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Questions from practice: Hand, foot and mouth disease

The paracetamol is for my eight-year-old son. The doctor says he’s got“hand, foot and mouth”. He went on a school trip to a local farm lastweek. Could he have picked it up from that? And should I keep him outof school until all the blisters disappear?

by Lin-Nam Wang

Hand, foot and mouth disease

Question

The paracetamol is for my eight-year-old son. The doctor says he’s got “hand, foot and mouth”. He went on a school trip to a local farm last week. Could he have picked it up from that? And should I keep him out of school until all the blisters disappear?

 

Answer

Figure 1: mouth ulcers (DRrP. Marazzi/ SPL)

Figure 1: mouth ulcers (DRrP. Marazzi/ SPL)

Figure 2: blisters on palm (©2006 Galderma S.A/www.dermquest.com)

Figure 2: blisters on palm (©2006 Galderma S.A/www.dermquest.com)

The parent is probably confusing his or her son’s condition with foot and mouth disease, a viral infection that affects cloven-hooved animals.

There have been no outbreaks of foot and mouth disease in the EU since 2007 and, according to the Department for Environment Food and Rural Affairs, there has only ever been one recorded case of this disease in a human in Britain.

Hand, foot and mouth disease (HFMD) is not related to foot and mouth disease and visiting a farm is, therefore, not a significant factor.

HFMD is a viral illness commonly caused by Coxsackie virus A16, but other strains of Coxsackie and enterovirus have also been implicated.

Diagnosis is usually clinical because by the time test results are obtained the person should have recovered. Children under 10 years of age are most commonly affected.

Typical symptoms are:

  • Ulcers in the mouth (on oral mucosa, tongue, gums and lips), which are usually surrounded by a red ring (see Figure 1)
  • Small spots on the hands and feet (particularly the palms and soles and between the fingers and toes), which become tender blisters (see Figure 2)

 

These symptoms resulted in the name of the disease but a rash can also appear on the buttocks, genitalia, trunk and thighs.

HFMD usually starts with fever, malaise and sore throat (a couple of days before the lesions develop).

The illness is typically mild and self-limiting, resolving within 10 days. There is no specific treatment. Paracetamol or ibuprofen can be used for fever and pain. A topical analgesic or anaesthetic for the mouth (appropriate to the age of the patient) may be recommended.

HFMD epidemics can occur because the causative virus is easily spread. It is found in nasal secretions, saliva, blister fluid and faeces. Attention to hand washing is important, particularly for preventing transmission by the oral faecal route — the virus can continue to be excreted for a few weeks so asymptomatic people can still pass on the infection.

Following advice from PatientUK, unless the child feels unwell he does not have to be kept out of school. However, it is worth stressing the importance of good hygiene practices and avoiding close contact with others. The parent may wish to consult the child’s school.

One of the most common complications of HFM is dehydration because painful ulcers in the mouth prevents the sufferer from eating and drinking. Fluid intake should be encouraged.

Rare complications of HMFD include viral meningitis and encephalitis so the parent should be made aware of prolonged influenza-like symptoms with headache with drowsiness, confusion and neck stiffness. HFMD is not a notifiable illness.

Citation: The Pharmaceutical Journal URI: 10963303

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