Hand, foot and mouth disease

Definition
Hand, foot and mouth disease is a viral infection that causes blisters that affect the inside of the mouth and the skin on the hands, fingers, toes, feet and sometimes the buttocks.

Causes/associated factors
Hand, foot and mouth disease is most commonly caused by an enterovirus called coxsackievirus A 16 and sometimes by enterovirus 71 or other enteroviruses. (Enteroviruses are a group of viruses that are found in the gastrointestinal and respiratory tracts.) You can't be infected by the same virus twice, but you can develop hand, foot and mouth disease more than once if you're infected by another virus.
Although adults contract hand, foot and mouth disease, it's most common in young children. Outbreaks may happen among groups of children in child care centers or classrooms, especially during the summer or early fall.

It's important to note that hand, foot and mouth disease is not the same illness as foot and mouth disease, which affects animals.


Transmission
The virus spreads by inhaling infected respiratory droplets or direct contact with infected respiratory secretions, saliva, stool or fluid from the blisters.
The incubation period (time from infection to the appearance of symptoms) is three to seven days. Communicability is greatest while symptoms are present. People who have no symptoms can also spread the virus to others, however. The virus may also be shed in an infected person's stool for several weeks after symptoms disappear. Doctors often recommend that infected children stay home from child care or school if they have mouth blisters and are drooling, or if they have a fever, diarrhea or weeping lesions on their hands. If your child is infected, ask your doctor how long isolation is necessary. You may also want to check with your child's child care provider or school for any individual policies.


Signs/symptoms
For some people symptoms are mild, if they appear at all. For those who develop symptoms, the first may include a mild fever, sore throat, poor appetite and malaise (a general feeling of discomfort or illness). Within one to two days, small blisters can develop in the mouth, often on the inner cheeks, gums or tongue. The blisters in the mouth may ulcerate or become open sores. A rash often appears as small red spots or blisters around the hands, palms, soles of the feet, and between the fingers and toes. The rash may also develop on the buttocks and in the groin, particularly in small children. Some people also develop swollen glands. If symptoms appear, they typically last seven to 10 days.

Diagnosis
Diagnosis is based on your medical history and a physical exam. Although samples to test for the virus can be taken from the throat, stool or any affected site, this isn't routinely necessary. If samples are taken, it may take two to four weeks to receive the test results.

Treatment
There is no specific treatment for hand, foot and mouth disease. If you're severely ill or have a weak immune system, antiviral medication may be prescribed. Self-care includes:
drinking plenty of fluids, especially cool ones
eating a soft, bland diet with nonacidic or cold foods
rinsing your mouth with warm water after eating
taking acetaminophen for fever or discomfort if recommended by the doctor
Sometimes, mouth sores can make swallowing painful. Children who are not eating or drinking normally may become dehydrated. If you're concerned about your child or recovery is not prompt, consult the doctor.


Complications
Hand, foot and mouth disease typically clears up on its own. There are usually no complications associated with the coxsackievirus A 16. Rarely, meningitis (inflammation of the membranes surrounding the brain or spinal cord) may result from an infection with this virus.
Other strains of enterovirus, such as enterovirus 71, may cause complications more often. Although rare, potential complications may include:

meningitis
encephalitis (inflammation of the membranes surrounding the brain or spinal cord)
pneumonia (infection of the lungs)
myocarditis (inflammation of the heart muscle)
paralysis (temporary or permanent loss of voluntary movement)

Pregnancy-specific information
The risk of contracting hand, foot and mouth disease during pregnancy appears to be small. Although a mother's infection is typically mild, some enterovirus infections can lead to a serious infection in the fetus, congenital abnormalities or, rarely, fetal death.

Senior-specific information
The incidence of hand, foot and mouth disease is lower among older adults. Elderly adults with weak immune systems may be at risk for persistent infections, however.

Prevention
To prevent hand, foot and mouth disease, teach children to wash their hands often (especially after going to the bathroom) and to cover their mouths when sneezing. The same rules apply to adults. Also, remember to wash your hands after handling diapers or other soiled materials. Clean all toys, eating utensils, bottle nipples or other objects that have saliva on them. Disinfect contaminated household surfaces and wash soiled clothing. Remember hand, foot and mouth disease can be spread through fluid from the blisters. Be careful to avoid exposure to open sores and break closed blisters. Finally, avoid exposing infants and young children to anyone with a respiratory illness.