation seen in children 1, 2
• Initial symptoms typically include:
  • Fever (usually low-grade but can be higher than 102.2°F/39°C) 6
  • Malaise and general discomfort 6
  • Sore throat 6
• The characteristic rash in adults may include:
  • Maculopapular or papulovesicular lesions on hands and feet 3
  • Lesions on the scalp, shins, and other atypical locations 1
  • Minimal oral lesions (unlike children who often have more pronounced oral involvement) 1

Diagnosis

• Diagnosis is primarily clinical, based on the characteristic distribution of lesions 7
• Laboratory confirmation can be achieved through:
  • Reverse transcriptase PCR (RT-PCR) of vesicle fluid samples, which have high viral loads 7
  • Respiratory samples or stool specimens can also be tested 7
• The differential diagnosis includes:
  • Erythema multiforme, herpes, varicella 3
  • Drug hypersensitivity reactions, infective endocarditis 8
  • Other conditions with palmar/plantar rash such as syphilis and meningococcal infection 6

Complications

• While typically self-limited in adults, rare but serious complications can occur:
  • Neurological complications such as encephalitis/meningitis 7
  • Acute flaccid myelitis or paralysis 7, 5
  • These complications are more commonly associated with Enterovirus 71 infections 5

Management

• Treatment is primarily supportive and focused on symptom relief:
  • Acetaminophen or NSAIDs for pain and fever 7, 3
  • Adequate hydration, especially if oral lesions make eating or drinking painful 3
  • Gentle oral hygiene and mild toothpaste for oral lesions 7
  • Moisturizing creams for skin lesions 7
• Zinc oxide may help reduce itchiness in skin lesions by forming a protective barrier 7
• Antiviral treatment is not available for HFMD 3

Prevention and Infection Control

• Hand hygiene is the most important preventive measure 7, 4
• Environmental cleaning of potentially contaminated surfaces 7
• Adults with HFMD should avoid close contact with others until fever resolves and mouth sores heal 7
• The virus can remain on surfaces and objects, making continued hand hygiene crucial 4

Return to Normal Activities

• Adults can generally return to work or normal activities once:
  • Fever has resolved 7
  • Mouth sores have healed 7
  • No new lesions have appeared for 48 hours 4
• Even after returning to normal activities, continued attention to hand hygiene is important as some viral shedding may continue 4

Important Considerations

• HFMD in adults is often underdiagnosed due to its atypical presentation and the common misconception that it only affects children 1, 2
• Adults with close contact to children with HFMD should be particularly vigilant about hand hygiene to prevent infection 5
• Immunocompromised adults may experience more severe disease and should be monitored closely 7