Can adults contract Hand, Foot, and Mouth Disease (HFMD)?

Can Adults Contract Hand, Foot, and Mouth Disease?

Yes, adults can absolutely contract Hand, Foot, and Mouth Disease (HFMD), though it occurs less frequently than in children. 1, 2, 3

Epidemiology in Adults

• HFMD is not exclusively a childhood disease—immunocompetent adults with intact immune systems can develop the infection, contrary to common misconception. 3
• Adults most commonly acquire HFMD through familial transmission from infected children, with documented cases of child-to-adult transmission within households. 4
• Adults are most infectious during the first week of illness, with viral shedding continuing for up to five days after symptom onset. 1

Clinical Presentation in Adults

Initial Symptoms

• Fever is typically the first symptom (usually low-grade but can exceed 102.2°F/39°C), accompanied by malaise, general discomfort, and sore throat. 1
• The characteristic vesicular rash develops on palms, soles, and oral mucosa, beginning as small pink macules that evolve to vesicular lesions. 1

Atypical Presentations

• Coxsackievirus A6 causes more severe and atypical presentations in adults, with widespread exanthema extending beyond the classic hand-foot-mouth distribution to involve the trunk, legs, and perioral zone. 5, 4
• These atypical cases can mimic serious dermatologic conditions including eczema herpeticum, vasculitis, syphilis, erythema multiforme, and Stevens-Johnson syndrome, making diagnosis challenging. 5

Important Diagnostic Considerations

When to Suspect HFMD in Adults

• History of close contact with an HFMD patient (especially children in the household) is a critical diagnostic clue. 6
• The characteristic distribution on palms and soles distinguishes HFMD from most other viral exanthems. 1
• Diagnosis is primarily clinical based on the characteristic distribution of lesions. 1

Laboratory Confirmation

• RT-PCR of vesicle fluid samples provides the highest diagnostic yield due to high viral loads at this site. 7, 1
• Respiratory samples or stool specimens can also be used when vesicle fluid is unavailable. 7

Complications in Adults

Neurological Complications (Rare but Serious)

• Encephalitis/meningitis, acute flaccid myelitis, and acute flaccid paralysis can occur, particularly with Enterovirus 71 infections. 1, 6
• A 21-year-old woman developed EV-71-induced encephalomyelitis with impaired consciousness, ptosis, and limb weakness, requiring IVIG therapy. 6

High-Risk Populations

• Immunocompromised adults may experience more severe disease and require closer monitoring. 1

Management in Adults

Supportive Care

• Acetaminophen or NSAIDs for pain and fever are the mainstay of treatment for a limited duration. 7, 1
• Gentle oral hygiene with mild toothpaste helps manage oral lesions. 7, 1
• Moisturizing creams (particularly urea-containing products) for hand and foot lesions, avoiding friction and heat exposure. 7, 1
• Zinc oxide may reduce itchiness in skin lesions by forming a protective barrier. 7, 1

For Severe Oral Involvement

• Benzydamine hydrochloride oral rinse or spray every 3 hours (particularly before eating) reduces inflammation and pain. 7
• Chlorhexidine oral rinse twice daily as an antiseptic measure. 7
• Betamethasone sodium phosphate mouthwash four times daily for more severe cases. 7

Return to Normal Activities

• Adults can return to work once fever resolves, mouth sores heal, and no new lesions appear for 48 hours. 1
• Continue strict hand hygiene even after returning to activities, as some viral shedding may persist. 1
• Avoid close contact with others until fever resolves and mouth sores heal. 1

Prevention

• Hand hygiene with soap and water is the most important preventive measure—more effective than alcohol-based sanitizers. 7
• Avoid sharing utensils, cups, or food with infected individuals. 7
• Environmental cleaning of potentially contaminated surfaces is crucial in preventing transmission. 1

Critical Pitfalls to Avoid

• Do not dismiss HFMD in adults based on age alone—delayed diagnosis can lead to continued disease spread, particularly to children. 3
• Do not overlook atypical presentations that may mimic other serious dermatologic conditions, especially with CV-A6 infections. 5
• Do not ignore neurological symptoms (altered consciousness, weakness, ptosis) as these require urgent evaluation and possible IVIG therapy. 6