Hand-Foot-and-Mouth Disease in Emergency Medicine
- Author: Pamela L Dyne, MD; Chief Editor: Richard G Bachur, MD more...
Background
Hand-foot-and-mouth (HFM) disease is a viral syndrome with a distinct exanthem-enanthem.
This clearly recognizable syndrome is characterized by vesicular lesions on the mouth and an exanthem on the hands and feet (and buttocks) in association with fever. See the images below.
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. Pathophysiology
Hand-foot-and-mouth disease is caused by a group of RNA viruses called enteroviruses. The most commonly implicated enterovirus is coxsackievirus A16.[1] However, coxsackieviruses A5, A9, A10, A16, B1, and B3; human enterovirus 71 (HEV71); as well as herpes simplex viruses (HSV) can cause the illness.
Cases are commonly spread via the fecal-oral or oral-oral route. Respiratory droplet transmission also may occur but is less likely. Typically, the virus seeds the GI tract via the buccal mucosa or the ileum. Over the next 72 hours (accounting for the incubation period), a viremia is established via spread through nearby lymph nodes.[2]
Epidemiology
Frequency
International
Distribution of this disease is worldwide, with a peak incidence in the summer and fall in temperate climates and with no seasonal pattern in the tropics.
Mortality/Morbidity
This illness has, essentially, a full recovery rate. However, HEV71 has been recently implicated in several large outbreaks with severe complications and deaths. Complications are rare, but as with any pruritic rash, a secondary skin infection may occur.
Severe complications may occur when CNS or cardiopulmonary involvement is present. These sequelae include dysphagia, limb weakness, cardiopulmonary failure, and even death. Although death is very rare, it is most often due to pulmonary hemorrhage or edema.
Enteroviruses as a group are a cause of aseptic meningitis and encephalitis; however, Hand-foot-and-mouth disease is not usually associated with meningitis.
Sex
Males and females are affected with equal frequency. Males are more likely to become symptomatically ill.
Age
Hand-foot-and-mouth disease, as well as severe disease complications, are more common among infants and children younger than 5 years.
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