Hand, foot and mouth disease is a common and highly contagious viral infection. Its cause belongs to the entero- virus family and is known by doctors as the coxsackie virus.
Foot and mouth disease in cows is a completely separate entity.
Children under the age of ten are particularly affected. While adults tend to have immunity, hand, foot and mouth disease may still occur in teenagers and adults, albeit mildly.
The incubation period - that is, the time from exposure to the virus to the development of symptoms -is between three and five days. This relatively long incubation period can make it difficult to establish who the virus was contracted from.
SYMPTOMS
Some people do not have any have any symptoms at all. Typically, in the early stages of the condition, those affected tend to feel generally unwell with fever, loss of appetite and a sore throat. Red spots also occur on the skin and in the mouth. Later, the typical rash of hand, foot and mouth disease appears.
The rash doesn't itch and occurs mainly on the palms of the hands and soles of the feet. The skin lesions may be flat, or raised and blister-like, and they may or may not be painful. The rash can also occur on the buttocks and in the genital area. Lesions in the mouth start as red spots, which progress to fluid-filled spots, called vesicles, and then ulcers.
COMPLICATIONS AND TREATMENT
Complications of hand, foot and mouth disease include significant oral pain, which prevents the affected person from eating and drinking. Dehydration may follow. The skin lesions may become secondarily infected with bacteria.
Only rarely, the condition may cause a so-called viral meningitis.
The meninges are a series of membranes that cover and protect the brain. Life-threatening meningitis is usually caused by bacteria rather than viruses, but it is very difficult to tell bacterial and viral meningitis apart without hospital assessment. Any child with headache, neck stiffness, eye pain caused by bright lights - known as photophobia - drowsiness, or vomiting should be assessed by a doctor as a matter of urgency.
Even less commonly, hand, foot and mouth disease may cause encephalitis, which is infection and inflammation of the brain itself. This can present with similar symptoms to meningitis, although drowsiness and confusion are more pronounced.
Hand, foot and mouth disease doesn't require any specific treatment per se, and as it is caused by a virus, antibiotics are not effective. Standard over-the-counter treatments may be considered for controlling symptoms. It should resolve itself after a week or so, usually with no consequence.
Secondary bacterial infection, however, may indeed require antibiotic treatment.
STRAINS AND RECOVERY
People may get hand, foot and mouth disease more than once due to the different strains of causative viruses. It is unusual to get it twice or more during the same outbreak unless the affected person has a comprised immune system, perhaps due to steroid use.
Once someone has recovered from hand, foot and mouth disease, the affected person may continue to shed the virus for a number of weeks and remain infectious. The virus travels through the air on microscopic water droplets, usually when the affected person coughs and sneezes. The virus can survive on hard surfaces, so it may be easily transferred from one person to another.
In addition, the virus may be breathed in directly or carried within bodily fluids such as saliva and in stool. The virus can remain in the stool for up to a month after a child has recovered from hand, foot and mouth disease, so strict hygiene measures should be adhered to.
In general, children affected by hand, foot and mouth disease should remain at home until they feel well and their symptoms have settled. It is not recommended that children stay away from nursery for longer than this, partly because those attending nursery are likely to have the virus as well. Strict hygiene measures must be adopted when in contact with children who have the condition, particularly thorough hand-washing and not sharing towels.
Hand, foot and mouth disease is usually a mild, self-limiting illness. While complications do occur, they are rare. As with any medical condition, if you are concerned, always speak to a doctor.
Dr Raj Thakkar BSc(Hons) MBBS MRCGP MRCP(UK) is a full-time GP in Buckinghamshire
