Endocrinologia

426

Hand-Foot-Mouth Disease

PTG
WORKUP The diagnosis is usually made on the basis of history and characteristic physical examination. LABORATORY TESTS • Not indicated unless the diagnosis is in doubt. • Throat culture or stool specimen may be obtained for viral testing but may take from 2 to 4 wk for results.

DEFINITION Hand-foot-mouth (HFM) disease is a viral illness characterized bysuperficial lesions of the oral mucosa and skin of the extremities. HFM is transmitted primarily by respiratory droplet contact in developed areas and feco-oral contact in developing countries. Although children are predominantly affected, adults are also at risk. This disease is usually self-limited and benign, although outbreaks in the Asia Pacific Region have been increasingly complicated byneurological and cardiopulmonary sequelae. SYNONYMS Vesicular stomatitis with exanthem Coxsackievirus infection
ICD-9CM CODES 074.0 Hand-foot-mouth disease

i

BASIC INFORMATION

• Skin lesions of the hands and feet start as linear erythematous papules (3 to 10 mm in diameter) that evolve into gray vesicles that may be mildly painful (Fig. 1-173). These vesicles are usually intact atpresentation and remain so until they desquamate within 2 wk. • Involvement of the buttocks and perineum is present in 31% of cases. • In rare cases, encephalitis, meningitis, myocarditis, poliomyelitis-like paralysis, and pulmonary edema may develop. Sporadic acute paralysis and long term neurologic sequelae have been reported with Enterovirus 71. • Although information is limited, there is no clearevidence that pregnancy outcomes are affected.

Rx

TREATMENT

EPIDEMIOLOGY & DEMOGRAPHICS • Children 5 yr are at the highest risk and have the most severe cases. • HFM is usually found in children 10 yr. • HFM is contagious. Close contacts of affected children, including family members and health care workers, are the most commonly affected adults. • Infection is spread from person to person bydirect contact with nasal discharge or stool. • A person is most contagious during the first week of illness. • Outbreaks tend to occur during the summer. • Infection leads to immunity, but a second episode may occur after infection with a different agent. PHYSICAL FINDINGS & CLINICAL PRESENTATION Symptoms: • After a 4- to 6-day incubation period, patients may report odynophagia, sore throat,malaise, and fever (38.3° to 40° C). • 1 to 2 days later the characteristic oral lesions appear. • In 75% of cases skin lesions on the extremities accompany these oral manifestations. • 11% of adults have cutaneous findings. • Lesions appear over the course of 1 or 2 days. Physical findings: • Oral lesions, usually between five and ten, are commonly found on the tongue, buccal mucosa, gingivae, and hardpalate. • Oral lesions initially start as 1- to 3-mm erythematous macules and evolve into gray vesicles on an erythematous base. • Vesicles are frequently broken by the time of presentation and appear as superficial gray ulcers with surrounding erythema.

ETIOLOGY • Coxsackievirus group A, type 16, was the first and is the most common viral agent isolated. • Coxsackie viruses A5, A7, A9, A10, B1, B2,B3, B5, and Enterovirus 71 have also been implicated. • Enterovirus 71 infection rates have been rising in the Asian Pacific region. This virus may lead to more severe cases of the disease including CNS involvement.

ACUTE GENERAL Rx • Palliative therapy is given for this usually self-limited disease. • Limited data suggest acyclovir may have a role in treatment of certain cases. DISPOSITIONPrognosis is excellent except in rare cases of central nervous system or cardiac involvement. Most are managed as outpatients. REFERRAL Not usually needed

Dx

DIAGNOSIS

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PEARLS & CONSIDERATIONS

DIFFERENTIAL DIAGNOSIS • Aphthous stomatitis • Herpes simplex infection • Herpangina • Behçet’s disease • Erythema multiforme • Pemphigus • Gonorrhea • Acute leukemia • Lymphoma • Allergic...