a.. Pediatric Database (PEDBASE)
b.. Discipline: DER
c.. Last Updated: 12/24/94
HAND-FOOT-AND-MOUTH DISEASE
DEFINITION:
A viral infection of the skin and oral mucosa characterized by vesicular eruptions
restricted to the hands and feet and in the mouth.
EPIDEMIOLOGY:
a.. incidence: common
b.. age of onset:
a.. any but usually in young children
c.. risk factors:
a.. summer and fall in small epidemics
PATHOPHYSIOLOGY:
1. Background
a.. first described in 1957
b.. etiological agents
a.. major - coxsackievirus A16, A5, and A10
b.. minor - enterovirus 71
c.. route of transmission
a.. ? direct person to person transmission
d.. incubation period
a.. 4-6 days
e.. clinical expression rate
a.. young children (100%)
b.. school-aged children (38%)
c.. adults (11%)
CLINICAL FEATURES:
1. Systemic Manifestations
a.. low-grade fever
b.. adenopathy
2. Cutaneous Manifestations
1. Hands and Feet
a.. hands more commonly involved than the feet
b.. dorsal surfaces more commonly involved than the palmar surfaces (often
interdigital)
c.. initially maculopapular lesions which form into grey-white vesicles on a
normal or erythematous base
d.. vesicles are from 3-7 mm in size and painless
e.. a maculopapular rash commonly appears on the buttock but rarely goes on to
form vesicles
2. Intraortal Lesions
a.. tongue and buccal mucosa most frequently involved with the palate, gums, and
lips less frequently involved
b.. - vesicles may go on to ulcerate
c.. vesicles are from 4-8 mm in size
3. Complications
1. Neurological Manifestations
a.. aseptic meningitis
b.. encephalitis
c.. paralytic disease
INVESTIGATIONS:
1. Serum
a.. CBC - leukocytosis
MANAGEMENT:
1. Supportive
a.. tylenol 15 mg/kg po q4h for fever
2. Prognosis
a.. self-limited and vesicles disappear after 1 week
