Dermatologic Manifestations of Hand-Foot-and-Mouth Disease Workup

  • Author: Brad S Graham, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Mar 21, 2012
 

Laboratory Studies

Generally, no laboratory studies are necessary for hand-foot-and-mouth disease (HFMD). Leukocyte counts are 4000-16,000/µL. Occasionally, atypical lymphocytes are present.

Recent studies show that elevated serum concentration of C-reactive protein (CRP) and fasting and elevated blood glucose were significantly higher in severe cases than in mild ones.[6]

The virus can be isolated from swabs of the vesicles or mucosal surfaces or from stool specimens and then inoculated into mice or cultured on viral tissue media.

Neutralizing antibodies rapidly disappear; thus, they are usually detectable only in the acute phase.

High levels of complement-fixing antibodies are present in the convalescent phase.

Studies have illustrated the usefulness of a molecular assay using polymerase chain reaction primers to arrive at a rapid and specific diagnosis in order to distinguish between coxsackievirus A16 and enterovirus 71.[12] This may hold promise in future outbreaks because infections with enterovirus 71 tend to be associated with more severe complications and fatalities. One study suggests that swabs be collected within 4 days of HFMD onset to increase diagnostic yield.[13]

Next

Imaging Studies

Acute flaccid paralysis associated with enterovirus 71–infected hand-foot-and-mouth disease (HFMD) can be seen in severe cases. MRI is an effective modality to investigate neurological complications associated with the enterovirus 71 epidemics. Involvement of posterior portions of the medulla oblongata and pons, and bilateral anterior horns of the spinal cord, are characteristic findings.[14]

Previous
Next

Histologic Findings

Classic histopathologic findings of hand-foot-and-mouth disease (HFMD) include an intra-epidermal vesicle that contains neutrophils and eosinophilic cellular debris. The adjacent epidermis has reticular degeneration, that is, intercellular and intracellular edema. The dermis has a mixed infiltrate. Eosinophilic intranuclear inclusions are observed with electron microscopic studies.

Neuropathology in fatal cases of enterovirus 71 infection have shown features of an acute encephalitis involving the brain stem and spinal cord.[15]

Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Brad S Graham, MD  Consulting Staff, Dermatology Associates of Tyler

Brad S Graham, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society of Dermatopathology, and Texas Dermatological Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Bernice R Krafchik, MBChB, FRCPC  Professor Emeritus, Department of Pediatrics, Section of Dermatology, University of Toronto

Bernice R Krafchik, MBChB, FRCPC is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, Canadian Medical Association, College of Physicians and Surgeons of Ontario, Royal College of Physicians and Surgeons of Canada, and Society for Pediatric Dermatology

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Edward F Chan, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Zhu Z, Xu WB, Xu AQ, et al. Molecular epidemiological analysis of echovirus 19 isolated from an outbreak associated with hand, foot, and mouth disease (HFMD) in Shandong Province of China. Biomed Environ Sci. Aug 2007;20(4):321-8. [Medline].

  2. Yan XF, Gao S, Xia JF, Ye R, Yu H, Long JE. Epidemic characteristics of hand, foot, and mouth disease in Shanghai from 2009 to 2010: Enterovirus 71 subgenotype C4 as the primary causative agent and a high incidence of mixed infections with coxsackievirus A16. Scand J Infect Dis. Dec 18 2011;[Medline].

  3. Yang C, Deng C, Wan J, Zhu L, Leng Q. Neutralizing antibody response in the patients with hand, foot and mouth disease to enterovirus 71 and its clinical implications. Virol J. 2011;8:306. [Medline].

  4. Chang LY, King CC, Hsu KH, et al. Risk factors of enterovirus 71 infection and associated hand, foot, and mouth disease/herpangina in children during an epidemic in Taiwan. Pediatrics. Jun 2002;109(6):e88. [Medline]. [Full Text].

  5. Chong CY, Chan KP, Shah VA, et al. Hand, foot and mouth disease in Singapore: a comparison of fatal and non-fatal cases. Acta Paediatr. Oct 2003;92(10):1163-9. [Medline].

  6. Yu JG, Liu YD, Qiao LY, Wang CJ. [Epidemiological study and clinical analysis of 931 children with hand foot and mouth disease in Yantai]. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi. Oct 2011;25(5):374-6. [Medline].

  7. McMinn P, Stratov I, Nagarajan L, Davis S. Neurological manifestations of enterovirus 71 infection in children during an outbreak of hand, foot, and mouth disease in Western Australia. Clin Infect Dis. Jan 15 2001;32(2):236-42. [Medline].

  8. Ooi MH, Wong SC, Mohan A, et al. Identification and validation of clinical predictors for the risk of neurological involvement in children with hand, foot, and mouth disease in Sarawak. BMC Infect Dis. Jan 19 2009;9:3. [Medline]. [Full Text].

  9. Sutton-Hayes S, Weisse ME, Wilson NW, Ogershok PR. A recurrent presentation of hand, foot, and mouth disease. Clin Pediatr (Phila). May 2006;45(4):373-6.

  10. Wei SH, Huang YP, Liu MC, Tsou TP, Lin HC, Lin TL. An outbreak of coxsackievirus A6 hand, foot, and mouth disease associated with onychomadesis in Taiwan, 2010. BMC Infect Dis. 2011;11:346. [Medline].

  11. Lee TC, Guo HR, Su HJ, Yang YC, Chang HL, Chen KT. Diseases caused by enterovirus 71 infection. Pediatr Infect Dis J. Oct 2009;28(10):904-10. [Medline].

  12. Tsao KC, Chang PY, Ning HC, et al. Use of molecular assay in diagnosis of hand, foot and mouth disease caused by enterovirus 71 or coxsackievirus A 16. J Virol Methods. Apr 2002;102(1-2):9-14. [Medline].

  13. Zhang X, Yan HP, Huang C, et al. [The etiology and clinical manifestations of 70 patients with hand-foot-mouth disease]. Zhonghua Yu Fang Yi Xue Za Zhi. Oct 2009;43(10):872-4. [Medline].

  14. Li J, Chen F, Liu T, Wang L. MRI Findings of Neurological Complications in Hand-Foot-Mouth Disease by Enterovirus 71 Infection. Int J Neurosci. Feb 20 2012;[Medline].

  15. Yang Y, Wang H, Gong E, et al. Neuropathology in 2 cases of fatal enterovirus type 71 infection from a recent epidemic in the People's Republic of China: a histopathologic, immunohistochemical, and reverse transcription polymerase chain reaction study. Hum Pathol. Apr 22 2009;[Medline].

  16. Yang Y, Zhang L, Fan X, Qin C, Liu J. Antiviral effect of geraniin on human enterovirus 71 in vitro and in vivo. Bioorg Med Chem Lett. Mar 15 2012;22(6):2209-11. [Medline].

  17. Liu J, Yang Y, Xu Y, Ma C, Qin C, Zhang L. Lycorine reduces mortality of human enterovirus 71-infected mice by inhibiting virus replication. Virol J. 2011;8:483. [Medline].

  18. Faulkner CF, Godbolt AM, DeAmbrosis B, Triscott J. Hand, foot and mouth disease in an immunocompromised adult treated with aciclovir. Australas J Dermatol. Aug 2003;44(3):203-6. [Medline].

  19. Toida M, Watanabe F, Goto K, Shibata T. Usefulness of low-level laser for control of painful stomatitis in patients with hand-foot-and-mouth disease. J Clin Laser Med Surg. Dec 2003;21(6):363-7. [Medline].

  20. Chen S, Yang Y, Yan X, Chen J, Yu H, Wang W. Influence of vitamin A status on the antiviral immunity of children with hand, foot and mouth disease. Clin Nutr. Dec 22 2011;[Medline].

  21. Ruan F, Yang T, Ma H, Jin Y, Song S, Fontaine RE. Risk factors for hand, foot, and mouth disease and herpangina and the preventive effect of hand-washing. Pediatrics. Apr 2011;127(4):e898-904. [Medline].

  22. Hood AF, Mihm MC. Hand-foot-and-mouth disease. In: Fitzpatrick TB, Austen KF, Wolff K, Eisen AZ, Freedberg IM, eds. Dermatology in General Medicine. 4th ed. New York, NY: McGraw-Hill; 1993:2521-3.

  23. Hurwitz S. The exanthematous diseases of childhood. In: Hurwitz, ed. Clinical Pediatric Dermatology: A Textbook of Skin Disorders of Childhood and Adolescence. 2nd ed. Philadelphia, Pa: WB Saunders; 1993:359-61.

 
Previous
Next
 
The lower lip has an ulcer with an erythematous halo.
The tongue has an ulcer with an erythematous halo.
A typical cutaneous lesion has an elliptical vesicle surrounded by an erythematous halo. The long axis of the lesion is oriented along the skin lines.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.