Coxsackie viruses, and hand, foot and mouth disease.


Hand, foot and mouth disease is a viral infection, which can appear in small children. There is no relation between this and the foot and mouth disease that affects animals.


Which ages does it affect?

The clinical picture of the disease most often occurs during the pre-school and early school age, up until the age of 10. Most people become exposed to the virus, and develop antibodies before adulthood.


During which season of the year does it usually appear?

Infections caused by enteroviruses can occur throughout the year, but they tend to be more frequent during the summer and autumn.


How is it transmitted?

It is easily transmitted from human to human – by secretions of the nose and mouth, through sneezing, coughing, as well as through faeces, and from infected objects.


How serious is it?

Many cases are asymptomatic, i.e. the body develops antibodies without manifesting any symptoms at all. The usual clinical manifestation of the disease is mild, and there are rarely complications. Patients rarely need hospitalisation, and the disease is rarely fatal.

Rarely, it may develop into viral meningitis. If the child complains of a headache, has stiffness in the neck, or pain in the back, you should seek medical evaluation.


What is the incubation period?

Three to seven days usually pass from the moment a child is exposed to the virus until the appearance of the first symptoms.


What are the symptoms of the disease?

The symptoms may last from 7 to 10 days.

The child usually has a relatively high fever and a sore throat. Small blisters appear in the mouth and on the sides of the tongue. Later, the blisters burst leaving small ulcers. The child has no appetite, and eating and drinking is difficult, due to pain in the mouth.

The rash usually appears on the palms, fingers, soles of the feet, and the area around the waistline of the nappy. The rash consists of mildly red spots with blisters in the middle. There is usually no itchiness.


How is transmission to other children prevented?

It is very important for the child and parents to wash their hands frequently. In addition, the affected child should not share the same towels, tooth brushes, or glasses with others.

The child should stay at home and away from school or nursery until all blisters in the mouth or the skin dry out, and don’t contain any more fluid.


What causes this disease?

Hand, foot and mouth disease is caused by a category of viruses called enteroviruses. The main enteroviruses that cause it are the Coxsackie A16 virus, and the EV71 virus.


How is it treated?

There is no medical treatment for the disease. Since it is caused by a virus, antibiotics cannot treat it, and their unnecessary administration increases the risk of side effects. Adequate treatment of the pain in the mouth is necessary – paracetamol and anti-inflammatory drugs are given. In addition, help the child stay hydrated, offering liquids in small quantities frequently. Offer soft pieces of food with non-acidic flavours.

Do not burst the blisters.


Remember about hand, foot and mouth disease that:

• It is easily transmitted from human to human, and not from animals.

• There is no special treatment, and antibiotics have no effect.

• There is no known danger for pregnant women or other population groups.

• If the child has a headache, stiffness of the neck, or pain in the back, you should immediately seek medical evaluation.


What else do enteroviruses cause?

Most cases of Coxsackie and echoviruses are asymptomatic. Sometimes they cause fever, which subsides on its own, without other symptoms. Other manifestations can be:

• Conjunctivitis

• Non-specific viral rash, for which they are the main causes, particularly during summer and autumn

• Herpangina, an acute infection with fever and lesions in the mouth

• Viral tonsillitis

• Pleurodynia, a viral infection with fever and pain in the ribs and chest, which lasts for 1-2 days

• Viral gastroenteritis with vomiting and diarrhea

• Aseptic viral meningitis

• Myocarditis

Stelios Papaventsis MRCPCH DCH IBCLC 2012

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