Hand Food Mouth Disease

Introduction
• HFMD is a common infectious disease that occurs most
often in children, but can also occur in adolescents and
occasionally in adults.
• In most cases, the disease is mild and self limiting,
with common symptoms.
• However, more severe symptoms such as meningitis,
encephalitis and polio-like paralysis may occur.
 Signs and symptoms
• Fever
• Sore throat
• Feeling of being unwell (malaise)
• Painful, red, blister-like lesions on
the tongue, gums and inside of the
cheeks
• A red rash, without itching but
sometimes with blistering, on the
palms, soles and sometimes the
buttocks
• Irritability in infants and toddlers
• Loss of appetite
 Causes
• viruses that belong to the Enterovirus genus
(group), which includes polioviruses, coxsackie
viruses, echoviruses, and other enteroviruses:

• Coxsackievirus A16 - the most common cause of

HFMD but other coxsackieviruses can also cause
the illness.
• Enterovirus 71 has also been associated with
cases and outbreaks of hand, foot, and mouth
disease, mostly in children in East and Southeast
Asia.
 Transmission
• The viruses that cause hand, foot, and mouth disease
can be found in an infected person’s
– nose and throat secretions (such as saliva, sputum, or
nasal mucus)
– blister fluid
– feces (poop)
• Incubation period: three to six days.
• A person with HFMD is most contagious during the first
week of illness.
• The virus can remain in body for weeks after the signs
and symptoms are gone and patient still can infect
others.
 Transmission
Exposure are through person-to-person contact:
• Close personal contact: hugging an infected person
• Through air: when infected person coughs or sneezes
• Contact with feces: changing diapers then touching
eyes, nose, or mouth before washing hands
• Contact with contaminated objects and surfaces: like
touching a doorknob that has viruses, then touching
eyes, mouth, or nose before washing hands
• Swallow recreational water: water in swimming pools
without proper chlorine treatment.
 Prevention
• Wash hands carefully. When soap and water
aren't available, use hand wipes or gels treated
with germ-killing alcohol.
• Disinfect common areas. Child care centers
should follow a strict schedule of cleaning and
disinfecting all common areas.
• Teach good hygiene. Explain to children why it's
best not to put their fingers, hands or any other
objects in their mouths.
• Isolate contagious people.
 Complications
• Dehydration
• Viral meningitis- inflammation of the meninges
covering the brain and spinal cord.
• Encephalitis- Inflammation of the brain parenchyma
Viral meningitis
 Introduction
• Viral meningitis is the most common type of
meningitis, an inflammation of the tissue that
covers the brain and spinal cord.
• It is often less severe than bacterial
meningitis, and most people get better on
their own (without treatment)
• However those who are immunocompromised
or newborn may have more severe symptoms.
 Causes
• Enterovirus (polio virus, Echovirus,
Coxsackievirus )
• Herpesvirus (Hsv-1,2, Varicella.Z,EBV )
• Paramyxovirus (Mumps, Measles)
• Togavirus (Rubella)
• Rhabdovirus (Rabies)
• Retrovirus (HIV)
 Signs and symptoms
children and adults Sign and symptoms in Infants
• Fever
• Headache
• Stiff neck
• Sensitivity to bright light
• Sleepiness or trouble
waking up from sleep
• Nausea
• Irritability
• Vomiting
• Lack of appetite
• Lethargy (a lack of energy)
• Myalgias
• Arthralgias
 Signs and symptoms
• Meningeal irritation is manifested as:
• Nuchal rigidity- impaired neck flexion(muscle spasm )
• Back pain
• Kernig sign pain with extension of the leg)
• Brudzinski sign (involuntary flexion of the knees and hips
after passive flexion of the neck while supine)

Testing for Testing for Brudzinski’s septicemia with

meningeal meningeal irritation contralateral reflex purpuric skin rash
irritation (neck (Kernig’s test) sign with head retraction
rigidity) and arched back
 Pathophysiology
• Viruses enter the CNS
through several
mechanisms.

• Many, such as
enteroviruses, replicate
outside the CNS and then
invade by haematogenous
spread.

• Viral particles pass

directly across the blood–
brain barrier, or are
carried across in infected
leukocytes (e.g. mumps,
measles or
herpesviruses), and then
infect vascular endothelial
cells.
 Diagnosis
• CSF Study- lumbar puncture
• Blood cultures
• CRP, ESR- Elevations of the Creactive protein,erythrocyte
sedimentation rate usually indicate bacterial cause.
• CT Scan- cerebral oedema may show slitlike lateral
ventricle and areas of low attenuation.
• PCR
• Virus isolation
 Treatment
• A child with rapidly progressing disease of less
than 24 hr duration, in the absence of
increased ICP, should receive antibiotics as
soon as possible after an LP is performed
• Acyclovir (an antiviral drug) for HSV or
varicella-zoster infection
• Antiretroviral drugs for HIV infection
• Supportive treatment of symptoms
 Complications
Meningitis complications can be severe. Neurological damage
including:

• Hearing loss
• Memory difficulty
• Learning disabilities
• Brain damage
• Gait problems
• Seizures
• Kidney failure
• Shock
• Death

With prompt treatment, even patients with severe meningitis can have
good recovery.