Hand, foot and mouth disease
Encyclopedia
Hand, foot and mouth disease (HFMD) is a human syndrome
caused by intestinal viruses of the Picornaviridae family
. The most common strains causing HFMD are Coxsackie A
virus
and Enterovirus 71 (EV-71).
HFMD usually affects infants and children, and is quite common. It is moderately contagious and is spread through direct contact with the mucus, saliva, or feces of an infected person. It typically occurs in small epidemics in nursery schools or kindergartens, usually during the summer and autumn months. The usual incubation period is 3–7 days.
It is uncommon in adults, but those with immune deficiencies are very susceptible. HFMD is not to be confused with foot-and-mouth disease
(also called hoof-and-mouth disease), which is a disease affecting sheep, cattle, and swine, and which is unrelated to HFMD (but also caused by a member of the Picornaviridae family).
The common incubation period (the time between infection and onset of symptoms) is from three to seven days.
Early symptoms are likely to be fever
often followed by a sore throat
. Loss of appetite and general malaise
may also occur. Between one and two days after the onset of fever, painful sores (lesion
s) may appear in the mouth and/or throat. A rash may become evident on the hands, feet, mouth, tongue, inside of the cheeks, and occasionally the buttocks (but generally, the rash on the buttocks will be caused by the diarrhea
.)
Only a very small minority of sufferers require hospital admission, mainly as a result of uncommon neurological
complications (encephalitis
, meningitis
, or acute flaccid paralysis) or pulmonary edema
/pulmonary hemorrhage
.
Syndrome
In medicine and psychology, a syndrome is the association of several clinically recognizable features, signs , symptoms , phenomena or characteristics that often occur together, so that the presence of one or more features alerts the physician to the possible presence of the others...
caused by intestinal viruses of the Picornaviridae family
Family (biology)
In biological classification, family is* a taxonomic rank. Other well-known ranks are life, domain, kingdom, phylum, class, order, genus, and species, with family fitting between order and genus. As for the other well-known ranks, there is the option of an immediately lower rank, indicated by the...
. The most common strains causing HFMD are Coxsackie A
Coxsackievirus
Coxsackievirus is a virus that belongs to a family of non enveloped linear positive-sense ssRNA viruses, Picornaviridae and the genus Enterovirus, which also includes poliovirus and echovirus. Enteroviruses are among the most common and important human pathogens and ordinarily its members are...
virus
Virus
A virus is a small infectious agent that can replicate only inside the living cells of organisms. Viruses infect all types of organisms, from animals and plants to bacteria and archaea...
and Enterovirus 71 (EV-71).
HFMD usually affects infants and children, and is quite common. It is moderately contagious and is spread through direct contact with the mucus, saliva, or feces of an infected person. It typically occurs in small epidemics in nursery schools or kindergartens, usually during the summer and autumn months. The usual incubation period is 3–7 days.
It is uncommon in adults, but those with immune deficiencies are very susceptible. HFMD is not to be confused with foot-and-mouth disease
Foot-and-mouth disease
Foot-and-mouth disease or hoof-and-mouth disease is an infectious and sometimes fatal viral disease that affects cloven-hoofed animals, including domestic and wild bovids...
(also called hoof-and-mouth disease), which is a disease affecting sheep, cattle, and swine, and which is unrelated to HFMD (but also caused by a member of the Picornaviridae family).
Signs and symptoms
Symptoms of HFMD include:- FeverFeverFever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
- HeadacheHeadacheA headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the...
- VomitingVomitingVomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...
- Fatigue
- MalaiseMalaiseMalaise is a feeling of general discomfort or uneasiness, of being "out of sorts", often the first indication of an infection or other disease. Malaise is often defined in medicinal research as a "general feeling of being unwell"...
- Referred ear pain
- Sore throatSore throatA sore throat or throat pain is a common physical symptom usually caused by acute pharyngitis, or throat inflammation, though it also occurs in a number of other situations, such as post trauma and in diphtheria. It can cause mild to extreme pain....
- PainPainPain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
ful oralMouthThe mouth is the first portion of the alimentary canal that receives food andsaliva. The oral mucosa is the mucous membrane epithelium lining the inside of the mouth....
lesionLesionA lesion is any abnormality in the tissue of an organism , usually caused by disease or trauma. Lesion is derived from the Latin word laesio which means injury.- Types :...
s - Non-itchy body rashRashA rash is a change of the skin which affects its color, appearance or texture. A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, cracked or blistered, swell and may be painful. The causes, and...
, followed by sores with blisterBlisterA blister is a small pocket of fluid within the upper layers of the skin, typically caused by forceful rubbing , burning, freezing, chemical exposure or infection. Most blisters are filled with a clear fluid called serum or plasma...
s on palms of hand and soles of feet - Oral ulcer
- Sores or blisters may be present on nose and nostrils
- Sores or blisters may be present on the buttocks of small children and infants
- Irritability in infants and toddlers
- Loss of appetite.
- DiarrheaDiarrheaDiarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...
The common incubation period (the time between infection and onset of symptoms) is from three to seven days.
Early symptoms are likely to be fever
Fever
Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
often followed by a sore throat
Sore throat
A sore throat or throat pain is a common physical symptom usually caused by acute pharyngitis, or throat inflammation, though it also occurs in a number of other situations, such as post trauma and in diphtheria. It can cause mild to extreme pain....
. Loss of appetite and general malaise
Malaise
Malaise is a feeling of general discomfort or uneasiness, of being "out of sorts", often the first indication of an infection or other disease. Malaise is often defined in medicinal research as a "general feeling of being unwell"...
may also occur. Between one and two days after the onset of fever, painful sores (lesion
Lesion
A lesion is any abnormality in the tissue of an organism , usually caused by disease or trauma. Lesion is derived from the Latin word laesio which means injury.- Types :...
s) may appear in the mouth and/or throat. A rash may become evident on the hands, feet, mouth, tongue, inside of the cheeks, and occasionally the buttocks (but generally, the rash on the buttocks will be caused by the diarrhea
Diarrhea
Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...
.)
Treatment
There is no specific treatment for hand, foot and mouth disease. Individual symptoms, such as fever and pain from the sores, may be eased with the use of analgesics. HFMD is a viral disease that has to run its course; many doctors do not prescribe medicine for this illness. Infection in older children, adolescents, and adults is typically mild and lasts approximately 1 week, occasionally longer. Fever reducers and luke-warm baths can help bring temperature down.Only a very small minority of sufferers require hospital admission, mainly as a result of uncommon neurological
Neurology
Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue,...
complications (encephalitis
Encephalitis
Encephalitis is an acute inflammation of the brain. Encephalitis with meningitis is known as meningoencephalitis. Symptoms include headache, fever, confusion, drowsiness, and fatigue...
, meningitis
Meningitis
Meningitis is inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. The inflammation may be caused by infection with viruses, bacteria, or other microorganisms, and less commonly by certain drugs...
, or acute flaccid paralysis) or pulmonary edema
Pulmonary edema
Pulmonary edema , or oedema , is fluid accumulation in the air spaces and parenchyma of the lungs. It leads to impaired gas exchange and may cause respiratory failure...
/pulmonary hemorrhage
Pulmonary hemorrhage
Pulmonary hemorrhage is an acute bleeding from the lung, especially in the upper respiratory tract and the endotracheal tube. When evident clinically, the condition is usually massive, associated with bleeding in other sites as well as more than one third of the lungs...
.
Complications
- Complications from the virus infections that cause HFMD are not common, but if they do occur, medical care should be sought.
- Viral or aseptic meningitis can rarely occur with HFMD. Viral meningitis causes fever, headache, stiff neck, or back pain. The condition is usually mild and clears without treatment; however, some patients may need to be hospitalized for a short time.
- Other more serious diseases, such as encephalitis (swelling of the brain), a polio-like paralysis, result even more rarely. Encephalitis can be fatal.
- There have been reports of fingernail and toenail loss occurring mostly in children within 4 weeks of their having hand, foot, and mouth disease (HFMD). At this time, it is not known whether the reported nail loss is or is not a result of the infection. However, in the reports reviewed, the nail loss has been temporary and nail growth resumed without medical treatment.
1998
- In 1998, there was an outbreak in TaiwanTaiwanTaiwan , also known, especially in the past, as Formosa , is the largest island of the same-named island group of East Asia in the western Pacific Ocean and located off the southeastern coast of mainland China. The island forms over 99% of the current territory of the Republic of China following...
, affecting mainly children. There were 405 severe complications, and 78 children died. The total number of cases in that epidemic is estimated to have been 1.5 million.
2006
- In 2006, an outbreak in KuchingKuchingKuching , officially the City of Kuching, and formerly the City of Sarawak, is the capital and most populous city of the East Malaysian state of Sarawak. It is the largest city on the island of Borneo, and the fourth largest city in Malaysia....
, SarawakSarawakSarawak is one of two Malaysian states on the island of Borneo. Known as Bumi Kenyalang , Sarawak is situated on the north-west of the island. It is the largest state in Malaysia followed by Sabah, the second largest state located to the North- East.The administrative capital is Kuching, which...
(according to the New Straits TimesNew Straits TimesThe New Straits Times is an English-language newspaper published in Malaysia. It is Malaysia's oldest newspaper still in print , having been founded as The Straits Times in 1845, and was reestablished as the "New Straits Times" in 1965. The paper served as Malaysia's only broadsheet format English...
, March 14). - In 2006, after an outbreak of ChikungunyaChikungunyaChikungunya virus is an insect-borne virus, of the genus Alphavirus, that is transmitted to humans by virus-carrying Aedes mosquitoes. There have been recent breakouts of CHIKV associated with severe illness...
in southern and some western parts of India, cases of HFMD were reported.
2007
- The largest outbreak of HFMD in India occurred in 2007 in the eastern part of the country in West Bengal. Authors found 38 cases of HFMD in and around Kolkata.
2008
- An outbreak in China, beginning in March in FuyangFuyang, AnhuiFuyang is a prefecture-level city in northwestern Anhui province, People's Republic of China. It borders Bozhou to the northeast, Huainan to the southeast, Lu'an to the south, and the province of Henan on all other sides.-Climate:-Administration:...
, Anhui, led to 25,000 infections, and 42 deaths, by May 13. Similar outbreaks were reported in Singapore (more than 2,600 cases as of April 20, 2008), Vietnam (2,300 cases, 11 deaths), Mongolia (1,600 cases), and Brunei (1053 cases from June–August 2008)
2009
- 17 children died in an outbreak during March and April 2009 in China's eastern Shandong Province, and 18 children died in the neighboring Henan Province. Out of 115,000 reported cases in China from January to April, 773 were severe and 50 were fatal.
- In IndonesiaIndonesiaIndonesia , officially the Republic of Indonesia , is a country in Southeast Asia and Oceania. Indonesia is an archipelago comprising approximately 13,000 islands. It has 33 provinces with over 238 million people, and is the world's fourth most populous country. Indonesia is a republic, with an...
, where the disease is often called SingaporeSingaporeSingapore , officially the Republic of Singapore, is a Southeast Asian city-state off the southern tip of the Malay Peninsula, north of the equator. An island country made up of 63 islands, it is separated from Malaysia by the Straits of Johor to its north and from Indonesia's Riau Islands by the...
an influenza or flu Singapura, the disease was reported in the JakartaJakartaJakarta is the capital and largest city of Indonesia. Officially known as the Special Capital Territory of Jakarta, it is located on the northwest coast of Java, has an area of , and a population of 9,580,000. Jakarta is the country's economic, cultural and political centre...
area, starting with eight young children. By late April, health agencies in Jakarta were warning community health centers and advocating preventive steps, including the use of thermal scanners in airports and avoiding travel to Singapore.
2010
- In China, an outbreak occurred in southern China's Guangxi Autonomous Region as well as Guangdong, Henan, Hebei and Shandong provinces. Until March 70,756 children were infected and 40 died from the disease.
2011
- In Vietnam, by 04.09 the disease was reported to have claimed 98 lives with 3/4 were children under 3 years old. Although there was no official declaration of an outbreak, over 42,000 cases have been reported. Over 10,000 new cases were recorded in the second half of August alone.