Hand, foot, and mouth disease

Common constitutional signs and symptoms of HFMD include fever, nausea, vomiting, feeling tired, generalized discomfort, loss of appetite, and irritability in infants and toddlers. Skin lesions frequently develop in the form of a rash of flat discolored spots and bumps which may be followed by vesicular sores with blisters on palms of the hands, soles of the feet, buttocks, and sometimes on the lips. The rash is rarely itchy for children, HFMD usually resolves on its own after 7–10 days. Image:Characteristic rash of hand, foot, and mouth disease, on human hands.jpg|Rash on palms of the hands File:Hand Foot Mouth Disease Adult 36Years.jpg|Rash on hands and feet of a 36-year-old man File:Hand foot and mouth disease on child feet.jpg|Rash on the soles of a child's feet ==Cause==

The viruses that cause the disease are of the Picornaviridae family. Coxsackievirus A16 is the most common cause of HFMD. Enterovirus 71 (EV-71) is the second-most common cause. Many other strains of coxsackievirus and enterovirus can also be responsible. Transmission HFMD is highly contagious and is transmitted by nasopharyngeal secretions such as saliva or nasal mucus, by direct contact, or by fecal–oral transmission. It is possible to be infectious for days to weeks after the symptoms have resolved. Childcare settings are the most common places for HFMD to be contracted because of toilet training, diaper changes, and children's propensity to put their hands into their mouths. HFMD is contracted through nose and throat secretions such as saliva, sputum, and nasal mucus as well as fluid in blisters, and stool. ==Diagnosis==

A diagnosis usually can be made by the presenting signs and symptoms alone. ==Prevention==

Preventive measures include avoiding direct contact with infected individuals (including keeping infected children home from school), proper cleaning of shared utensils, disinfecting contaminated surfaces, and proper hand hygiene. These measures are effective in decreasing the transmission of the viruses responsible for HFMD. Protective habits include hand washing and disinfecting surfaces in play areas. No vaccine is currently available in the United States. ==Treatment==

Medications are usually not needed as hand, foot, and mouth disease is a viral disease that typically resolves on its own. Currently, there is no specific curative treatment for hand, foot, and mouth disease. Disease management typically focuses on achieving symptomatic relief. Pain from the sores may be eased with the use of analgesic medications. Infection in older children, adolescents, and adults is typically mild and lasts approximately 1 week, but may occasionally run a longer course. Fever reducers can help decrease body temperature. A minority of individuals with hand, foot, and mouth disease may require hospital admission due to complications such as inflammation of the brain, inflammation of the meninges, or acute flaccid paralysis. Non-neurologic complications such as inflammation of the heart, fluid in the lungs, or bleeding into the lungs may also occur. ==Complications==

Complications from the viral infections that cause HFMD are rare but require immediate medical treatment if present. HFMD infections caused by Enterovirus 71 tend to be more severe and are more likely to have neurologic or cardiac complications including death than infections caused by Coxsackievirus A16. Minor complications due to symptoms can occur such as dehydration, due to mouth sores causing discomfort with intake of foods and fluid. ==Epidemiology==

Hand, foot and mouth disease most commonly occurs in children under the age of 10 HFMD is more common in rural areas than urban areas; however, socioeconomic status and hygiene levels need to be considered. Poor hygiene is a risk factor for HFMD. Outbreaks • In 1997, an outbreak occurred in Sarawak, Malaysia with 600 cases and over 30 children died. • In 1998, there was an outbreak in Taiwan, affecting mainly children. There were 405 severe complications, and 78 children died. The total number of cases in that epidemic is estimated to have been 1.5 million. Vietnam (2,300 cases, 11 deaths), Mongolia (1,600 cases), and Brunei (1,053 cases from June–August 2008). • In 2009 17 children died in an outbreak during March and April 2009 in China's eastern Shandong Province, and 18 children died in the neighboring Henan Province. Out of 115,000 reported cases in China from January to April, 773 were severe and 50 were fatal. • In 2010 in China, an outbreak occurred in southern China's Guangxi Autonomous Region as well as Guangdong, Henan, Hebei, and Shandong provinces. Until March, 70,756 children were infected and 40 died from the disease. By June, the peak season for the disease, 537 had died. • The World Health Organization reporting between January and October 2011 (1,340,259) states the number of cases in China had dropped by approx 300,000 from 2010 (1,654,866) cases, with new cases peaking in June. There were 437 deaths, down from 2010 (537 deaths). • In December 2011, the California Department of Public Health identified a strong form of the virus, coxsackievirus A6 (CVA6), where nail loss in children is common. • In 2012 in Alabama, United States there was an outbreak of an unusual type of the disease. It occurred in a season when it is not usually seen and affected teenagers and older adults. There were some hospitalizations due to the disease but no reported deaths. • In 2012 in Cambodia, 52 of 59 reviewed cases of children reportedly dead () due to a mysterious disease were diagnosed to be caused by a virulent form of HFMD. Although a significant degree of uncertainty exists with reference to the diagnosis, the WHO report states, "Based on the latest laboratory results, a significant proportion of the samples tested positive for enterovirus 71 (EV-71), which causes hand foot and mouth disease (HFMD). The EV-71 virus has been known to generally cause severe complications amongst some patients." • HFMD infected 1,520,274 people with up to 431 deaths reported at the end of July in 2012 in China. • In 2018, more than 50,000 cases occurred through a nationwide outbreak in Malaysia with two deaths also reported. India 2022 An outbreak of an illness referred to as tomato fever or tomato flu was identified in the Kollam district on May 6, 2022. The illness is endemic to Kerala, India and gets its name because of the red and round blisters it causes, which look like tomatoes. Flu may be a misnomer. The condition mainly affects children under the age of five. An article in The Lancet states that the appearance of the blisters is similar to that seen in Mpox, and the illness is not thought to be related to SARS-CoV-2. Symptoms, treatment and prevention are similar to HFMD. ==History==

HFMD cases were first described clinically in Canada and New Zealand in 1957. The disease was termed "Hand Foot and Mouth Disease", by Thomas Henry Flewett, after a similar outbreak in 1960. ==Research==

Novel antiviral agents to prevent and treat infection with the viruses responsible for HFMD are currently under development. Preliminary studies have shown inhibitors of the EV-71 viral capsid to have potent antiviral activity. == References ==