Hand, foot, and mouth disease Hand, foot, and mouth disease (HFMD) is caused by viruses, specifically viruses that belong to the Enterovirus family (CDC, 2021). Common causes of hand, foot, and mouth disease are: ● Coxsackievirus A16 is typically the most common cause of hand, foot, and mouth disease in the U.S. Other coxsackieviruses can also cause the illness. ● Coxsackievirus A6 can also cause HFMD, and the symptoms may be more severe. ● Enterovirus 71 (EV-A71) has been associated with cases and outbreaks in East and Southeast Asia. Although rare, EV- A71 has been associated with more severe diseases such as encephalitis (brain swelling). Individuals with HFMD are usually most contagious during their first week of being sick. The virus can sometimes spread to others for days or weeks after symptoms go away (if they have symptoms at all). Hand, foot, and mouth disease is common in children under age 5 years, but anyone can get it. The illness is
usually not serious, but it is very contagious. It spreads quickly at schools and daycare centers. HFMD is common in the U.S. and occurs mostly in the summer and fall, but patients can present with symptoms anytime (CDC, 2021). Symptoms of HFMD are presented in Table 3. Someone infected with one of these viruses is contagious, meaning they can pass the virus to other people. The virus can spread to others through an infected person’s: ● Nose and throat secretions, such as saliva, drool, or nasal mucus ● Fluid from blisters or scabs ● Feces (stool) Because it is common and usually mild, children can continue to go to childcare and schools as long as they: ● Are not febrile ● Have no uncontrolled drooling with mouth sores ● Feel well enough to participate in classroom activities
Table 3. HFMD Symptoms Fever and Flulike Symptoms
Mouth Sores
Skin Rash
Patients also get a skin rash on the palms of the hands and soles of the feet . It can also show up on the buttocks, legs, and arms. The rash is usually not itchy and looks like flat or slightly raised red spots, sometimes with blisters with an area of redness at their base. Fluid in the blister and the resulting scab that forms as the blister heals can contain the virus that causes HFMD. Keep blisters clean and avoid touching them.
Patients often get a fever and other flulike symptoms 3 to 5 days after infection. Symptoms can include: • Fever • Eating or drinking less • Sore throat • Feeling unwell
Patients get painful mouth sores. These sores usually start as small red spots, often on the tongue and insides of the mouth, that blister and can become painful. Signs that swallowing might be painful include: • Not eating or drinking • Drooling more than usual • Only wanting to drink cold fluids Check for sores on the soft palate and pharynx.
(CDC, 2021)
Williams, A. (2007). Scarlet fever 2. https://commons.wikimedia.org/ wiki/File:Scarlet_fever_2.jpg. CC BY-SA 2.5 Treat symptoms and prevent dehydration. Patients should be advised to take over-the-counter medications to relieve fever and the pain caused by mouth sores. Never give aspirin to children. Advise patients to drink plenty of liquids. Mouth sores can make swallowing painful, so patients may not want to drink much. Make sure they drink enough to stay hydrated. Commercial preparations of Pedialyte popsicles alleviate painful sores.
Figure 3: Hand, Foot, and Mouth Disease
Case study #1 Sophia was a busy mother of two young children, Sarah and Jack. They had just started preschool, and Sophia was excited for them to begin their educational journey. However, she soon realized that with preschool came the risk of illness, as both Sarah and Jack were diagnosed with hand, foot, and mouth disease. Sophia immediately took her children to their NP, who confirmed the diagnosis of hand, foot, and mouth disease. The NP explained that the illness typically resolves on its own within a week to 10 days, but there are ways to manage the symptoms and prevent the spread of the virus.
What are appropriate treatment recommendations to provide to Sophia? a. Antibiotics b. Antiviral medication c. Over-the-counter pain relievers d. Topical steroid cream Rationale: The correct answer is c. There is no specific treatment for the illness, but supportive care can help manage symptoms. Over-the-counter pain relievers such as acetaminophen or ibuprofen can help relieve fever and mouth pain. Aspirin should never be given.
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Book Code: AUS3024
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