Hand, foot, and mouth disease (HFMD), an enteroviral disease, presents with some symptoms that are easily diagnosable, as well as certain atypical features. This article covers diagnosis, treatment and management protocol for HFMD.

In India, HFMD was first reported in the year 2003 from Calicut (Kerala). Thereafter, Indian states like West Bengal, Kerala, Odisha, Maharashtra, and Karnataka have reported this infection in the recent past.

HFMD, a viral exanthem, is most commonly caused by strains of Coxsackie A16, a type of enterovirus. It is known to affect children below 10 years of age. The usual incubation period for the virus is 3 to 7 days. The disease is moderately contagious and outbreaks of HFMD are usually common in daycares and summer camps. Nose and throat discharges, saliva, fluid from blisters, or the stool of infected persons are the infective materials. Infected persons are most contagious during the first week of the illness but can remain infectious up to several weeks (as the virus persists in stool).

Symptoms to check out

The Ministry of Health and Family Welfare portal states that HFMD is a mild disease and the symptoms could be as follows:

• HFMD may start with early symptoms like low-grade fever accompanied by loss of appetite. This is commonly followed by a sore throat.
• 1 or 2 days after the onset of fever, a rash may become evident on the hands, feet, mouth, tongue, inside of the cheeks, and also the buttocks, knees, and elbows.
• Appearance of painful sores or lesions may be visible in the mouth or throat.

 It is important to note that sometimes, HFMD may not show any symptoms or patients may present with only rash or mouth ulcers.

HFMD can also be caused by EV71, associated with meningitis and encephalitis and may show mixed neurological (headache, stiff neck, or back pain) and respiratory symptoms. In HFMD due to EV71, complications may be serious with fatal outcome.

Hand, foot and mouth disease can also present with atypical features like concomitant aseptic meningitis. Enterovirus infections that cause hand, foot, and mouth disease are notorious for involving the central nervous system (CNS) and may cause encephalitis, polio-like syndrome, acute transverse myelitis, Guillain-Barre syndrome, benign intracranial hypertension, and acute cerebellar ataxia.

Treatment/Management

Hand, foot, and mouth disease is a self-limiting mild clinical syndrome that resolves in 7 to 10 days with symptomatic treatment.

The treatment is primarily supportive. Pain and fever can be managed with NSAIDs and acetaminophen. Making sure the patient remains well hydrated is important. Additionally, a mixture of liquid ibuprofen and liquid diphenhydramine can be used to gargle which helps coat the ulcers, ameliorating the pain.

Few other common considerations for HFMD patients are:

• Ensuring adequate fluid intake to prevent dehydration- cold liquids are generally preferable.
• Avoiding spicy or acidic substances which may cause discomfort.
• Treatment of fever with antipyretics.
• Mouthwashes or sprays that numb pain.
• Prompt medical care for children showing severe symptoms.

As HFMD is a contagious disease, doctors should advise good hygienic practices to patients to prevent further transmission of the disease. Usually, all patients recover without any aggressive treatment and complications are uncommon. However, if liquid intake is inadequate due to painful oral sores then dehydration may be seen. Aseptic or viral meningitis may rarely develop with symptoms of fever, headache, stiff neck, or back pain and may require hospitalisation for a few days.

New therapies

So far, no drug has been approved, but promising novel agents include molecular decoys, translation inhibitors, receptor antagonists and replication inhibitors. One new antiviral agent that has shown promise in the treatment of enterovirus 71 is pleconaril.

References

• Guerra AM, Waseem M. Hand Foot And Mouth Disease. [Updated 2018 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431082/
• Hand, Foot and Mouth Disease . National Health Portal. Available at https://www.nhp.gov.in/disease/communicable-disease/hand-foot-and-mouth-disease