Hand, foot & mouth disease (HFMD)

Question 1

What is the causative agent for HFMD?

Answer 1

Numerous members of the Enteroviruses group of the family Picornaviridae e.g. coxsackievirus, echovirus, enterovirus (EV) 71.

Question 2

What is the incubation period for HFMD?

Answer 2

3-5 days (range 2 days to 2 weeks)

Question 3

What is the infectious period for HFMD?

Answer 3

Few days before onset of prodromal symptoms to about 1 week from the onset of illness.

Question 4

What is the route of transmission for HFMD?

Answer 4

• Faecal-oral route
• Direct contact: respiratory droplets, saliva, vesicular fluid
• Indirect contact: articles/fomites contaminated by secretio

Question 5

What are the clinical features of HFMD?

Answer 5

Children < 10 years have highest risk of infection, majority of infections occur at preschool age (although infection can also occur in adults)

• 50-80% are asymptomatic
• Fever lasts 2-3 days (up to 5 days) followed by a rash over the palms, soles, dorsum of the feet, shins and buttocks. Rash starts as papules and become vesicles. Resolves in 7-10 days
• Mouth ulcers over the soft/ hard palate, uvula, buccal mucosa and tongue.
• May also have cough or rhinitis.
• May also have no rash but only ulcers in which case the patient is labelled as herpangina which is due to the same group of enteroviruses.

Question 6

What are the complications of HFMD?

Answer 6

• Myocarditis
• Pulmonary oedema
• Acute respiratory distress syndrome (ARDS)
• Viral pneumonitis
• Aseptic meningitis
• Brainstem encephalitis
• Acute flaccid paralysis
• Secondary bacterial infection

Question 7

What are the investigations required for HFMD?

Answer 7

• Rapid diagnosis can be performed by sending a nasopharyngeal throat swab or stool sample for enterovirus PCR.
• Stool/rectal swab, swab of vesicle fluid or oral ulcers can be sent for enterovirus isolation which takes 5-6 weeks. The yield of virus isolation is highest from the stool followed by vesicles and throat swabs.

Question 8

What is the management for children with HFMD?

Answer 8

• Patients with signs and symptoms of severe disease should be referred to hospital for further management; e.g. prolonged hyperpyrexia, tachycardia, tachypnoea, poor feeding or severe vomiting, lethargy.
• Symptomatic measures: anti-pyretics, tepid sponging, IV drip for rehydration.
• Hospitalisation for treatment of complications.
• Antibiotics (especially versus Staphylococcus) are used when there is evidence of secondary bacterial infection; e.g. raised total white counts.