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Abstract: This article is about a 2-year-old female child who suddenly developed a fever with a temperature up to 38.5°C. The parents also noticed that many herpes could appear on the palms of the child’s hands, soles of the feet, and the palate and posterior pharyngeal wall of the mouth. The child was diagnosed with HFMD through her symptoms and signs as well as ancillary examinations, and her condition was controlled and she recovered well through isolation and anti-fever, anti-herpetic and anti-viral medication.
Basic information】Female, 2 years old
Type of disease】Hand, foot and mouth disease
Hospital】The Second Hospital of Harbin Medical University
Date of Consultation】May 2022
Treatment plan】Antipyretic (ibuprofen, acetaminophen) + antiherpetic treatment (recombinant human interferon α2b spray) + antiviral treatment (antiviral oral solution)
Treatment period】7 days of home isolation treatment
Treatment effect] The disease was controlled and the herpes and fever completely disappeared.
I. Initial consultation
A parent brought her 2-year-old child to the clinic with a flushed face and crying face. Through questioning the medical history, we learned that the child had repeated fever for more than 1 day, with poor mental health and a temperature up to 38.5℃. I thought it was just a cold, so I gave the child aminophenol xanthamine pellets for 1 day, and took the antipyretic medicine ibuprofen and acetaminophen several times when he had a fever. The initial suspicion was that the fever was accompanied by herpes hand, foot, and mouth = hand, foot, and mouth disease. After re-inquiring about the medical history, the parents informed the child that children in contact around the child had similar symptoms. The child was carefully asked if he had a history of contact with infectious diseases, drug and food allergies, vaccination history, and a routine blood test + C-reactive protein (CRP) was completed, which showed normal white blood cells and mildly elevated C-reactive protein (CRP). Based on the exposure history, symptoms and examination results, the child was diagnosed with HFMD.
II. Treatment history
After the child was identified as HFMD, isolation and symptomatic treatment were mainly required. However, since there is no specific treatment drug for HFMD, the child could use ibuprofen and acetaminophen for heat treatment of high fever, oral spray of recombinant human interferon α2b spray for herpes in the mouth, in addition to taking antiviral oral solution at the same time. Parents should be informed in detail that HFMD is an infectious disease caused by coxsackievirus or EV71 virus infection, and that mild cases can be cured spontaneously, and the disease usually subsides in about 1 week. However, attention should be paid to isolation after returning home to avoid infecting the people living together at home or other children. If the child has persistent high fever, drowsiness, depression, lethargy, coma, or convulsive seizures, he/she needs to go to the hospital immediately for emergency treatment.
Treatment effect
The child’s fever subsided in 3 days after antipyretic, antiherpetic and antiviral treatment, and the painful symptoms were effectively relieved, he could eat moderately and his mental state was restored. Since the child’s condition is mild, there will be no adverse effects on growth and development, few sequelae, and no scarring of herpes on the hands and feet. During the phone call, the family said that the herpes had completely disappeared by the 7th day and the child was recovering well.
IV. Notes
I am very happy for the child and her parents that her condition is under control and her herpes and fever have subsided. However, the following points should be noted.
1. Although HFMD can heal spontaneously, repeated high fever during the period can make the child feel very uncomfortable, so parents should ensure that the child gets enough sleep during home observation to ensure that the child’s immunity is in the best condition.
2, at the same time the child fever can take a combination of physical cooling and drug antipyretic, physical cooling such as warm water bath, paste antipyretic paste, etc., if the child appears persistent high fever does not go down, drowsiness, depression, convulsions and other symptoms, to the hospital immediately to the emergency medical treatment.
3, if the child does not dare to eat, parents should pay attention to encourage the child to eat, mainly light, high vitamin food, as little as possible to eat salty, hot food, avoid spicy, stimulating diet, so as not to aggravate the oral pain. Also pay attention to drink more water to keep the patient’s mouth clean, which helps the recovery of oral herpes. Choose comfortable and soft bedding and clothing for the child, and pay attention to cleanliness.
V. Personal insight
The case in this paper needs to be reminded that it is difficult to confirm the diagnosis of HFMD directly when herpes does not appear in the early stage, and it is necessary to exclude other diseases and ask in detail whether there is a history of contact with HFMD before considering the possibility of HFMD. While confirming the diagnosis of HFMD is mainly based on clinical manifestations + laboratory tests + history of infectious disease exposure, only a few patients require virology for coxsackievirus and EV71 virus testing, such as those with abnormal immunity, atypical presentation, and severe symptoms.
Since HFMD is an infectious disease caused by viral infection and mild cases are self-limiting, special antiviral treatment is generally not required for children with mild disease, and symptomatic treatment is the main focus. However, a small number of HFMD can cause severe symptoms, which may combine with multiple organ damage and even endanger life, so it is important to seek medical attention in a timely manner to clarify the severity of the disease and treat it effectively under the guidance of a doctor if herpes of hand, foot and mouth with fever occurs.