Medical Care
The treatment of hand-foot-and-mouth disease (HFMD) is supportive. [19] In fact, there is no antiviral agent specific for the etiologic agents. Ensure adequate fluid intake to prevent dehydration. Cold liquids are generally preferable. Spicy or acidic substances may cause discomfort. Intravenous hydration may be necessary if the patient has moderate-to-severe dehydration or if discomfort precludes oral intake. Fever may be treated with antipyretics. Pain may be treated with standard doses of acetaminophen or ibuprofen. Direct analgesia may also be applied to the oral cavity via mouthwashes or sprays. Intravenous immunoglobulin (IVIG) and milrinone have shown some efficacy in a few reports. [6, 7, 8]
There is a relative dearth of treatment options for enterovirus-associated HFMD cases. Recent research has yielded several promising novel and existing therapeutics targeting specific viral mechanisms of action. These include molecular decoys, receptor antagonists, uncoating and translation inhibitors, polyprotein processing inhibitors, and replication inhibitors. Pleconaril is an uncoating inhibitor that shows promise in enterovirus 71–associated infections.
Amantadine and quinacrine, both translation inhibitors, and ribavirin, a replication inhibitor, are also being investigated as treatment options. [20]
Prevention
A vaccine would be desirable, especially against the Enterovirus A71 (EV-A71). [21] EV71 vaccine in China was found effective in prevention, with CA16 and EV71 proportions found inversely related to the vaccination rate in Canton (Guangzhou), China. [1] It may have a protective effect on the occurrence of encephalitis, which may still may develop. [22] Bivalent enterovirus 71 (EV71) and coxsackievirus A16 (CA16) vaccines may be advantageous. [23] There is no vaccine available in American or the European Union at present.
A suitable mitigation strategy to minimize enterovirus transmission among children with HFMD to control severe EV epidemics may be case isolation and class suspension if more than two having an onset of HFMD in one classroom within one week. [24]
Care with sample collection is desirable, as puncture with a contaminated lancet may produce severe HFMD. [25]
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The lower lip has an ulcer with an erythematous halo.
Tables
Illness |
Etiologic Agent |
Usual Severity of Clinical Illness |
Appearance of Lesions |
Locations of Lesions |
Other Features |
HFMD |
Coxsackie-virus A16 (most common), A5, A7, A9, A10, B2, B5 Enterovirus 71 |
Mild |
Papules → Vesicles → ulcerations on an erythematous base Usually 2-6 mm |
Gingiva Buccal mucosa Tongue Pharynx |
Lesions may also be found on hands, feet, buttocks, and genitalia. Low-grade fever |
Herpangina |
Coxsackie-virus A1-A10, A16, A22 Echovirus 3, 6, 9, 16, 17, 25, 30 |
Moderate; can be severe |
Papules → Vesicles → ulcerations on an erythematous base Usually 2-4 mm |
Posterior oral cavity Tonsils, soft palate, uvula |
Temperature generally high |
Herpetic gingivostomatitis |
Herpes simplex virus-1 |
Moderate to severe |
Vesicles ulcerations |
Anterior oral cavity Lips, gingiva, buccal mucosa |
Temperature generally high Lymphadenopathy |
Aphthous stomatitis |
Unknown |
Mild to severe |
Ulcerations; larger than in viral enanthems |
Lips, tongue, buccal mucosa; generally not diffuse |
Afebrile May be recurrent |
Stevens-Johnson syndrome |
Immunologic |
Moderate to severe |
Coalescent vesicles, which then ulcerate |
Lips, gingiva, buccal mucosa, tongue, pharynx |
Targetlike cutaneous lesions Diffuse mucous membrane involvement |
