Can a patient have both Hand, Foot, and Mouth (HFM) disease and herpangina?

From the Guidelines

Yes, a patient can have both hand, foot, and mouth disease (HFMD) and herpangina simultaneously, as they are both caused by enteroviruses, particularly coxsackieviruses. While HFMD typically presents with vesicular lesions on the hands, feet, and mouth, herpangina specifically causes painful ulcers on the posterior pharynx, soft palate, and tonsillar pillars. These conditions can overlap in a single patient because the same virus can cause both clinical presentations, or a patient might be infected with multiple enterovirus strains simultaneously.

Key Considerations

• The diagnosis of enterovirus infections, including HFMD and herpangina, is crucial for identifying the cause of the illness and for public health purposes, as highlighted in the study by 1.
• Treatment for both conditions is supportive, focusing on pain management with acetaminophen or ibuprofen, maintaining hydration, and using topical oral anesthetics like viscous lidocaine for painful mouth lesions.
• Both conditions are highly contagious through direct contact with saliva, respiratory secretions, and fecal matter, and typically resolve within 7-10 days without specific antiviral therapy, as noted in the study by 1.

Management Approach

• The management approach remains the same regardless of whether one or both conditions are present, with an emphasis on supportive care and prevention of complications.
• It is essential to consider the possibility of co-infection with multiple enterovirus strains, as well as other viral or bacterial pathogens, when diagnosing and managing patients with HFMD and herpangina.
• The study by 1 recommends testing for both HRV and EV, and considering cross-reactivity of PCR used, which is essential for accurate diagnosis and management.

From the Research

Clinical Presentation of HFM Disease and Herpangina

• HFM disease is characterized by a low-grade fever, a maculopapular or papulovesicular rash on the hands and soles of the feet, and painful oral ulcerations 2.
• Herpangina (HA) is frequently associated with clinical signs of HFM, with the predominant clinical presentation being HA (63.8%) and this was frequently associated with clinical signs of HFM (48%) 3.

Co-Occurrence of HFM Disease and Herpangina

• A study found that an enterovirus infection was diagnosed in 143 (64.4%) patients and serotype identification was achieved in 141/143 (98.6%), with the predominant serotypes being coxsackievirus A10 (39.9%) and A6 (28%) 3.
• The study suggests that patients can have both HFM disease and herpangina, as the clinical presentation of HA was frequently associated with clinical signs of HFM 3.

Prevention and Management

• Hand-washing and disinfecting potentially contaminated surfaces and fomites are the best methods to prevent the spread of HFM disease 2, 4.
• Treatment for HFM disease is supportive and directed toward hydration and pain relief as needed with acetaminophen or ibuprofen 2.
• Vaccines able to confer protection against the most common aetiologic agents in a given country have been developed, but simultaneous circulation of more than one causative virus and modification of the molecular epidemiology of infectious agents make preparations based on a single agent relatively inadequate 5.