Dr. Sadman Jawad presented on Hand Foot and Mouth Disease. The disease is most commonly caused by Coxsackie virus A16 and can also be caused by Enterovirus 71. It usually causes a mild illness with low grade fever and a distinctive rash on the hands, feet, and mouth. Complications can include herpangina, respiratory issues, eye problems, and neurological or cardiac manifestations. Diagnosis is usually clinical. Treatment is supportive with rest, fluids, and antipyretics. Prevention includes good hygiene and avoiding close contact in settings like child care. The presentation included details on a recent 6-year-old patient admitted to CIMCH with fever, respiratory distress, sore

1. Topic Presentation
(Hand Foot Mouth Disease)
Presented by
Dr. Sadman Jawad
Intern Doctor
Department of Pediatrics, CIMCH

4. Hand Foot and Mouth Disease
• Hand foot and mouth disease one of the distinctive rash syndromes is
most frequently caused by Coxsackie virus A16 sand can also be
caused by Enterovirus 71.
• It is usually a mild illness with or without low grade fever.
• The oropharynx is usually inflamed and contains scattered vescicles
on the tongue, buccal mucosa, posterior pharynx, palate, gingiva and
lips.
• The hands are more commonly involved than the feet.

5. • Coxsackievirus A16 was first identified in 1958 in Canada.
• Enterovirus 71 was discovered much later in 1969 in California from
the stool of an infant who was suffering from non-hand foot mouth
disease encephalitis.

6. Incidence
• The symptomatic case hospitalisation rate of HFMD is 6%
(2.8%–14.9%), of which 18.7% (6.7%–31.5%) are expected to
develop complications. 5% (2.9%–7.4%) of such cases are
fatal, bringing the overall case fatality ratio to be 52.3 (24.4–
92.7) per 100 000 symptomatic infections.

8. Risk Factors
• Age is the main risk factor for hand foot and mouth disease. The
disease mostly affects children younger than ages 5 to 7 years.
• Children in child care settings are very vulnerable because the
infection spreads by person to person contact.
• Older children are thought to have immunity against it because they
often build antibodies after exposure to the viruses that cause the
disease but they still may be affected.

10. Clinical Features
• Fever usually low grade
• Sore throat
• Painful, red, blister like lesion on the tongue, gums and inside the
cheeks.
• Red vesicular rash, without itching but sometimes with blistering on
the palms, soles, buttocks etc.
• Irritability and loss of appetite.

11. Complications
• Herpangina
• Respiratory manifestations- sore throat, coryza,
• Occular manifestations- photophobia, blurred vision, conjunctival
erythema, congestion etc.
• Myocardidtis and pericarditis
• GI manifestations- emesis, diarrhoea, abdominal pain, hematochezia
• Neurologic manifestation- meningitis, encephalitis
• Myositis and arthritis

12. Diagnosis
• Completely clinical diagnosis

13. Some Accepted Tests
• Enzyme linked immunosorbent assay(highly sensitive from 1st week).
• RT-PCR is now considered as the primary modality for enterovirus
serotype identification.

14. Management
• No specific treatment
• Only supportive eg. Paracetamol for fever.
• More fluid intake
• Rest
• Cold milk, ice cream soft diet may soothe the mouth
• Milrirone has been suggested as a useful agent in severe
cardiopulmonary disease
• Immunoglobulin has been utilized to treat enterovirus infections
based on the importance of the humoral immune response to
enterovirus infection.

15. Prevention
• Wash hands often.
• When soap and water are not available use hand sanitizer.
• Teach good hygiene to children.
• Disinfect common areas with diluted solution of chlorine bleach and
water.
• Avoid close contact in child care setting.

16. Differential Diagnosis
• Chicken pox
• Measles

17. Received Cases
• During the past weeks we have received a fair amount of such cases.
• Let us have a look at one of them:

20. Salient Feature
• Ruby Islam, 6 year old, female baby, hailing from Chawkbazar, got
admitted to CIMCH on 15th October , with the complaints of fever for
4 days, respiratory distress for 4 days, sore throat for the same
duration and red blister like lesion on tongue, gums, arm, palms and
buttock.

21. • Fever was of low grade and continuous in nature. There was no
history of evening rise of temperature and night sweat. Highest
recorded temperature was 101F. It was not assocated with chills and
rigor. It decreased by taking antipyretic. On the second day of fever
some rashes were noticed on the baby’s palms, soles and buttock.

22. • There were also some maculopapular, vescicular and pustular lesions.
Patient also complained of sore throat. The patient was irritable and
could not take food due to sore throat. Her bladder and habit are
normal.
• With these complaints she got admitted to CIMCH for further
management.