HAND, FOOT & MOUTH

DISEASE (HFMD)
Charlotte Saldanha, MD
Eric Jake C. Lim

DIFFERENTIAL
DIAGNOSIS

DIFFERENTIAL
DIAGNOSIS
Herpangina
Enterovirus

OTHERS:
Herpes simplex, Lyme Disease, Pharyngitis
(viral)

HERPANGINA
Acute

febrile illness,
associated with small
vesicular or ulcerative
lesions on the posterior
oropharyngeal structures
(enanthem).

HERPANGINA
RULE-IN
Fever
Sore

throat and pain upon

swallowing
Anorexia
Emesis
Abdominal pain
Maculopapular rash

HERPANGINA
RULE-OUT

Cannot

totally rule-out

ENTEROVIRUS
Ubiquitous

viruses transmitted
form person-to-person via direct
contact with virus shed from the
GIT or URT
3 Genera
Poliovirus
Coxsackievirus (Groups A & B)
Echoviruses

ENTEROVIRUS
Disease of children < 10
RULE-IN
Most common is CAV-16
Incubation: 3-6 days
Prodromal: fever, cough,

y/o

sore
throat, malaise and anorexia.
Prodrome lasts 12-36 hours then
vesicular eruptions of hands, feet
and oral cavity

HAND FOOT MOUTH DISEASE

Prepared by: Eric Jake C. Lim

DMSF

Pediatric Department

HAND FOOT MOUTH

DISEASE
HFM

Disease is a viral syndrome

with a distinct exanthem
enanthem.

This

clearly recognizable syndrome

is characterized by enanthem
(vesicular lesions on the mouth)
and an exanthem (on the hands
and feet and buttocks) in

HAND FOOT MOUTH

DISEASE

The lower lip has an ulcer with an

erythematous halo.

HAND FOOT MOUTH

DISEASE

The tongue has an ulcer with an

erythematous halo.

HAND FOOT MOUTH

DISEASE

A typical cutaneous lesion has an

elliptical vesicle surrounded by an
erythematous halo. The long axis of the

HAND FOOT MOUTH

DISEASE

WHAT CAUSES HFMD?

The

most common causes of Hand,

Foot and Mouth disease are
coxsackie virus A16,
enterovirus 71 (EV71)

The

enterovirus group includes

polioviruses,
coxsackieviruses,
echoviruses and other enteroviruses.

WHEN AND WHERE DOES

HFMD OCCUR?
Individual cases and
outbreaks of HFMD occur
worldwide, more frequently in
summer and early autumn (in
temperate countries).

WHEN AND WHERE DOES

HFMD OCCUR?
In the recent past, major
outbreaks of HFMD
attributable to enterovirus
EV71 have been reported in
Malaysia in 1997 and in
Taiwan in 1998.
HFMD is endemic in Malaysia

IS HFMD SERIOUS?
HFMD

caused by
coxsackie virus A16
infection
is a mild disease and
nearly all patients recover

within 7 to 10 days.
Complications

are

IS HFMD SERIOUS?
HFMD

caused by
Enterovirus EV71 may be
associated with
neurological complications
such as aseptic
meningitis and

IS HFMD SERIOUS?
Cases

of fatal encephalitis
which occurred during
outbreaks of HFMD in
Malaysia in 1997 and in
Taiwan in 1998 were
caused by EV71.

IS HFMD CONTAGIOUS?
Yes,

HFMD is moderately
contagious.
A person is most
contagious during the first
week of the illness.

IS HFMD CONTAGIOUS?
The

virus can be transmitted

from person to person via
direct contact with nose and

throat discharges, saliva,

fluid from blisters, or the stool
of infected persons.

IS HFMD CONTAGIOUS?
The

virus may continue to be

excreted in the stools of
infected persons up till 1
month.
HFMD is not transmitted to or
from pets or other animals.

HOW SOON WILL SOMEONE

BECOME ILL AFTER GETTING
INFECTED?
The usual period from

infection to onset of
symptoms (incubation
period) is 3 to 7 days.
Fever is often the first
symptom of HFMD
followed by blister/rash.

WHAT ARE THE CLINICAL

SIGNS AND SYMPTOMS?
HFMD

begins with a mild

fever, poor appetite,
malaise ("feeling sick"),
and frequently a sore
throat.
One or 2 days after the
fever begins, painful sores

WHAT ARE THE CLINICAL

SIGNS AND SYMPTOMS?
They

begin as small
red spots that blister
and then often become
ulcers.

WHAT ARE THE CLINICAL

SIGNS AND SYMPTOMS?
They

are usually located on

the tongue, gums, and
inside of the cheeks.
The skin rash develops over
1 to 2 days with flat or
raised red spots, some with
blisters on the palms of the
hand and the soles of the

WHAT ARE THE CLINICAL

SIGNS AND SYMPTOMS?
A

person with HFMD may

have only the rash or the
mouth ulcers.

BLISTER ON THE PALM OF

THE HAND

BLISTER ON THE DORSUM

OF THE FEET

BLISTER THEN BECOMES

ULCER ON THE INNER GUM

BLISTER ON THE SOLES OF

THE FEET

HOW FOOT, HAND &

MOUTH DISEASE
DIAGNOSED?
Based on a complete
history and physical
examination of your child.
It is generally suspected
on the appearance of
blister-like rash on hands,
feet and mouth in children

HOW FOOT, HAND &

MOUTH DISEASE
DIAGNOSED?
Usually,

the doctor can

distinguish between HFMD and
other causes of mouth sores
based on the
age of the patient,
the pattern of symptoms reported

by the patient or parent, and

the appearance of the rash and
sores on examination.

HOW FOOT, HAND &

MOUTH DISEASE
DIAGNOSED?
A

throat and/or blister swab

collected preferably within 2
days of onset of HFMD may
be sent to a laboratory to
determine which enterovirus
caused the illness.

COMMON PITFALLS IN HFMD