HFMD is an infectious disease caused by enterovirus. There are more than 20 types of enterovirus that cause HFMD, among which Coxsackievirus A16 (Cox A16) and enterovirus 71 (EV 71) are the most common. Most children under the age of 5 years old present with mouth pain, anorexia, low fever, small herpes or ulcers on the hands, feet and mouth. Individual children with severe disease develop rapidly, leading to death. There is a lack of effective therapeutic drugs and the treatment is mainly symptomatic.
Etiology
There are several enteroviruses that can cause HFMD. The most common are coxsackievirus type A16 and enterovirus 71. The routes of infection include gastrointestinal, respiratory and contact transmission.
Clinical presentation
Hand, foot and mouth disease mainly occurs in children under 5 years of age, incubation period: mostly 2 to 10 days, an average of 3 to 5 days
1.Common case performance
Acute onset, fever, mouth pain, anorexia, scattered herpes or ulcers in the oral mucosa, located in the tongue, cheek mucosa and hard forehead, etc., can also spread to the soft palate, gums, tonsils and pharynx. The hands, feet, buttocks, arms, and legs appear as macules, which later turn into herpes, and the herpes may be surrounded by an inflammatory redness with less fluid inside the herpes. The hands and feet are more frequent, and the back of the palms are present. The number of rashes can be as few as a few or as many as a few dozen. The rash does not leave traces after fading, and there is no hyperpigmentation. In some cases, the rash is only a rash or herpetic pharyngitis. Most cases heal within a week and have a good prognosis. In some cases, the rash is atypical, such as a single site or only a maculopapular rash.
2.Severe cases
Several cases (especially those younger than 3 years old) progress rapidly, with meningitis, encephalitis (brainstem encephalitis is the most dangerous), encephalomyelitis, pulmonary edema and circulatory disorders appearing in about 1-5 days after the onset of the disease, and very few cases are critical and can lead to death, and surviving cases can have sequelae.
(1) neurological manifestations of concurrent central nervous system diseases: poor mental health, drowsiness, easily startled, headache, vomiting, delirium or even coma; limb tremors, myoclonus, nystagmus, ataxia, oculomotor disorders; weakness or acute flaccid paralysis; convulsions. On examination, meningeal irritation signs, diminished or absent tendon reflexes, and positive Bartholomew’s sign were seen. The combination of central nervous system symptoms is more common in children under 2 years of age.
(2)Respiratory system manifestations with pulmonary edema: shallow breathing, dyspnea or rhythm changes, lip cyanosis, coughing, coughing white, pink or bloody foamy sputum; wet nymphal woven grass can be heard in the lungs.
(3) Circulatory system manifestations complicating myocarditis manifestations: pale gray face, skin pattern, cold extremities, cyanosis of fingers (toes); cold sweating; prolonged capillary refill time. Heart rate increases or decreases, pulse is shallow or weak or even disappears; blood pressure increases or decreases.
Examination
Routine examination: the peripheral blood leukocyte count is reduced or normal; urine and stool are generally not abnormal. A throat swab or stool specimen can be sent to the laboratory for virus testing, but it takes 2 to 4 weeks for virus testing to produce results.
Diagnosis
Based on clinical symptoms and signs, and in the case of a large epidemic, especially the typical distribution characteristics of the rash in the oral cavity and hand and foot areas. The diagnosis is not difficult.
Differential diagnosis
In case of scattered occurrence, it must be distinguished from herpes cheek infection and rubella.
1. Herpes simplex stomatitis
Herpes simplex virus can develop in all seasons and is mainly disseminated. Herpes and ulcers appear on the oral mucosa. However, there is no herpes rash on the hands and feet.
2. Herpes cheilitis
Mainly caused by coxsackievirus, the child has fever, sore throat, and scattered grayish-white herpes on the oral mucosa, surrounded by redness, and the herpes breaks down to form an ulcer. The lesions are in the posterior part of the oral cavity; e.g., anterior tonsils, soft palate, and uvula, and rarely involve the buccal mucosa, tongue, and gingiva. Atypical children must be tested for pathogenesis and serology.
Treatment
1.General treatment
If there is no complication, the prognosis of this disease is generally good, and it will be cured within a week. The main symptomatic treatment.
(1) First of all, isolate the child, and the contact person should pay attention to disinfection and isolation to avoid cross-infection.
(2) Symptomatic treatment, good oral care. If the herpes and ulcers in the mouth are serious, gargle or paint the affected area with rehabilitative new liquid, or put Similac into a paste and put it on the ulcerated surface with a cotton swab after meals.
(3) Clean clothes and bedding, dress comfortably and softly, and change them often.
(4) Cut baby’s nails short and wrap baby’s hands if necessary to prevent scratching the rash
(5) The rash on the hands and feet can be coated with glycomet lotion at the beginning, and 0.5% iodophor can be applied when a herpes forms or when it breaks down.
(6) Babies with rashes on the buttocks should always clean up their urine and stool to keep the buttocks clean and dry.
(7) You can take anti-viral drugs and herbal medicines to clear heat and detoxify, and supplement vitamin B and C, etc.
2.Combined treatment
(1) Closely monitor the changes in the condition, especially the function of the brain, lungs, heart and other important organs; pay special attention to monitoring blood pressure, blood gas analysis, blood sugar and chest X-ray in critically ill patients.
(2) Pay attention to the maintenance of water, electrolytes, acid-base balance and the protection of important organs.
(3) In cases of increased intracranial pressure, dehydration treatment such as mannitol can be given. In severe cases, methylprednisolone and intravenous gammaglobulin can be given as appropriate.
(4) In cases of hypoxemia, respiratory distress and other signs of respiratory failure, early mechanical ventilation is recommended.
(5) Maintain stable blood pressure and give vasoactive drugs if necessary.
Other serious treatment: if DIC, pulmonary edema, heart failure, etc. appear, corresponding treatment should be given.
3.Antiviral drugs
Because antiviral drugs are generally best used 24 hours to 48 hours before the onset of the disease. And often when we diagnose HFMD, it has passed the most effective treatment stage, and now also do not advocate the use of antiviral drugs.
Prevention
1.Wash children’s hands with soap or hand sanitizer before and after meals and after going out, do not let children drink raw water or eat cold food, and avoid contact with sick children.
2. Caregivers should wash their hands before touching children, after changing diapers or handling feces, and dispose of dirt properly.
3.Bottles and pacifiers used by infants and children should be washed well before and after use.
4. During the epidemic period, children should not be taken to public places with poor air circulation, and attention should be paid to maintaining household sanitation, frequent ventilation of the living room, and regular drying of clothes and blankets.
5. Children should go to medical institutions promptly when symptoms appear. Parents should dry or disinfect the child’s clothes and disinfect the child’s feces in a timely manner; children with minor illnesses do not need to be hospitalized and should stay home for treatment and rest to reduce cross-infection.
6. Wash and disinfect toys, personal hygiene utensils, tableware and other items daily.
7. Conduct daily morning checkups in childcare units, and when suspicious children are found, take measures to send them to the clinic and rest at home in a timely manner; disinfect the items used by the children immediately.
8. When the number of affected children increases, report to the health and education departments in a timely manner. Depending on the need for epidemic control local education and health departments may decide to take measures to close childcare institutions or elementary school.