Hand, Foot, and Mouth Disease (HFMD)

This grand rounds presentation and discussion focused on hand, foot, and mouth disease (HFMD). HFMD is a highly contagious, self-limiting viral illness most commonly seen in children under ten years old [Pue14]. It is caused by viruses in the enterovirus family, most frequently the coxsackievirus A16. It is spread by direct contact with nasal discharge, saliva, blister fluid, or stool. The individual may be asymptomatic and still be contagious, with the virus persisting for several weeks, most commonly in stool. HFMD is not the same as foot and mouth disease, which is found in cattle, and there is no cross-species infectious concern.

Presentation:HFMD typically presents with one to two days of fever, sore throat, general malaise, painful mouth lesions, and a red rash that often appears on the palms of the hands and soles of the feet.

Diagnostics:HFMD is diagnosed clinically, with no need for further testing unless there is reason to believe it may be caused by enterovirus-71, which is commonly found in Asia and has more severe symptoms, side effects, and complications [Ste13]. To test for the virus type, a throat swab or swab of the vesicle fluid is most effective. A CBC may also be done and will show an elevated WBC and atypical lymphocytes [Ame13].

Differential Diagnoses:

• Nongenital herpes simplex virus type 1 (HSV-1): A common infection that most often involves the oral mucosa or lips. The primary oral infection may range from asymptomatic to very painful, leading to poor oral intake and dehydration. Recurrent infections cause cold sores that can affect appearance and quality of life. The virus can be transmitted by kissing or sharing utensils or towels. Transmission involves mucous membranes and open or abraded skin. In primary oral HSV-1, symptoms may include a fever, followed by mouth lesions with submandibular and cervical lymphadenopathy. The mouth lesions…

This document provides an overview of HFMD, including its cause, mode of transmission, presentation, diagnostics, and differential diagnoses, focusing specifically on its common confusion with HSV-1 due to similar oral presentations.