This document discusses hand, foot and mouth disease (HFMD), caused most commonly by coxsackievirus A16 and enterovirus 71. It presents the typical symptoms, which include fever followed by painful sores in the mouth and a rash on the hands, feet and buttocks. HFMD is moderately contagious through direct contact with saliva, blister fluid or stool. While most cases are mild and resolve within a week, infection with enterovirus 71 can potentially cause neurological complications such as meningitis or encephalitis. Diagnosis is usually made based on symptoms and appearance of the rash and sores.

1. Charlotte Saldanha, MD
Eric Jake C. Lim

3. Herpangina
Enterovirus
OTHERS:
Herpes simplex, Lyme Disease, Pharyngitis (viral)

4.  Acute febrile illness, associated
with small vesicular or ulcerative
lesions on the posterior
oropharyngeal structures
(enanthem).

5. RULE-IN
 Fever
 Sore throat and pain upon swallowing
 Anorexia
 Emesis
 Abdominal pain
 Maculopapular rash

6. RULE-OUT
 Cannot totally rule-out

7.  Ubiquitous viruses transmitted form
person-to-person via direct contact
with virus shed from the GIT or URT
 3 Genera
 Poliovirus
 Coxsackievirus (Groups A & B)
 Echoviruses

8. RULE-IN
 Disease of children < 10 y/o
 Most common is CAV-16
 Incubation: 3-6 days
 Prodromal: fever, cough, sore throat,
malaise and anorexia.
 Prodrome lasts 12-36 hours then
vesicular eruptions of hands, feet and
oral cavity

9. Prepared by: Eric Jake C. Lim  Pediatric Department DMSF

10.  HFM 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.

11. The lower lip has an ulcer with an
erythematous halo.

12. The tongue has an ulcer with an erythematous
halo.

13. 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.

15.  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.

16.  Individual cases and outbreaks of
HFMD occur worldwide, more
frequently in summer and early
autumn (in temperate countries).

17.  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.

18. HFMD caused by coxsackie virus
A16 infection
is a mild disease and
nearly all patients recover within 7
to 10 days.
Complications are uncommon.

19. HFMD caused by Enterovirus
EV71 may be associated with
neurological complications such
as aseptic
meningitis and
encephalitis.

20. Cases of fatal encephalitis which
occurred during outbreaks of
HFMD in Malaysia in 1997 and in
Taiwan in 1998 were caused by
EV71.

21. Yes, HFMD is moderately
contagious.
A person is most contagious
during the first week of the
illness.

22.  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.

23. 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.

24. 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.

25. 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.

26. They begin as small red
spots that blister and then
often become ulcers.

27.  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.

28. A person with HFMD may have
only the rash or the mouth
ulcers.

29. BLISTER ONTHE PALM OFTHE
HAND

30. BLISTER ONTHE DORSUM OFTHE
FEET

31. BLISTERTHEN BECOMES ULCER
ONTHE INNER GUM

32. BLISTER ONTHE SOLES OFTHE
FEET

33. 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.

34.  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.

35.  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.