Hand-Foot-and-Mouth Disease (HFMD) Workup

Updated: Jun 07, 2022
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Michael Stuart Bronze, MD  more...
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Laboratory Studies

The diagnosis of hand-foot-and-mouth disease (HFMD) is typically based on clinical grounds. Laboratory studies are usually unnecessary. However, when it mimics Stevens-Johnson Syndrome [17]  or erythema multiforme, [18]  a skin biopsy specimen would be desirable.

The virus can be isolated and identified via culture and immunoassay from cutaneous lesions, mucosal lesions, or stool samples. Oral specimens have the highest isolation rate. In patients with vesicles, vesicle swabs are also a good source for viral collection. In patients without vesicles, rectal swabs can be collected. For viral isolation, 2 swab collections are recommended—from the throat and the other from either vesicles or the rectum.

Serologic testing (eg, acute and convalescent antibody levels) may be obtained.

Differentiating coxsackie-associated from EV-71–associated HFMD may have prognostic significance. Polymerase chain reaction (PCR) and microarray technology are among the various ways of identifying the causative virus. Specific assays vary between hospitals. [5]