NR 602 Week 2 Pediatric Grand Rounds Presentation; Hand, Foot and Mouth Disease (HFMD)

This grand rounds presentation and discussion focused on hand, foot and mouth disease (HFMD).

Hand, Foot and Mouth Disease

HFMD is a highly contagious, self-limiting viral illness most commonly seen in children under ten years old [ CITATION Pue14 \l 1033 ].  It caused by viruses in the enterovirus family, most frequently the coxsackievirus A16. It is spread by direct contact with nasal discharge, saliva, blister fluid or stool.  The individual may be asymptomatic and still be contagious with the virus persisting for several weeks, most commonly in stool. HFM is not the same as foot and mouth disease which is found in cattle and there is no cross species infectious concern. HFMD typically presents with one to two days of fever, sore throat, general malaise, painful mouth lesions and a red rash that often appears on the palms of hands and soles of the feet.

Diagnostics

HFMD is diagnosed clinically with no need for further testing unless there is reason to believe it may be causde by enterovirus-71 which is commonly found in Asia and has more severe symptoms, side effects and complications [ CITATION Ste13 \l 1033 ]. To test for the virus type, a throat swab or swab of the vesicle fluid is most effective. A CBC may also be done and will show an elevated WBC and atypical lymphocytes [ CITATION Ame13 \l 1033 ].

Differential Diagnoses

Nongenital herpes simplex virus type 1 (HSV-1) is a common infection that most often involves the oral mucosa or lips. The primary oral infection may range from asymptomatic to very painful, leading to poor oral intake and dehydration. Recurrent infections cause cold sores that can affect appearance and quality of life. The virus can be transmitted by kissing or sharing utensils or towels. Transmission involves mucous membranes and open or abraded skin. In primary oral HSV-1, symptoms may include a fever, followed by mouth lesions with submandibular and cervical lymphadenopathy. The mouth lesions consist of painful vesicles on a red, swollen base that occur on the lips, gingiva, oral palate, or tongue. Herpetic whitlow is a vesicular lesion found on the hands or digits. It occurs in children who suck their thumbs [ CITATION Usa10 \l 1033 ].