Hand_Foot_and_Mouth_Disease_Flashcards
What is hand, foot and mouth disease?
Hand, foot and mouth disease is a self-limiting viral infection affecting children, caused by coxsackievirus A16 and enterovirus 71, among others.
What are the clinical features of hand, foot and mouth disease?
Clinical features include mild systemic upset, sore throat, fever, oral ulcers, and vesicles on the palms of the hands and soles of the feet.
How is hand, foot and mouth disease managed?
Management is symptomatic, focusing on hydration and analgesia. Children do not need to be excluded from school unless they feel unwell.
Should children with hand, foot and mouth disease be excluded from school?
No, children with hand, foot and mouth disease do not need to be excluded from school but should stay home until they feel better. Large outbreaks should be reported.
summarise
Hand, foot and mouth disease
Hand, foot and mouth disease is a self-limiting condition affecting children. It is caused by the intestinal viruses of the Picornaviridae family (most commonly coxsackie A16 and enterovirus 71). It is very contagious and typically occurs in outbreaks at nursery
Clinical features
mild systemic upset: sore throat, fever
oral ulcers
followed later by vesicles on the palms and soles of the feet
Management
symptomatic treatment only: general advice about hydration and analgesia
reassurance no link to disease in cattle
children do not need to be excluded from school
the HPA recommends that children who are unwell should be kept off school until they feel better
they also advise that you contact them if you suspect that there may be a large outbreak.
A 7-year-old girl is brought in to see her GP by her mother, who states that she has had a sore throat and developed a skin eruption for the last couple of days. On examination, you note 3-4 mm erythematous macules and papules on the dorsum of her hands and her heels. You diagnose her with hand, foot and mouth disease. The mother asks if she needs to stay off school. What advice will you give her regarding school exclusion?
Stay off school for 48 hours from onset of symptoms
No need to stay off school if she feels well
Stay off school for 48 hours from onset of rash
Stay off school until rash has subsided
Stay off school until all symptoms have subsided
No need to stay off school if she feels well
Hand foot and mouth disease does not require exclusion from a childcare setting or school
Important for meLess important
If a child with hand, foot and mouth disease feels well, there is no need to stay off school.
summarise hand, foot and mouth
Hand, foot and mouth disease
Hand, foot and mouth disease is a self-limiting condition affecting children. It is caused by the intestinal viruses of the Picornaviridae family (most commonly coxsackie A16 and enterovirus 71). It is very contagious and typically occurs in outbreaks at nursery
Clinical features
mild systemic upset: sore throat, fever
oral ulcers
followed later by vesicles on the palms and soles of the feet
© Image used on license from DermNet NZ
© Image used on license from DermNet NZ
Management
symptomatic treatment only: general advice about hydration and analgesia
reassurance no link to disease in cattle
children do not need to be excluded from school
the HPA recommends that children who are unwell should be kept off school until they feel better
they also advise that you contact them if you suspect that there may be a large outbreak.
A 9-month-old girl is generally unwell with a low-grade pyrexia, oral ulcers and the following appearance of her feet:
Which one of the following is most likely to be responsible for this presentation?
Measles
Human herpesvirus 8 (HHV-8)
Parvovirus B19
Vasculitis
Coxsackie A16
Coxsackie A16
Hand, foot and mouth disease is most commonly caused by coxsackie A16 and enterovirus
The correct answer is Coxsackie A16. This virus is the most common cause of Hand, Foot and Mouth Disease (HFMD), a common viral illness in children, which often presents with low-grade fever, oral ulcers and a characteristic vesicular rash on the palms and soles. The image likely shows this type of rash. HFMD is usually self-limiting and management is mainly supportive.
Measles can also cause fever and oral lesions (Koplik’s spots), but these are typically accompanied by a generalised maculopapular rash spreading from head to foot, not limited to hands and feet as in HFMD. Measles also tends to present with more severe symptoms including cough, coryza, conjunctivitis and high-grade fever.
Human herpesvirus 8 (HHV-8) is associated with Kaposi’s sarcoma, primary effusion lymphoma and some types of multicentric Castleman disease. It does not typically cause symptoms like those described in the question stem.
Parvovirus B19, also known as ‘slapped cheek syndrome’ or fifth disease, presents with characteristic bright red cheeks followed by a lacy erythematous rash on the body. Although it can cause mild pyrexia and malaise, it does not generally lead to oral ulcers or vesicular rashes on hands and feet.
Finally, Vasculitis, inflammation of blood vessels that causes changes in the vessel walls including thickening, weakening or scarring can lead to various symptoms depending on the organs affected. Cutaneous vasculitis may result in petechiae or purpura but would not typically present with isolated hand-foot rashes as seen in HFMD. Fever could be present if there is systemic involvement but oral ulcers are not a typical feature of vasculitis.
buzz words
sore throat
skin eruption
3-4 mm erythematous macules and papules
on the dorsum of her hands and heel
generally unwell
low-grade pyrexia
oral ulcers
You are junior doctor at a GP practice. Your next patient is a 3-year-old girl who is notably irritable and teary. Her father explains that she has had a reduced appetite for the past couple of days.
On examination you note multiple vesicles over both palms and around the mouth. She is also pyrexial.
Given the likely diagnosis, what is the most appropriate next step?
1% hydrocortisone for one week
Advise symptomatic treatment only
IM benzylpenicillin STAT
PO prednisolone for 1 week
Send blood cultures
Advise symptomatic treatment only
Hand, foot and mouth disease requires symptomatic treatment only
This young girl has hand, foot and mouth disease; a common, self-limiting viral illness caused by the coxsackie virus A16. It is contagious and easily spreads between children, especially at nurseries. The child may have some general malaise but the vesicles do not cause discomfort for the child.
Differentiate from chicken pox as these are isolated to the palms/soles/mouth and heal without crusting.
A stat dose of benzylpenicillin is for suspected cases of meningitis. The lesions described here are vesicles rather than a rash.
There is no need for blood cultures to be sent as it will not affect the management.
Steroids (cream or orally) are not a recognised treatment for hand, foot and mouth disease. You would consider hydrocortisone cream for an eczematous rash but that is not the diagnosis here.
