How to manage an adult patient with Hand, Foot, and Mouth Disease (HFMD)?

Management of Adult Patients with Hand, Foot, and Mouth Disease (HFMD)

Adult HFMD should be managed with supportive care focused on hydration and pain relief using acetaminophen or ibuprofen, as the disease is typically self-limited and resolves within 7-10 days without specific antiviral therapy. 1

Initial Clinical Assessment

When evaluating an adult with suspected HFMD, look specifically for:

• Contact history with HFMD patients (children are common sources) 2
• Classic triad: Low-grade fever, painful oral ulcerations, and maculopapular or papulovesicular rash on palms and soles 1, 3
• Atypical presentations in adults may include vesicles on hands, nasopharynx, and buttocks, which can be subtle or unobvious 2, 3
• Neurological symptoms including impaired consciousness, ptosis, limb weakness, or decreased muscle power—these are red flags for severe complications 2, 4

Diagnostic Workup

For Uncomplicated Cases

• Clinical diagnosis is sufficient based on characteristic presentation 1, 3
• No laboratory confirmation is required for typical presentations 1

For Severe or Complicated Cases

• RT-PCR testing of throat swabs, skin lesion swabs, anal swabs, and cerebrospinal fluid to confirm enterovirus (particularly EV-71) 2
• Brain and spinal cord MRI if neurological symptoms are present to assess for encephalomyelitis 2
• Cerebrospinal fluid analysis if central nervous system involvement is suspected 2

Treatment Algorithm

Uncomplicated HFMD (Majority of Adult Cases)

Supportive care is the cornerstone of management:

• Pain management: Acetaminophen or ibuprofen for fever and oral pain 1
• Hydration: Aggressive oral fluid intake to prevent dehydration from painful oral lesions 1
• Avoid oral lidocaine: Not recommended due to lack of evidence and potential risks 1
• Expected course: Lesions resolve in 7-10 days 1, 3

Severe HFMD with Neurological Complications

Intravenous immunoglobulin (IVIG) should be administered promptly:

• Single dose of IVIG for confirmed encephalomyelitis or severe neurological involvement 2
• IVIG has been shown to reduce fever, accelerate resolution of skin lesions, and shorten recovery time 2
• Hospitalization is required for monitoring cardiopulmonary and neurological status 4

Critical Red Flags Requiring Immediate Escalation

Watch for these potentially fatal complications that require urgent intervention:

• Neurological: Altered consciousness, seizures, focal weakness, cranial nerve palsies, acute flaccid paralysis 2, 4
• Cardiopulmonary: Respiratory distress, pulmonary edema, shock 4
• These complications are associated with EV-71 and can be fatal if not recognized early 4

Infection Control and Prevention

• Handwashing is the most effective prevention method 1
• Disinfection of potentially contaminated surfaces and fomites 1
• Transmission routes: Fecal-oral, oral-oral, and respiratory droplet contact 1
• Patients remain contagious and should avoid contact with vulnerable populations (young children, immunocompromised) 1

Common Pitfalls to Avoid

• Do not prescribe antiviral medications: No specific antiviral treatment is available or indicated for HFMD 1
• Do not dismiss subtle presentations: Adults may have less obvious skin and mucosal lesions compared to children, but can still develop severe complications 2
• Do not overlook neurological screening: Even mild neurological symptoms warrant further investigation given the risk of encephalomyelitis 2, 4
• Do not use oral lidocaine: Despite its intuitive appeal for oral pain, it is not recommended 1

Follow-Up Considerations

• Neurological sequelae can occur even after apparent recovery, so patients with any neurological involvement during acute illness should have follow-up neurological assessment 4
• Most uncomplicated cases require no specific follow-up beyond symptom resolution 1, 3