Infectious Diseases A to Z: Hand, Foot, and Mouth Disease

With this new column, Elite Healthcare will compile an index of various infectious diseases, with occasional highlights of emerging conditions.

Hand, Foot, and Mouth Disease

A disease that is common in infants and children under the age of 5 years due to their lack of immunity, hand, foot, and mouth disease is a contagious condition that is caused by multiple viruses. More commonly contracted in the United States during spring, summer, and fall, the disease is not typically a serious illness, but in rare instances, the infection can lead to the development of viral meningitis and require hospitalization. However, according to the Centers for Disease Control and Prevention (CDC), for almost all patients the condition will subside in 7-10 days without medical intervention. Older children and adults can also be sickened by the disease, and extremely rare conditions that result due to the disease can include polio-like paralysis or encephalitis, which can be fatal, according to the CDC. Fingernail and toenail loss have also been reported complications of the condition and occurs most commonly among children within the first few weeks of contracting the disease. According to CDC officials, it is uncertain whether the loss of one’s nail(s) is a result of the condition. However, in the reports reviewed, the nail loss was temporary, and the nail grew back without medical treatment.1

Generally, the first signs and symptoms include fever, reduced appetite, sore throat, and malaise. Painful sores can then begin to develop in the mouth (herpangina) 1-2 days after the start of fever. These sores typically begin as small, red spots in the back of the mouth. They can then blister and can become painful. Additionally, rashes to the palms of the hands, soles of the feet, knees, elbows, buttocks, and genital area may develop, which may also blister.

Dehydration may also occur, especially in younger children, if they are not able to swallow liquids due to any painful sores in the mouth. Patients and parents should be advised to seek medical care in these cases. The CDC also warns that some people who acquire the infection will be asymptomatic, but can still pass the virus on to others and that most individuals will display only mild illness or none at all.

Causes & Modes of Transmission:

Caused by viruses belonging to the enterovirus genus, which includes polioviruses, coxsackieviruses, echoviruses, and others, several types of enteroviruses may be identified in outbreaks of hand, foot and mouth disease, according to the CDC. Transmission is most likely to occur through contact with an infected person. Traces of the virus can be found in nose and throat secretions, blister fluid and feces. Exposure to the viruses that cause hand, foot, and mouth disease can also occur through the air when an infected person coughs or sneezes contact with feces when changing diapers, and contact with contaminated objects and surfaces, such as doorknobs. Swallowing contaminated recreational water is also a mode of transmission, although not one that is very common, according to the CDC. While some people can and will be contagious for weeks, the disease is most contagious during the first week of illness. The condition is not known to be transmitted to or from pets or other animals, according to the CDC.

Treatment Strategies:

No specific treatment for hand, foot, and mouth disease exists, according to the CDC, however, symptoms can be relieved through the use of over-the-counter medications that help to reduce pain and fever. (Remember that aspirin should not be administered to children.) Mouthwashes and sprays that numb mouth pain can also be utilized, and it is important for patients to drink enough liquids to prevent dehydration. Those who cannot swallow enough liquids to avoid dehydration may need to receive an IV.

Prevention Parameters:

While there is no vaccine in the U.S. that protects against the viruses that cause hand, foot, and mouth disease, research is ongoing, according to the CDC. Healthcare providers should encourage and promote regular hand washing to lessen people’s chances of being sick with this condition. Parents should especially be reminded to wash their hands especially after changing diapers and using the toilet. (The CDC also offers more advice via its Clean Hands Save Lives! resource).2 Frequently touched surfaces should also be cleaned and disinfected often, as well as any soiled items, such as toys. Avoiding close contact, kissing, hugging, and/or sharing of eating utensils and cups with those who have been diagnosed with hand, foot, and mouth disease is also strongly recommended.

References

  1. Hand, foot, and mouth disease (HFMD) complications. CDC. 2019. Accessed online: www.cdc.gov/hand-foot-mouth/about/complications.html
  2. Handwashing: clean hands save lives. CDC. 2019. Accessed online: www.cdc.gov/handwashing

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