Can hand, foot, and mouth disease (HFMD) cause severe throat pain and mouth blisters?

Hand, Foot, and Mouth Disease: Severe Throat Pain and Mouth Blisters

Yes, hand, foot, and mouth disease (HFMD) commonly causes severe throat pain and mouth blisters as hallmark features of the illness. These oral manifestations are typically among the first symptoms to appear and can significantly impact eating and drinking. 1, 2

Clinical Presentation of Oral Involvement

Fever and sore throat are the initial symptoms of HFMD, appearing after an incubation period of 3-10 days. 2 The oral manifestations include:

• Painful vesicular eruptions and erosions in the oral cavity that develop a few days after fever onset 2, 3
• Severe throat pain that can compromise drinking and eating 1
• Mouth sores that typically involve the tongue, palate, and buccal mucosa 1

The oral lesions are characterized by maculopapular or vesicular eruptions that can be quite painful, particularly in young children. 2 Constitutional symptoms like fever are common and accompany the oral findings. 4

Severity and Distribution

The severity of oral involvement in HFMD varies but can be substantial:

• Oral mucosa is the first site of involvement in the majority of cases 4
• The disease may remain confined to mucosal surfaces or extend to involve the skin 4
• Widespread exanthema beyond the classic distribution occurs in many cases, with 87.6% of confirmed cases showing skin lesions on sites other than hands, feet, and mouth 3

Diagnostic Confirmation

When HFMD is suspected based on oral lesions and throat pain:

• Vesicle fluid samples have high viral loads and are ideal for testing using reverse transcriptase PCR (RT-PCR) 1
• Respiratory samples and/or stool specimens can also be used for diagnosis 4, 1
• Multiple samples from different sites should be collected when possible 4

Management of Oral Symptoms

Supportive care is the mainstay of treatment for oral manifestations:

• Oral analgesics such as acetaminophen or NSAIDs for pain relief and fever reduction 1
• Apply white soft paraffin ointment to the lips every 2 hours to prevent drying and cracking 1
• Benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating, to reduce inflammation and pain 1
• Clean the mouth daily with warm saline mouthwashes or use an oral sponge for comfort 1
• Chlorhexidine oral rinse twice daily as an antiseptic measure 1

Common Pitfalls

• Diagnostic delay is very common when HFMD is confined to the oral mucosa 4, so maintain high clinical suspicion in children with severe oral pain and vesicular lesions
• Do not dismiss the diagnosis in adults, as intra-familial transmission from children to immunocompetent adults can occur 5
• Avoid acidic, spicy, hot, or crusty foods that can exacerbate oral pain 4
• Ensure adequate hydration, as severe oral pain may prevent adequate fluid intake 1

Severe Complications to Monitor

While most cases are self-limiting, be alert for:

• Neurological complications such as encephalitis/meningitis, particularly with Enterovirus 71 1, 2
• Severe respiratory symptoms including pulmonary edema in progressive cases 2
• Inability to maintain oral intake requiring intravenous fluids 1