Skip to Main Content

Clinical Summary

Hand, foot, and mouth syndrome (HFMS) is a seasonal (summer-fall) viral infection caused most frequently by coxsackievirus A16, with other enterovirus serotypes implicated less frequently. Toddlers and school-aged children are affected most commonly, although adults may also be affected. It is characterized by a prodrome of fever, malaise, sore throat, and anorexia over 1 to 2 days, followed by the appearance of the characteristic enanthem in the posterior oropharynx and tonsillar pillars consisting of small, red macules evolving into small vesicles 1 to 3 mm in diameter that rapidly ulcerate. Oral manifestations are followed by a vesicular eruption characterized by 3- to 7-mm erythematous macules with a central gray vesicle on the hands and feet involving the palmar and plantar surfaces and interdigital surfaces. A nonvesicular rash may also be present on the buttocks, face, and legs.

FIGURE 14.36

Hand, Foot, and Mouth Syndrome. Erythematous vesicular rash scattered on the palms consistent with coxsackievirus. (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 14.37

Hand, Foot, and Mouth Syndrome. Vesicular rash of the feet consistent with coxsackievirus. (Photo contributor: Larry B. Mellick, MD.)

FIGURE 14.38

Hand, Foot, and Mouth Syndrome. Discrete vesicular erosions on the posterior oropharynx and soft palate secondary to coxsackievirus. (Photo contributor: Larry B. Mellick, MD.)

FIGURE 14.39

Hand, Foot, and Mouth Syndrome. Nonvesicular rash on the buttocks, a common site. (Photo contributor: Binita R. Shah, MD. From Shah B, Lucchesi M, Amodio J, Silverberg M. Atlas of Pediatric Emergency Medicine. 2nd ed. New York, NY: McGraw Hill; 2013: Fig. 3.66D, p. 111.)

Management and Disposition

Supportive therapy (hydration maintenance with fever and pain control) is the mainstay of treatment. It is essential to discuss the duration and characteristics of the illness with the parents. In most cases, the course is self-limited, resolving in 2 to 3 days after the appearance of rash without further complication. Rare secondary complications such as myocarditis, pneumonia, pulmonary hemorrhage, and meningoencephalitis may occur.

FIGURE 14.40

Hand, Foot, and Mouth Syndrome. Severe vesicular rash of the feet consistent with coxsackievirus. (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 14.41

Hand, Foot, and Mouth Syndrome. Severe vesicular rash of the palms consistent with coxsackievirus. (Photo contributor: Lawrence B. Stack, MD.)

Pearls

  1. The child is contagious until all vesicles have resolved.

  2. The oral lesions tend to involve the posterior oropharynx, as contrasted with those ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.