the case.
A mother brings her 18 month old child to your emergency department with a 24 hour history of fevers. She is now worried that her daughter has developed these little red spots.
On examination, she is well appearing & happy but febrile to 38.6*C.
This rash is found on her hands (amongst other places)….
Hand, Foot & Mouth disease.
Cause.
- Coxsackievirus (usu. A16)
- ~ Enterovirus family…
Epidemiology.
- Typically in children < 5 years.
- Most commonly toddlers & infants.
- Seasonal distribution (spring & summer months).
- Spread via respiratory droplets & contact with blister-contents.
- Viral shedding in faeces continues for several weeks post infection.
Clinical Presentation.
- Prodrome of mild fever, sore throat & malaise.
- May have mild URTI symptoms & reduced appetite.
- Lasts 1-2 days, followed by emergence of rash.
- Small 1-3mm macules progressing to 3-5mm gray vesicles w/ red border.
- Sometimes ulcerate –> very painful.
- Palmar lesions.
- Tongue, palate, uvula & tonsillar pillars (even buttocks) may have lesions.
- Poor oral intake is typical [mild dehydration only].
- Healing occurs in 7-10 days.
- Rarely complicated by viral meningitis.
Management.
- No specific treatment/cure.
- Parental reassurance.
- Supportive care.
- Analgesia.
- Hydration.
- Do not pierce blisters.
“Do we need to keep the kids away from her ?” Mum asks…
Risk to Pregnant Females.
- No known risk to foetus or pregnant women.
- A few document cases of newborn infection (from late 3rd trimester maternal infection)
- Presents as early as 48 hours.
- May be symptomatic.
- Hepatitis, encephalitis & myocarditis in the newborn.
- Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 7th Edition.
- www.rch.org.au
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