Description

Hand, foot, and mouth disease is a viral illness with the characteristic clinical features of the following:

• Vesiculoulcerative stomatitis
• Papular or vesicular exanthem on the hands and/or the feet
• Constitutional symptoms such as fever and malaise

Epidemiology

• In temperate climates, hand, foot, and mouth disease is most common in the summer and fall (a pattern common to many of the enterovirus infections).
• In tropical climates, disease is present year-round.
• Incubation period is 3 to 6 days.
• Highly contagious, afflicting up to 50% of those exposed
• Close household contacts are particularly susceptible.
• Most common in children <5 years but may affect adults
• May occur as an isolated case or in an epidemic distribution

General Prevention

• Frequent hand washing, especially after changing diapers, and good personal hygiene are the most useful means to prevent spread of enteroviral illnesses.
• Contact precautions should be maintained with all hospitalized patients.
• The prodromal and enanthem periods appear to be the most contagious; however, some may shed virus in the stool up to 3 months after infection.

Pathophysiology

• Enteroviruses are acquired primarily from oral–fecal contamination, but respiratory secretions may also transmit the virus.
• Lymphatic invasion leads to viremia and spread to secondary sites.
• Viremia ceases with antibody production.
• Direct inoculation of the extremities from oral lesions has been hypothesized with regard to hand, foot, and mouth disease.

Etiology

Coxsackie A16 virus is the most common causative agent. Other enterovirus serotypes commonly associated include:

• Coxsackieviruses A5, A7, A9, A10, A16, B1, and B3
• Enterovirus 71
• Echoviruses