HAND, FOOT AND MOUTH DISEASE (HFM)

HAND, FOOT & MOUTH DISEASE (HFMD)Charlotte Saldanha, MDEric Jake C. LimDIFFERENTIAL DIAGNOSISDIFFERENTIAL DIAGNOSISHerpanginaEnterovirusOTHERS:Herpes simplex, Lyme Disease, Pharyngitis (viral) HERPANGINAAcute febrile illness, associated with small vesicular or ulcerative lesions on the posterior oropharyngeal structures (enanthem).HERPANGINARULE-INFever Sore throat and pain upon swallowing AnorexiaEmesisAbdominal painMaculopapular rash

HERPANGINARULE-outCannot totally rule-out

ENTEROVIRUSUbiquitous viruses transmitted form person-to-person via direct contact with virus shed from the GIT or URT3 GeneraPoliovirusCoxsackievirus (Groups A & B)EchovirusesENTEROVIRUSRULE-INDisease of children < 10 y/oMost common is CAV-16Incubation: 3-6 daysProdromal: fever, cough, sore throat, malaise and anorexia.Prodrome lasts 12-36 hours then vesicular eruptions of hands, feet and oral cavity

HAND FOOT MOUTH DISEASEPrepared by: Eric Jake C. Lim Pediatric Department DMSF

HAND FOOT MOUTH DISEASEHFM Disease is a viral syndrome with a distinct exanthem enanthem.

This clearly recognizable syndrome is characterized by enanthem (vesicular lesions on the mouth) and an exanthem (on the hands and feet and buttocks) in association with fever.HAND FOOT MOUTH DISEASE

The lower lip has an ulcer with an erythematous halo. HAND FOOT MOUTH DISEASE

The tongue has an ulcer with an erythematous halo. HAND FOOT MOUTH DISEASE

A typical cutaneous lesion has an elliptical vesicle surrounded by an erythematous halo. The long axis of the lesion is oriented along the skin lines. HAND FOOT MOUTH DISEASE

WHAT CAUSES HFMD?The most common causes of Hand, Foot and Mouth disease are coxsackie virus A16, enterovirus 71 (EV71)The enterovirus group includes polioviruses, coxsackieviruses, echoviruses and other enteroviruses. WHEN AND WHERE DOES HFMD OCCUR?Individual cases and outbreaks of HFMD occur worldwide, more frequently in summer and early autumn (in temperate countries). WHEN AND WHERE DOES HFMD OCCUR?In the recent past, major outbreaks of HFMD attributable to enterovirus EV71 have been reported in Malaysia in 1997 and in Taiwan in 1998. HFMD is endemic in Malaysia and occurs every year. IS HFMD SERIOUS?HFMD caused by coxsackie virus A16 infection is a mild disease and nearly all patients recover within 7 to 10 days. Complications are uncommon.

IS HFMD SERIOUS?HFMD caused by Enterovirus EV71 may be associated with neurological complications such as asepticmeningitis and encephalitis. IS HFMD SERIOUS?Cases of fatal encephalitis which occurred during outbreaks of HFMD in Malaysia in 1997 and in Taiwan in 1998 were caused by EV71. IS HFMD CONTAGIOUS?Yes, HFMD is moderately contagious. A person is most contagious during the first week of the illness. IS HFMD CONTAGIOUS?The virus can be transmitted from person to person via direct contact with nose and throat discharges, saliva, fluid from blisters, or the stool of infected persons. IS HFMD CONTAGIOUS?The virus may continue to be excreted in the stools of infected persons up till 1 month. HFMD is not transmitted to or from pets or other animals. HOW SOON WILL SOMEONE BECOME ILL AFTER GETTING INFECTED?The usual period from infection to onset of symptoms (incubation period) is 3 to 7 days. Fever is often the first symptom of HFMD followed by blister/rash. WHAT ARE THE CLINICAL SIGNS AND SYMPTOMS?HFMD begins with a mild fever, poor appetite, malaise ("feeling sick"), and frequently a sore throat. One or 2 days after the fever begins, painful sores develop in the mouth. WHAT ARE THE CLINICAL SIGNS AND SYMPTOMS?They begin as small red spots that blister and then often become ulcers. WHAT ARE THE CLINICAL SIGNS AND SYMPTOMS?They are usually located on the tongue, gums, and inside of the cheeks. The skin rash develops over 1 to 2 days with flat or raised red spots, some with blisters on the palms of the hand and the soles of the feet. WHAT ARE THE CLINICAL SIGNS AND SYMPTOMS?A person with HFMD may have only the rash or the mouth ulcers.

BLISTER ON THE PALM OF THE HAND

BLISTER ON THE DORSUM OF THE FEET

BLISTER THEN BECOMES ULCER ON THE INNER GUM

BLISTER ON THE SOLES OF THE FEETHOW FOOT, HAND & MOUTH DISEASE DIAGNOSED?Based on a complete history and physical examination of your child. It is generally suspected on the appearance of blister-like rash on hands, feet and mouth in children with a mild febrile illness.HOW FOOT, HAND & MOUTH DISEASE DIAGNOSED?Usually, the doctor can distinguish between HFMD and other causes of mouth sores based on the age of the patient, the pattern of symptoms reported by the patient or parent, and the appearance of the rash and sores on examination. HOW FOOT, HAND & MOUTH DISEASE DIAGNOSED?A throat and/or blister swab collected preferably within 2 days of onset of HFMD may be sent to a laboratory to determine which enterovirus caused the illness. COMMON PITFALLS IN HFMD