Hand foot , mouth disease : A viral infection in children re-visited !

Clinical scenario:
   A 4-year-old male child presented with a history of pain in his mouth of 3 days duration. There was no history of fever. On examination,  the patient  had a small blister  in the buccal mucosa as shown in figure and blisters  on sole and limbs 
There was no pallor, jaundice or lymphadenopathy.
The examination of the abdomen revealed a scaphoid soft abdomen with no organomegaly. The other systemic examination was unremarkable.
Investigations : 
     The diagnosis of hand foot mouth disease was made on clinical grounds.

 

Salient features of the Hand, foot and mouth disease (HFMD)

• HFMD is not related to the foot and mouth disease that is found in animals.
• This is a viral infection that causes a rash or blisters on the hands and feet or around the mouth. 
• There are two types of viruses that cause HFMD, and the symptoms vary depending on the virus. Hand, foot and mouth disease is very common viral infection in Kashmir in the summer season.

• HFMD mainly affects children under the age of 10, but can also affect adolescents.
•  It spreads easily from one person to another.
•  It is possible to contract the virus more than once, but the symptoms will be less severe.

Signs and symptoms of HFMD

• If your child has HFMD, they may feel tired, have a fever, and have a rash. Depending on which virus your child has, the skin rash can look like: Small, oval, white blisters on the palms, soles of the feet, as well as in the mouth. 
• Your child may have a sore mouth and throat, leading to poor appetite or risk of dehydration (drinking and eating can be painful because of the mouth blisters).
•  It takes its own course ( 7-10 days), needs NO antibiotic, spreads very quickly and can cause dehydration which can rarely cause prerenal azotemia if not treated 
• A red skin rash with a brown scale on it. The rash appears on the outer arms, hands, legs, feet, around the mouth and upper buttocks. The trunk is usually relatively clear. Sometimes there are blisters present, but they are not usually in the mouth and your child can eat and drink as usual.
• The blisters should not be itchy like chickenpox blisters. If your child has eczema, the HFMD can cause eczema to worsen and potentially become infected with bacteria.

How is HFMD spread?

• HFMD is most commonly caused by the coxsackie virus. The main way HFMD spreads is through contact with the fluid from inside the blisters, or with the droplets spread from sneezing and coughing. The virus can also be present in bowel movements for up to several weeks after the person has recovered.

How to prevent the spread of HFMD:

• Wash your hands thoroughly after touching your child’s bodily fluids. This includes touching their blisters, helping them blow their nose, and changing nappies or helping with toileting. 
• Make sure your child doesn’t share items such as cutlery, drinking cups, towels, toothbrushes and clothing.
•  Keep your child home from school, kindergarten or childcare until all the fluid in their blisters has dried. 

Care at home

• HFMD is a viral infection that rarely causes further complications. Antibiotics do not work on viruses and are not given to children with HFMD.
•  HFMD will get better on its own, but there are ways you can care for your child at home:
• If your child is in pain or is uncomfortable, give them pain relief, such as paracetamol or ibuprofen. Do not give aspirin. 
• Pain relief for children.: Give your child frequent sips of water or an oral rehydration solution to stop them becoming dehydrated.
• Leave blisters to dry naturally.
• Do not pierce or squeeze them.
• If your child is unwell with a fever and a skin rash (small bright red spots or purple spots or unexplained bruises) that does not turn to skin-colour (blanch) when you press on it, this may be a sign of meningococcal infection.

Key points to remember :

HFMD is a mild illness that has a self-limiting course. Two types of viruses cause HFMD, and the rash depends on which virus your child has. HFMD is spread easily from one person to another

This case was contributed by
Dr Yasir Wani
MBBS MD.
Consultant Paediatrician and neonatologist Star Hospital Sanat Nagar Srinagar KASHMIR 9906691966 yasirwani1234@gmail.com