Diagnosis
Hand-Foot-and-Mouth disease
An acute self-limited viral infection in children (95% of the cases among < 5 years of age) that presents as fever, sore throat, loss of appetite, lethargy, and followed by a vesicular eruption in the mouth, hands, feet, buttocks, and/or genitalia lasting 7-10 days.
Also known as: Enteroviral vesicular stomatitis
Etiology
Cause [vmn]
Coxsackievirus
Pathophysiology [vmn]
Fecal-oral transmission or via contact with skin lesions and oral secretions
Virus replicates in the lower intestine and pharynx lymphoid tissue
Spreads to the regional lymph nodes
Spread to multiple organs, including the central nervous system, heart, liver, and skin
Complications of serious enteroviral infection [vmn]
Dehydration
Aseptic meningitis
Encephalitis
Encephalomyelitis
Acute cerebellar ataxia
Guillain-Barre syndrome
Benign intracranial hypertension
Enteritis
Myocarditis and cardiomyopathy
Pulmonary edema and pneumonia
Pancreatitis
Hemorrhagic conjunctivitis
First trimester spontaneous miscarriage or intrauterine growth restriction
Thrombocytopenia and disseminated intravascular coagulopathy
Hepatitis in the newborn have (rare)
Epidemiology
Incidence per 100.000 [fma][pd8][27h][pz9][r5z]
Symptoms & findings
Symptoms
Fever, Lethargy, Malaise, Onycholysis, Sore throat, Vomiting
Clinical findings
Anamneses
None listed.
Localized findings
Approach
Clinical diagnosis: exanthem involving hands, feet, mouth, genitals and buttocks
Swabs (oral, vesicle, rectal)
Tissue culture
Immunoassay
Serology
PCR
Skin biopsy (blister)
Treatment
HFMD infection is usually mild and complete resolution is seen within 7–10 days. Infection often results in long-term immunity to the specific virus.
Symptomatic care: [qr3]
Pain relief: Paracetamol or ibuprofen
Antiseptic mouthwashes or topical soothing agents (Xylocaine)
Hydration: If oral intake is poor, nasogastric or intravenous fluids may be indicated
Blister care
Leave blisters to dry naturally
Do not pierce/rupture the blisters to reduce contagion
Keep the blisters clean and apply non-adherent dressings to erosions
Differential diagnoses
Chickenpox, Eczema, Erythema multiforme, Herpangina, Herpes simplex, Herpes zoster, Impetigo, Insect Bite, Kawasaki disease, Pharyngitis, Pompholyx, Rocky mountain spotted fever, Stevens-Johnson syndrome, Toxic epidermal necrolysis
References
[1] Guerra AM, Orille E, Waseem M. Hand, Foot, and Mouth Disease. [Updated 2023 Mar 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431082/
[2] Wang J, Cao Z, Zeng DD, Wang Q, Wang X, Qian H. Epidemiological analysis, detection, and comparison of space-time patterns of Beijing hand-foot-mouth disease (2008-2012). PLoS One. 2014 Mar 24;9(3):e92745.
[3] Wang, J., Hu, T., Sun, D. et al. Epidemiological characteristics of hand, foot, and mouth disease in Shandong, China, 2009–2016. Sci Rep 7, 8900 (2017).
[4] Jiang, L., Jiang, H., Tian, X. et al. Epidemiological characteristics of hand, foot, and mouth disease in Yunnan Province, China, 2008–2019. BMC Infect Dis 21, 751 (2021).
[5] Peng, D., Ma, Y., Liu, Y. et al. Epidemiological and aetiological characteristics of hand, foot, and mouth disease in Sichuan Province, China, 2011–2017. Sci Rep 10, 6117 (2020).
[6] Guo T, Liu J, Chen J, Bai Y, Long Y, Chen B, et al. Seasonal Distribution and Meteorological Factors Associated with Hand, Foot, and Mouth Disease among Children in Xi’an, Northwestern China. The American Journal of Tropical Medicine and Hygiene [Internet]. 2020 Mar 9;102(6):1253–62.
[7] https://dermnetnz.org/topics/hand-foot-and-mouth-disease
[8] http://emedicine.medscape.com/article/218402; [Medscape]