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Hand, foot and mouth disease is an infectious disease caused by enteroviruses. There are more than 20 types of enteroviruses that cause hand, foot and mouth disease. Coxsackie virus A16 (Cox A16) and enterovirus 71 (EV 71) ) Is the most common. It usually occurs in children under 5 years of age, showing oral pain, anorexia, low fever, small herpes or small ulcers in the hands, feet, mouth and other parts. Most children heal about a week or so, and a few children can cause myocarditis, pulmonary edema, and sterility. Meningoencephalitis and other complications. Individual severely ill children develop rapidly and cause death. There is currently a lack of effective treatments for symptomatic treatment.

Basic Information

English name: hand-foot-and-mouth disease, HFMD
Visiting department: Pediatrics, Pediatric Infectious Diseases
Multiple groups: Toddler
Common locations: Hands, feet, mouth

Common causes: Enterovirus infection
Common symptoms: Mouth pain, anorexia, low fever, small herpes on hands, feet, mouth, etc.
Contagious: Have
way for spreading: Gastrointestinal, respiratory, contact

Causes of hand, foot and mouth disease

There are a variety of enteroviruses that can cause hand, foot and mouth disease. The most common are Coxsackie virus A16 and enterovirus 71. The routes of infection include the digestive tract, respiratory tract and contact transmission.

Clinical manifestations of hand, foot and mouth disease

Hand, foot and mouth disease mainly occurs in children under 5 years of age, and the incubation period is mostly 2 to 10 days, with an average of 3 to 5 days.

Common case manifestation

Acute onset, fever, mouth pain, anorexia, oral mucosa scattered scattered herpes or ulcers, located in the tongue, buccal mucosa and hard forehead, etc., can also affect the soft palate, gums, tonsils and pharynx. Macular papules appear on the hands, feet, buttocks, arms, and legs, and then turn into herpes. There may be inflammatory flushes around the herpes and less fluid in the pustules. There are many hands and feet, both on the back of the palm. The number of rashes ranges from a few to a few dozen. Leave no trace after dissipating, no pigmentation. Some cases show only rash or herpetic angina. Healed within one week, and the prognosis is good. In some cases, the rash is not typical, such as a single site or only maculopapular rash.

2. Performance of severe cases

A small number of cases (especially those under 3 years of age) have progressed rapidly, and meningitis, encephalitis (the most dangerous of which is brainstem encephalitis), encephalomyelitis, pulmonary edema, and circulatory disorders occur in about 1 to 5 days after onset. The case is critically ill and can cause death. Survival cases can have sequelae.

(1) Nervous system performance Complicated with central nervous system disease: poor mentality, drowsiness, panic, headache, vomiting, delirium and even coma; limb tremor, myoclonus, nystagmus, ataxia, eye movement disorders; weakness or Acute flaccid paralysis; convulsions. Examination revealed meningeal irritation, weakened or disappeared tendon reflexes, and positive Pap syndrome. Children with central nervous system symptoms are more common in children under 2 years of age.

(2) Respiratory system manifestations with pulmonary edema: shallow breathing, dyspnea, or changes in rhythm, cyanosis of the lips, cough, white, pink, or bloody foamy sputum; wet lungs or sputum sounds can be heard in the lungs .

(3) Circulatory system manifestations and myocarditis manifestations: pale complexion, skin pattern, cold limbs, cyanosis of fingers (toes); cold sweat; prolonged capillary refilling time. The heart rate increases or decreases, the pulse rate decreases or weakens, or even disappears; the blood pressure increases or decreases.

Hand, Foot and Mouth Disease Examination

Routine examination: peripheral blood leukocytes decreased or normal; urine and stool were generally normal. Pharyngeal swabs or stool specimens can be sent to the laboratory for virus testing, but virus testing takes 2 to 4 weeks to produce results.

Hand, Foot and Mouth Disease Diagnosis

According to clinical symptoms and signs, the characteristics of typical rash distribution in the oral cavity, hands, and feet during large-scale epidemics. The diagnosis is not difficult.

Differential diagnosis of hand, foot and mouth disease

When scattered, it must be distinguished from herpes pharyngitis and rubella:

Herpes simplex stomatitis

The disease can occur in all four seasons, caused by herpes simplex virus, mainly in sporadic cases. Herpes and ulcers appear in the oral mucosa. But there is no herpes on the hands and feet.

2. Herpetic pharyngitis

Mainly caused by coxsackie virus, the child has fever and sore throat, and the oral mucosa is scattered with gray-white herpes, with red around and herpes ulceration. The lesions are in the back of the mouth; for example, the front of the tonsils, soft palate, and uvula, rarely involve the buccal mucosa, tongue, and gums. Atypical children must be examined for etiology and serum.

Hand, Foot and Mouth Disease Treatment

General treatment

The prognosis of this disease is generally good if there are no complications, and it usually heals within one week. Mainly symptomatic treatment.

(1) Isolate the child first, and the contacts should be disinfected and isolated to avoid cross infection.

(2) Symptomatic treatment and oral care.

(3) The clothes and bedding should be clean, and the clothes should be comfortable, soft and frequently changed.

(4) Shorten your baby's nails and wrap your baby's hands if necessary to prevent scratching the rash

(5) Babies who have a rash on their hips should clean their stools at any time to keep their hips clean and dry.

(6) Can take antiviral drugs, clearing heat and detoxifying Chinese herbal medicine, and supplementing vitamins B and C.

2. Combined treatment

(1) Closely monitor the changes of the condition, especially the important organ functions such as brain, lung, and heart; critically ill patients pay special attention to monitoring blood pressure, blood gas analysis, blood glucose and chest radiographs.

(2) Pay attention to maintaining water, electrolyte, acid-base balance and protection of important organs.

(3) Those with increased intracranial pressure will be treated accordingly.

(4) Those who have signs of respiratory failure such as hypoxemia and dyspnea should be treated with mechanical ventilation as soon as possible.

(5) Maintain blood pressure stability.

Other severe treatments: If DIC, pulmonary edema, heart failure, etc. occur, they should be treated accordingly.

3. Antiviral drugs

Because antiviral drugs are generally best used 24 to 48 hours before onset. And often when we are diagnosed with hand, foot and mouth disease, we have passed the most effective stage of treatment, and now we do not advocate the use of antiviral drugs.

Hand, Foot and Mouth Disease Prevention

1. Wash your hands with soap or hand sanitizer, etc. before meals, after going out, and after going out. Do not let children drink raw water or cold food, and avoid contact with sick children.

2. Caregivers should wash their hands before handling children, change diapers for young children, and handle feces, and dispose of dirt properly.

3. Baby bottles and pacifiers used by infants should be thoroughly cleaned before and after use.

4. It is not advisable to bring children to public places where crowds gather and poor air circulation during the epidemic of this disease. Pay attention to maintaining family environmental hygiene. The room should be ventilated frequently and clothes should be frequently washed.

5. Children with related symptoms should go to a medical institution for treatment. Children should not touch other children. Parents should promptly dry or sterilize the children's clothing, and disinfect the feces of children in time. Mild children do not need to be hospitalized. They should be treated and rested at home to reduce cross infection.

6. Daily disinfection of toys, personal hygiene appliances, tableware and other items.

7. The childcare unit conducts morning inspection every day, and when suspicious children are found, they take measures to send them to the clinic in time and rest at home. The items used by the children should be disinfected immediately.

8. When the number of children increases, report to the health and education department in a timely manner. Depending on the needs of the epidemic control, local education and health departments may decide to adopt childcare institutions or elementary school holiday measures.