Hand, Foot and Mouth Disease – The Gift That Keeps On Giving

Hand, Foot and Mouth!Hand, Foot and WHAT!!

Hand, foot and what? Isn’t that the virus that infected all of those cows in England? Is that the reason that everyone in my playgroup looks like they have chicken pox? Should we move into an underground bunker? Are we all going to turn into zombies? AAAAAAAAHHHHH!!!! (answers below!)

Greetings, friends from around the world!  If you are one of my loyal readers from the local area, you may have heard rumors of a recent cluster of hand, foot and mouth (HFM) disease cases in Sigonella. I wanted to give you a little more information about the disease – so hopefully, you can feel comfortable crawling out of your bunkers!

    A happily recovering recent patient of mine. He has now returned to bouncing off of walls!
A happily recovering recent patient of mine. He has now returned to bouncing off of walls!

So, what is it?

Hand, foot and mouth disease (or syndrome) is a common viral infection, usually affecting kids (but can affect adults). I suppose a more accurate name for the condition would be “hand, foot, mouth and buttock disease” because those are the most common places that I see the rash. In addition to a fever, children will get ulcers on the lips and mouth and whitish blisters or red bumps on the hands and feet. The condition is classically caused by viruses such as coxsackievirus, echovirus or enterovirus. The most common is coxsackievirus – scary name, usually not so scary of an illness. These viruses can cause a variety of rashes –some people may have red bumps everywhere, some may seem to have bruises on their feet, others are covered with little blisters – usually on the areas described above, but often everywhere. And if some are you are saying – “hey, that’s what my rash looked like!”, that’s probably because you saw me recently. All the rashes that I just listed, I have seen in the past two days.

Oh, no – what do I do!

The good news is that other than possibly ruining your holiday portrait with a face-full of little blisters, this is generally a pretty mild disease. The fever usually goes away on its own in 2-3 days. The rash will generally peak in the same time frame. After that, your kid will be happy and back to bouncing off your walls. However, often the rash can take a week or two to heal; ulcers in the mouth should heal more quickly. There are a few kids that can get a little sicker – most commonly if sores in the mouth make it difficult to drink, leading to dehydration. Some of the viruses listed above can also cause meningitis, encephalitis or myocarditis (infections of the nervous system or heart). However, these are rare, usually caused by different strains of virus than those that cause HFM, and especially in the case of nervous system infections, almost always resolve in a week or so. If you think your child is dehydrated, in a lot of discomfort, or more sick than you would expect (expect your child to act like a fussy but normal version of him or herself), you should bring them to your local friendly medical provider to be seen.

Treatment is generally just keeping kids comfortable while their bodies heal themselves. If swallowing is uncomfortable, some Tylenol or Motrin might help the pain and/or fever, and cold or soft foods (like popsicles and ice cream – yum!) will always be well received. If that’s not enough, your doctor may have some suggestions for mouthwashes, lozenges or prescription medications.

The blisters classically look like this
The blisters classically look like this

Harmless, maybe – but I still don’t want it!

Prevention is difficult. Most transmission is via stool (Gross! Wash your hands after using the bathroom or changing a diaper!), but it can also be transmitted via nasal discharge, blister fluid or saliva. It’s easy enough for me to say “wash your hands,” but unfortunately, the little kids spreading the most virus aren’t very good at that yet!  Therefore, keeping surfaces disinfected and clean is also important (although admittedly difficult!).  The virus is most infectious in the first few days of illness; it’s reasonable to keep your kid away from other children if they still have open blisters on the mouth or skin.

Regarding the questions at the beginning of this article:
1) mouth
2) foot and mouth disease (not hand, foot and mouth) is a highly contagious disease that results in big outbreaks every few years; fortunately, unless you are a farm animal (i.e. cow, elephant, hedgehog) you are not susceptible
3) Yes
4) If you want to, but not because of hand, foot and mouth
5) Maybe.

Here is a link from the Centers for Disease Control and Prevention (CDC) on this topic if you want information from someone a little more serious.  Thanks to Children’s Hospital Colorado for the foot and mouth picture.  Thanks to the patient above for being willing to volunteer his face as a visual aid!  Most of my info came (as usual) from UpToDate.com.

Below – an unrelated festive holiday video from me to you.  Please, don’t try this at home (unless you are a highly trained internet medical professional like myself).  I apologize for being kind of a bad example.

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