Hand, foot, and mouth disease is a common illness of infants and children
With the schools in full flow and the start of the rainy season, there is the ever growing risk among children of having hand-foot- and mouth disease (HFMD).
If and when this disease does break out at schools, it could be an epidemic and cause schools to close.
What causes hand- foot- mouth disease?
A group of viruses called enterovirus causes hand-foot-mouth disease.
The most common strains causing this disease are Coxsackievirus A16 and Enterovirus 71. Hand-foot-mouth disease should not be confused with foot-and-mouth disease of cattle, sheep and swine. Although the names are similar, these two diseases are not related at all. The usual incubation period is three to six days. It typically occurs in small epidemics in nursery schools or kindergartens.
Transmission
The virus that causes the HFMD disease can be transmitted via snot, saliva, faeces and pus on hands or in droplet spreads from an infected individual, who may not appear to have any symptoms. The transmission occurs easily during the first week of illness, as the virus is concentrated in the throat. In two to three weeks, the virus enters the body through the membranes of the pharynx and the intestine, concentrating at the tonsil and the intestinal lymphoid tissue and released from the body with the faeces. There is no evidence of transmission via insects, water, food, and wastes.
Symptoms
Fever, sore mouth and throat, and blisters on the hands and feet are common symptoms. It begins with a fever, poor appetite and frequently a sore throat. One or two days after the fever begins, painful sores develop in the mouth. They begin as small red spots that blister and then often become ulcers. A skin rash develops over one to two days with flat or raised red spots, some with blisters. The rash does not itch, and it is usually located on the palms of the hands and soles of the feet. It may also appear on the buttocks and not all the symptoms will be present in all cases.
Treatment
There is no specific treatment for HFMD. Symptomatic treatment is given to provide relief from fever, aches, or pain from the mouth ulcers. Antibiotic is not helpful since it is caused by a virus. Nearly all victims of the disease recover in seven to 10 days. Complications are uncommon.
Rarely, a patient with a Coxsackievirus A16 infection may develop viral meningitis. Enterovirus 71 may also cause viral meningitis and, rarely, more serious diseases, such as encephalitis.
Enterovirus 71 encephalitis may be fatal.
Particular attention should be given to washing hands, especially after changing diapers of a child suffering from HFMD.
Dr Nuthaitip Kashemsri na Ayudhaya is attached to the Child's Health Institute at Samitivej Sukhumvit Hospital. She has a diploma from the Thai Board of Paediatrics and a diploma from the Thai Board of Family Medicine.
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