Hand, Foot, and Mouth Disease and Cough
Yes, cough is associated with hand, foot, and mouth disease (HFMD), particularly as an early respiratory symptom that occurs alongside fever and before the characteristic rash develops. 1
Clinical Presentation of Respiratory Symptoms in HFMD
Respiratory symptoms such as cough and rhinitis may occur, especially in younger children with HFMD. 1 These symptoms typically appear during the initial phase of illness:
- Fever is usually the first symptom, often low-grade but can exceed 102.2°F (39°C) 1
- Cough and rhinitis develop as part of the early symptom complex, occurring before or concurrent with the characteristic vesicular lesions 1
- General malaise and irritability accompany these respiratory symptoms in the prodromal phase 1
Disease Progression Timeline
The typical progression helps contextualize when cough appears:
- Initial symptoms (Days 1-2): Fever, cough, rhinitis, sore throat, malaise 1, 2
- Oral lesions (Days 2-3): Small red spots progress to painful vesicles and ulcers in the mouth 1
- Characteristic rash (Days 3-4): Vesicular eruptions appear on hands and feet 1
- Resolution: Fever subsides within 3-4 days, while oral ulcers may persist 7-10 days 1, 3
Distinguishing HFMD from Other Conditions
The presence of cough in HFMD can create diagnostic confusion with other childhood illnesses:
- Unlike varicella (chickenpox), HFMD lesions concentrate on hands, feet, and mouth rather than being widely distributed 1
- Unlike Kawasaki disease, HFMD presents with vesicular lesions rather than diffuse erythema 1
- The combination of cough, fever, and subsequent vesicular rash in the characteristic distribution should prompt consideration of HFMD 1
Severe Complications Involving Respiratory System
While cough is typically mild and self-limited, clinicians must remain vigilant for severe respiratory complications:
- Respiratory distress may indicate neurogenic pulmonary edema, a rare but serious complication particularly associated with Enterovirus 71 infections 1, 2
- Severe progressive HFMD can present with pulmonary edema requiring mechanical ventilation 2
- Warning signs requiring immediate evaluation include persistent high fever, lethargy, severe headache, stiff neck, or unusual irritability 1
Clinical Implications
The American Academy of Pediatrics recommends considering HFMD in the differential diagnosis of infants and toddlers presenting with fever, malaise, irritability, and respiratory symptoms like cough, followed by development of characteristic vesicular lesions. 1 The presence of cough does not exclude HFMD and should be recognized as part of the typical clinical presentation, particularly in younger children during the early disease phase.