Hand, Foot, and Mouth Disease (Coxsackievirus)

Vignette

5-year-old boy presents to the Emergency Department with low-grade fever and lesions on his hands and feet. Mom notes that two other kids in his kindergarten class have a similar rash. She also noticed ulcers on his tongue and inner inner cheeks. 

Epidemiology: 

• most cases affect children younger than 10-years-old
  
• tends to occur during the summer-fall
  

Etiology

• Coxsackievirus A16
  
• Enterovirus 71

Clinical Findings

• prodrome of fever, malaise, and sore throat
• vesicular rash
  

• mouth: mucositis, vesicles on buccal mucosa, tongue, palate, uvula, or tonsillar pillars 
• hands: tender vesicular lesions on the palms and back (dorsum) of hands which may form bullae ulcerate  
• feet: including the soles

Diagnosis

• based on clinical findings above

Management

• Isolation - highly infectious
• Supportive therapy (hydration maintenance with fever and pain control)
  
• Painful oral ulcers can be treated with topical oral anesthetics
• Magic Mouthwash - 2% viscous lidocaine, Benadryl, and Maalox 
•  20% topical benzocaine (Orabase)
• Fever and Joint Pains
• Acetaminophen or NSAIDs/cyclooxygenase (COX)-2's
  
• AVOID ASPIRIN viral illnesses in children younger than 12 years of age, to prevent Reye syndrome.

Prognosis

• Self-limited - resolves in 2 to 3 days after the appearance of rash 
  

Review

• See my video on vesicular rashes below for a quick review
• The color-coded highlighting is as follows:
• Green - the diagnosis or disease process
• Orange - key features and buzzwords
• Blue - management and treatment