Hand-foot-and-mouth disease overview

# Overview
Hand foot and mouth disease (HFMD) is a common, contagious viral illness of infants and children younger than 5 years old, but can also occur in older children and adults. It is is caused by a number of enteroviruses, including Coxsackie A16 and Enterovirus 71 (EV71) in the family Picornaviridae. It is characterized by fever, sores in the mouth, and a rash with blisters on hands and feet.

# Historical Perspective
Notable outbreaks have occurred in Malaysia, Taiwan and China in the past. Hand, foot and mouth disease infected 1,520,274 people with 431 deaths reported up to end of July in 2012 in China. .

# Classification
Hand-foot-and-mouth disease may be classified according to international classification of diseases-10 (ICD-10) into B08.4 Enteroviral vesicular stomatitis with exanthem.

# Pathophysiology
Hand-foot-and-mouth disease usually affects infants and children, and is quite common. It is highly contagious and is spread through direct contact with the mucus or feces of an infected person. It typically occurs in small epidemics in nursery schools or kindergartens, usually during the summer and autumn months.

# Causes
Hand-foot-and-mouth disease may be caused by the following viral organisms Coxsackie viruses (Coxsackievirus A2, A4 to A10, A16, B2, B3, B5), Echoviruses (Echovirus 1, 4, 7, 19) and Enteroviruses (A71).

# Differentiating Hand-foot-and-mouth disease from other Diseases
Herpes simplex virus infections, chicken pox and measles present similar to hand-foot-and-mouth disease, and needs to be differentiated from each other clinically using appropriate diagnostic tests.

# Epidemiology and Demographics
Individual cases and outbreaks of hand-foot-and-mouth disease occur worldwide, more frequently in summer and early autumn. In the recent past, major outbreaks of hand-foot-and-mouth disease attributable to enterovirus 71 have been reported in some South East Asian countries (Malaysia, 1997; Taiwan, 1998)

# Risk Factors
The risk factors predisposing for hand foot mouth disease include: close contact with infected patient, attendance at a kindergarten/child care center, residence in rural areas and poor hygiene.

# Screening
According to the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for hand-foot-and-mouth disease.

# Diagnosis

## History and Symptoms
It is characterized by fever, sores in the mouth, and a rash with blisters. Hand-foot-and-mouth disease begins with a mild fever, poor appetite, malaise and frequently a sore throat.

## Physical Examination
Hand-foot-and-mouth disease is one of many infections that result in mouth sores. Another common cause is oral herpesvirus infection, which produces an inflammation of the mouth and gums. Usually, the physician can distinguish between hand-foot-and-mouth disease and other causes of mouth sores based on the age of the patient, the pattern of symptoms reported by the patient or parent, and the appearance of the rash and sores on examination. A throat swab or stool specimen may be sent to a laboratory to determine which enterovirus caused the illness. Since the testing often takes 2 to 4 weeks to obtain the results, it is therefore not done.

## Laboratory Findings
Physical examination is usually diagnostic for hand foot and mouth disease. However, throat swabs, swabs from the lesion and Tzanck test can be used in diagnosing hand-foot-and-mouth disease.

## EKG
There are no EKG findings associated with hand-foot-and-mouth disease.

## X-Ray
There are no X-Ray findings associated with hand-foot-and-mouth disease.

## CT Scan
There are no CT findings associated with hand-foot-and-mouth disease.

## MRI
There are no MRI findings associated with hand-foot-and-mouth disease.

## Ultrasound
There are no ultrasound findings associated with hand-foot-and-mouth disease.

## Other Diagnostic Tests
Hand foot mouth disease is a clinical diagnosis, there is no need for performing diagnostic tests, however molecular testing can be done to identify the serotype of enterovirus.

# Treatment

## Medical therapy
No specific treatment is available for this or other enterovirus infections. Symptomatic treatment is given to provide relief from fever, aches, or pain from the mouth ulcers.

## Surgical therapy
Surgical intervention is not recommended for the management of hand foot mouth disease.

## Primary Prevention
Specific prevention for hand-foot-and-mouth diseaseor other non-polio enterovirus infections is not available, but the risk of infection can be lowered by good hygienic practices. Preventive measures include frequent handwashing, especially after diaper changes, cleaning of contaminated surfaces and soiled items first with soap and water, and then disinfecting them by diluted solution of chlorine-containing bleach (made by mixing approximately 14 cup of bleach with 1 gallon of water. Avoidance of close contact (kissing, hugging, sharing utensils, etc.) with children with hand-foot-and-mouth disease may also help to reduce of the risk of infection to caregivers.

## Secondary prevention
Secondary prevention measures are the same as the primary preventive measures that should be followed for hand foot mouth disease.