Contents

Search

hand-foot-&-mouth disease

Etiology: - Coxsackievirus A16 (enterovirus 71) - Coxsackievirus A6 [3,6] Epidemiology: 1) summer & fall 2) primarily in children < 10 years of age 3) multiple family members affected 4) enterovirus 71 cause of epidemic deaths (~54 children) in Camdodia 2012 5) also reported in military trainees [6] - case report in an adult [7] Clinical manifestations: 1) tender vesicles, erosions in mouth - can occur in the absence of oral lesions [6] 2) 0.25 cm papules on hands & feet with rim of erythema (erythematous halo) evolving into tender vesicles 3) occurrence of a varicella-like rash or a rash with an atypical distribution may represent an atypical presentation [5] 4) transient fever 5) spontaneous resolution in 100% of those affected in military outbreak [6] 6) case report in adult [7] - lesions on the palms resolved within 2 weeks - lesions on the feet & on the oral mucosa resolved within 8 weeks [7] * images of infection in an adult [7]

Related

hand & foot syndrome; palmar-plantar erythrodysesthesia; acral erythema

General

viral infection stomatitis (includes oral ulceration) exanthem

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 317-18
  2. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 93
  3. Severe Complications of hand, foot and mouth disease (HFMD) caused ny EV-71 in Cambodia - conclusion of joint investigation World Health Organization http://www.who.int/csr/don/2012_07_13/en/index.html
  4. Centers for Disease Control and Prevention Notes from the Field: Severe Hand, Foot, and Mouth Disease Associated with Coxsackievirus A6 - Alabama, Connecticut, California, and Nevada, November 2011-February 2012 MMWR March 30, 2012 / 61(12);213-214 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6112a5.htm
  5. Buttery VW et al Notes from the Field: Atypical Presentations of Hand, Foot, and Mouth Disease Caused by Coxsackievirus A6 - Minnesota, 2014. MMWR Weekly. July 31, 2015 / 64(29);805 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6429a8.htm
  6. Banta J, Lenz B, Pawlak M et al. Notes from the Field: Outbreak of hand, foot, and mouth disease caused by coxsackievirus A6 among basic military trainees - Texas, 2015. MMWR Morb Mortal Wkly Rep 2016 Jul 8; 65:678. http://www.cdc.gov/mmwr/volumes/65/wr/mm6526a3.htm
  7. Murase C, Akiyama M Hand, Foot, and Mouth Disease in an Adult. N Engl J Med 2018; 378:e20. April 5, 2018 PMID: 29617579 http://www.nejm.org/doi/full/10.1056/NEJMicm1713548
  8. A Guide to Clinical Management and Public Health Response for Hand, Foot and Mouth Disease (HFMD) World Health Organization http://www.wpro.who.int/publications/docs/GuidancefortheclinicalmanagementofHFMD.pdf
  9. Centers for Disease Control and Prevention Hand, Foot, and Mouth Disease (HFMD) http://www.cdc.gov/hand-foot-mouth/about/index.html