Late-stage symptoms of hand, foot, and mouth disease

Written by Yan Xin Liang
Pediatrics
Updated on September 02, 2024
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Hand, foot, and mouth disease is an acute infectious disease caused by enterovirus infection. Generally, there are more than twenty types of enteroviruses that cause hand, foot, and mouth disease, but the most common are Coxsackie virus A16 and enterovirus 71. The initial symptoms of hand, foot, and mouth disease are blisters in the hands, feet, and mouth; some cases include fever, while others do not. In later stages, the disease may exhibit recurring fevers, and the blisters on the mouth, hands, feet, and buttocks may burst and crust over. After crusting, the blisters gradually heal, but in some cases, the disease can progress to severe cases. For instance, complications such as encephalitis, brainstem encephalitis, myocarditis can occur, and some cases may develop neurogenic pulmonary edema, pulmonary hemorrhage, and circulatory failure, among others. However, such severe cases are generally rare.

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Written by Feng Hai Tao
Pediatrics
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Symptoms of Hand, Foot, and Mouth Disease in Children

The symptoms of hand, foot, and mouth disease in children primarily result from viral infections of the intestine, a common communicable disease particularly prevalent among children under five, especially those under three years of age. The symptoms can be categorized into typical cases where most children experience a sudden onset of illness, often accompanied by upper respiratory tract infection symptoms such as fever, nasal congestion, runny nose, sneezing, loss of appetite, nausea, and vomiting. Some may also experience headaches. Additionally, rashes or vesicles may appear on the hands, feet, mouth, and buttocks, typically surrounded by inflammatory red skin with little fluid inside the vesicles. These lesions are characterized by being painless, non-itchy, non-crusted, and non-scarring. It is important to note that not all children will have simultaneous rashes on their hands, feet, and mouth areas. In severe cases, while most children experience only mild symptoms and can be isolated at home, some may develop complications involving the nervous system and impairment of respiratory and circulatory functions. This can manifest as muscle spasms, encephalitis, acute flaccid paralysis, cardiopulmonary failure, and neurogenic pulmonary edema. Therefore, once a severe case is identified, hospitalization is recommended to prevent potential fatalities or long-term sequelae.

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Written by Yao Li Qin
Pediatrics
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Characteristics of hand, foot, and mouth disease rash

Hand, foot, and mouth disease is a rash disease caused by an intestinal virus infection, characterized by scattered maculopapular and vesicular rashes on the hands, feet, buttocks, and other areas. Typically, small vesicles appear on the oral mucosa, or they may already have ruptured into shallow ulcers, primarily located on the tongue, buccal mucosa, palate, and inner lips. Subsequently, rashes appear on the hands and feet, most commonly as maculopapules, which then develop into vesiculopapules about three to seven millimeters in size. The vesicles have a relatively thick covering and are surrounded by reddened skin, predominantly located at the extremities. Sometimes, they may extend to the arms, legs, buttocks, or perineal area. The distribution of the rash is centrifugal, with the number of lesions varying from a few to dozens. Generally, the lesions absorb on their own within two to three days without desquamation, scarring, or pigmentation. The vesicles and ulcers in the mouth mostly heal on their own within a week.

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Written by Yan Xin Liang
Pediatrics
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Is hand, foot and mouth disease itchy?

Hand, foot and mouth disease is an infectious disease caused by enteroviruses. There are more than 20 types of enteroviruses that cause hand, foot and mouth disease, among which Coxsackievirus A16 and Enterovirus 71 are the most common. Its main clinical symptoms include mouth pain, decreased appetite, mild fever, and the appearance of small vesicles or small ulcers on the hands, feet, mouth, and other areas. Most infected children can recover in about a week. The rash of hand, foot and mouth disease typically appears on the hands, feet, buttocks, arms, and legs as maculopapular rash, which can later turn into vesicles. These vesicles are surrounded by an inflammatory red halo and contain relatively little fluid. The rash is not itchy. Thus, the rash of hand, foot and mouth disease is unlike other allergic rashes; it does not cause itching or discomfort.

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Written by Yao Li Qin
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Initial symptoms of hand, foot, and mouth disease

Hand, foot, and mouth disease is a common pediatric exanthematous disease caused by an enterovirus infection, primarily manifesting on the hands, feet, mouth, and buttocks with scattered vesicular and pustular rashes. The incubation period for hand, foot, and mouth disease generally ranges from three to five days. The initial stage of the illness may include fever and sore mouth, or discomfort in the throat, leading to reluctance in children to eat. Accompanying symptoms might include mild coughing, runny nose, and throat discomfort. During a physical examination, a doctor may observe scattered small vesicles in the mouth mucosa, or shallow ulcers that have already erupted. These are mainly found on the lingual and buccal mucosa, as well as the mucosa on the inner side of the lips and upper palate. Subsequently, rashes appear on the hands and feet, generally starting as maculopapular rashes that slowly turn into vesicular rashes. These rashes are distributed eccentrically and typically resolve on their own within two to three days without scaling, scarring, or pigmentation. The oral vesicles usually heal on their own within a week. Some children with milder cases may only exhibit rashes or vesicular pharyngitis.

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Written by Yan Xin Liang
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How long should hand, foot, and mouth disease be isolated?

Hand, foot, and mouth disease is an infectious disease caused by enterovirus infection. There are more than 20 common types of enteroviruses, with Coxsackievirus A16 and Enterovirus 71 being the most common. The main clinical symptoms include fever, mouth pain, loss of appetite, and small blisters or ulcers on the hands, feet, and mouth. Most affected children can heal on their own in about a week, so ordinary cases can be isolated for about a week until all the rashes have crusted over and disappeared. However, for severe cases, the isolation period should be extended appropriately, possibly lasting 10-14 days, or even longer.