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CASE REPORT
Year : 2016  |  Volume : 17  |  Issue : 4  |  Page : 290-293

Hand, foot, and mouth disease: A case series from rural set up of Gujarat


Department of Dermatology and Venereology, Pramukhswami Medical College, Karamsad, Gujarat, India

Date of Web Publication7-Oct-2016

Correspondence Address:
Pragya Nair
Department of Dermatology and Venereology, Pramukhswami Medical College, Karamsad - 388 325, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-7250.184331

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  Abstract 

Hand foot and mouth disease (HFMD) is common viral illness among children characterized by prodromal fever followed by sore throat, rash over hands and feet, and ulcers in mouth. Though rare, patients can develop complications. The treatment of HFMD is usually supportive. It is important for us as a health care professional to be aware about this condition to prevent complications. Good hygienic practices are the most important preventive strategies to stop epidemics. A series of eight cases diagnosed as HFMD on clinical basis are presented here.

Keywords: Contagious, coxackie virus, foot and mouth disease, hand, viral infection


How to cite this article:
Singh R, Diwan N, Nair P. Hand, foot, and mouth disease: A case series from rural set up of Gujarat. Indian J Paediatr Dermatol 2016;17:290-3

How to cite this URL:
Singh R, Diwan N, Nair P. Hand, foot, and mouth disease: A case series from rural set up of Gujarat. Indian J Paediatr Dermatol [serial online] 2016 [cited 2021 Oct 22];17:290-3. Available from: https://www.ijpd.in/text.asp?2016/17/4/290/184331


  Introduction Top


Hand foot and mouth disease (HFMD) is self-limiting viral disease once considered a disease of cattle affects predominantly children and immunocompromised adults. It is highly contagious, transmitted through faeco-oral route, oro-oral route and by droplet infection. It is characterized by prodromal fever followed by sore throat, rash over hands and feet and ulcers in mouth.[1] It usually resolves within 2 weeks without any complications. Many outbreaks have been seen in recent decades all over the world because of its high infectivity. Humans are thought to be the only natural host of coxsackievirus. As it is transmitted by oro-oral or fecal-oral routes, education regarding hygienic precautions is very important. A series of eight patients diagnosed on a clinical basis as HFMD are presented here.


  Case Report Top


Cases ranged from 2 to 16 years of age group with two males and six females. All patients presented with fever and malaise. Morphology was in the form of papules [Figure 1] and [Figure 2], erosion [Figure 3], crust [Figure 4], vesicles [Figure 5] and [Figure 6] and excoriation. Apart from hand, foot, and oral cavity which was affected in all patients, other sites affected were limbs, perianal region, and buttock in five patients [Table 1]. None of the patients developed any complications.
Figure 1: Multiple erythematous papules over both palms

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Figure 2: Erythematous papules over upper limb

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Figure 3: Erosion over lower lip

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Figure 4: Papules with crusting at buttocks and perianal region

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Figure 5: Erythematous papules and vesicles over perineal region and inner aspect of thigh

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Figure 6: Multiple vesicles over both palms

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Table 1: Clinical details of patients

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  Discussion Top


HFMD was first reported by Robinson and Rhodes in 1958 from Toronto, Canada. It is a common and sometimes potentially fatal infectious disease in children which largely relies on clinical manifestations for early diagnosis, which includes maculopapular or vesicular rashes on soles, palms and buttocks, and oral ulcers in the pharynx.[2]

It is caused by few serotypes of genus enteroviruses (family picornaviridae), most frequently coxackie virus A16 (CAV), and human enterovirus 71. Other serotypes associated are CAV 4, 5, 9, and 10 and coxackie virus B 2 and 5.[3]

Epidemics of HFMD generally occur in the summer to early autumn months, although cases can occur sporadically through out the year. Our patients also presented in the months of autumn.

The incubation of disease is from 3 to 6 days. Disease starts with prodromal symptoms of fever, malaise, sore throat, and sometimes vomiting followed by painful oral ulcers on buccal mucosa, tongue, and hard palate. This initial phase of enanthem is usually followed by erythematous, papular or vesicular skin lesions, localized predominantly on palms and soles. Less commonly the lateral and dorsal surface of hands and feet, and perioral skin can be affected.[1] Buttocks and genitalia can also be involved [4] as was seen in few of our cases. Oral lesions usually precede cutaneous lesions, but the simultaneous occurrence of lesions on the hands, feet, and in the oral cavity in adults is very infrequent. In addition, oral lesions may occur without cutaneous lesions.[5]

HFMD is commonly misdiagnosed as aphthous ulcers. Oral erosions in HFMD are usually smaller, more uniform and asymptomatic unlike those in herpetic gingivostomatitis which are painful and coalesces, and those of varicella usually last longer and always crust. Cutaneous lesions mimics as varicella zoster, papular urticaria, impetigo, and pompholyx, but the constellation of features is unique enough to aid instant clinical diagnosis with certainty in almost all cases.

The diagnosis of HFMD is mainly based on clinical grounds. The virus can also be isolated and identified via culture, immunoassay, serologic testing, polymerase chain reaction and microarray technology but laboratory studies are usually unnecessary.

HEV-71 has resulted in outbreaks of HFMD with associated neurologic involvement in the western Pacific region which includes polio like syndrome, aseptic meningitis, encephalitis, encephalomyelitis, acute cerebellar ataxia, acute transverse myelitis, Guillain-Barré syndrome, opsomyoclonus syndrome, and benign intracranial hypertension.[6]

The first report of disease outbreak in India came in 2004 from Calicut.[7] After 3 years, the first large outbreak occurred in 2007 from Kolkata and West Bengal. Many small scales outbreaks have been repeatedly reported from different places.[8] Due to mild nature of the disease, it goes undiagnosed or even ignored by the patient himself.

The treatment of HFMD is usually supportive. Ensure adequate fluid intake to prevent dehydration. Fever is treated with antipyretics. Pain may be treated with standard doses of acetaminophen or ibuprofen. Direct analgesia may be applied to the oral cavity through mouthwashes or sprays. Intravenous immunoglobulin and milrinone have shown some efficacy in a few reports.[9] Pleconaril is an uncoating inhibitor that shows promise in enterovirus 71-associated infections. Amantadine and quinacrine, both translation inhibitors, and ribavirin, a replication inhibitor, are also being investigated as treatment options.

There is no normal enteric virus flora. Usually, only one type of enterovirus multiplies within the intestine of an individual at any given time. Polio vaccination has eliminated polioviruses from the gut, thereby increasing the chances of coxsackieviral and echoviral infections. It is possible that the emergence of HFMD in India may be related to the mass polio vaccination routinely done nowadays.[10]

Prevention of further spread of the disease is the only way to control it from becoming a large outbreak. As the organisms are enterovirus, they spread through faeco-oral route. Strict implementation of basic protocols like monitoring cleanliness of the hands, utensils and drinking water and avoiding direct contact with affected people. Restriction of the affected children from attending school or other outdoor activities is a simple but effective strategy.[11]


  Conclusion Top


HFMD, that was once considered a disease of cattle, has been emerging as a common human childhood disease in the last few years. The incidence of this disease increases every year. Though in most of the cases, it is nonfatal, there are some reported cases of complications seen in HFMD patients. It is important for dermatologists, pediatrician, general dentist as well as physician to be aware of this disease as they may be the first health care professional to be consulted in such cases. Good hygienic practices are the most important preventive strategies.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
  References Top

1.
Kaminska K, Martinetti G, Lucchini R, Kaya G, Mainetti C. Coxsackievirus A6 and hand, foot and mouth disease: Three case reports of familial child-to-immunocompetent adult transmission and a literature review. Case Rep Dermatol 2013;5:203-9.  Back to cited text no. 1
    
2.
Ooi MH, Wong SC, Lewthwaite P, Cardosa MJ, Solomon T. Clinical features, diagnosis, and management of enterovirus 71. Lancet Neurol 2010;9:1097-105.  Back to cited text no. 2
    
3.
Robinson CR, Doane FW, Rhodes AJ. Report of an outbreak of febrile illness with pharyngeal lesions and exanthem: Toronto, summer 1957; isolation of group A coxsackie virus. Can Med Assoc J 1958;79:615-21.  Back to cited text no. 3
    
4.
Saeed A, Khan QM, Waheed U, Arshad M, Asif M, Farooq M. RT-PCR evaluation for identification and sequence analysis of foot-and-mouth disease serotype O from 2006 to 2007 in Punjab, Pakistan. Comp Immunol Microbiol Infect Dis 2011;34:95-101.  Back to cited text no. 4
    
5.
Shin JU, Oh SH, Lee JH. A case of hand-foot-mouth disease in an immunocompetent adult – Case report. Ann Dermatol 2010;22:216-8.  Back to cited text no. 5
    
6.
Chan KP, Goh KT, Chong CY, Teo ES, Lau G, Ling AE. Epidemic hand, foot and mouth disease caused by human enterovirus 71, Singapore. Emerg Infect Dis 2003;9:78-85.  Back to cited text no. 6
    
7.
Sasidharan CK, Sugathan P, Agarwal R, Khare S, Lal S, Jayaram Paniker CK. Hand-foot-and-mouth disease in Calicut. Indian J Pediatr 2005;72:17-21.  Back to cited text no. 7
    
8.
Dwibedi B, Kar BR, Kar SK. Hand, foot and mouth disease (HFMD): A newly emerging infection in Orissa, India. Natl Med J India 2010;23:313.  Back to cited text no. 8
    
9.
Toida M, Watanabe F, Goto K, Shibata T. Usefulness of low-level laser for control of painful stomatitis in patients with hand-foot-and-mouth disease. J Clin Laser Med Surg 2003;21:363-7.  Back to cited text no. 9
    
10.
Rao PK, Veena K, Jagadishchandra H, Bhat SS, Shetty SR. Hand, foot and mouth disease: Changing Indian scenario. Int J Clin Pediatr Dent 2012;5:220-2.  Back to cited text no. 10
    
11.
Sarma N. Hand, foot, and mouth disease: Current scenario and Indian perspective. Indian J Dermatol Venereol Leprol 2013;79:165-75.  Back to cited text no. 11
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1]



 

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