Can a 35-Year-Old Male Get Hand, Foot, and Mouth Disease?
Yes, a 35-year-old male can absolutely contract hand, foot, and mouth disease (HFMD), though it occurs much less commonly in adults than in children. 1, 2, 3
Epidemiology in Adults
HFMD predominantly affects children under 10 years of age, with most cases occurring in those younger than 5 years, but adults are not immune to infection. 1, 4
Multiple documented cases exist of HFMD in immunocompetent adults at age 35, confirming that this exact age group can develop the disease. 2, 3
Adults typically acquire HFMD through exposure to infected children or contaminated surfaces, with transmission occurring via fecal-oral, oral-oral, and respiratory droplet routes. 1
Clinical Presentation in Adults
Adults often present with atypical features compared to the classic pediatric presentation:
Fever is usually the first symptom, which may be low-grade but can exceed 102.2°F (39°C), accompanied by malaise, sore throat, and general discomfort. 5
The characteristic rash begins as small pink macules that evolve to vesicular lesions on the palms, soles, and oral mucosa, though adults may have more widespread distribution involving the legs, scalp, and shins. 5, 6
Oral lesions present as painful aphthous ulcerations that can cause significant odynophagia (painful swallowing). 2
Polyarthralgia affecting the knees and hands has been reported in adult cases, which is less common in pediatric presentations. 2
Important Considerations for Adult Cases
Immunocompetent adults can develop HFMD without any underlying immune deficiency, though the disease is more frequently recognized in immunocompromised individuals. 3
Complications can be more severe in adults:
Acute myocarditis has been documented as a serious complication occurring approximately 3 weeks after initial presentation in a 35-year-old male. 2
Neurological complications including encephalitis, meningitis, acute flaccid myelitis, and acute flaccid paralysis are potential severe outcomes, particularly with enterovirus 71 (EV-A71). 7
Causative Agents
Coxsackievirus A16 has historically been the most common cause in the United States, but coxsackievirus A6 and A9 are increasingly recognized in adult cases. 1, 2, 4
Enterovirus 71 (EV-A71) is associated with more severe outbreaks, especially in Asia. 7
Diagnostic Approach
When evaluating a 35-year-old male with suspected HFMD:
Look for the characteristic triad: vesicular lesions on hands and feet, oral ulcerations, and fever (though fever may be absent in mild cases). 1
Reverse transcriptase PCR (RT-PCR) of vesicle fluid provides the highest diagnostic yield, as vesicle fluid has high viral loads. 7
Respiratory samples or stool specimens can also be tested when vesicle fluid is unavailable. 7
Distinguish from herpes simplex virus, as HSV has available antiviral treatment options whereas HFMD does not. 7
Management
Treatment is entirely supportive:
Oral analgesics such as acetaminophen or NSAIDs should be used for pain relief and fever reduction. 7
For oral lesions: Apply white soft paraffin ointment to lips every 2 hours, use warm saline mouthwashes, and consider benzydamine hydrochloride oral rinse or spray every 3 hours before eating. 7
For skin lesions: Apply intensive moisturizing creams (particularly urea-containing products) to hands and feet, and avoid friction and heat exposure. 7
Zinc oxide can be applied as a protective barrier to soothe inflamed areas and reduce itchiness. 7
No antiviral treatment is available for HFMD, unlike herpes simplex virus infections. 7, 1
Prevention and Transmission Risk
Handwashing with soap and water is more effective than alcohol-based sanitizers for preventing HFMD transmission. 7
The patient should avoid close contact with others until fever resolves and mouth sores heal, even if skin lesions persist. 7
Viral shedding can continue for weeks after symptom onset, so the patient may remain contagious even after clinical improvement. 7
Common Pitfalls
Do not dismiss HFMD in adults simply because it is "a childhood disease" – delayed diagnosis can lead to continued transmission and missed complications. 3
Do not use oral lidocaine for pain management, as it is not recommended. 1
Monitor for cardiac and neurological complications, particularly if symptoms worsen or new symptoms develop 2-3 weeks after initial presentation. 2