Hand-foot-and-mouth disease is a viral and highly contagious infectious disease that often reaches epidemic proportions, especially in the Pacific region and Southeast Asia. The disease primarily affects children and manifests itself primarily in fever and painful skin rashes as well as blisters in the mouth, on the palms of the hands, and on the soles of the feet, although in rarer cases, brainstem inflammation may also accompany the disease.
What characterizes hand-foot-and-mouth disease?
By hand-foot-and-mouth disease, physicians mean a highly contagious but usually harmless viral disease. The viral infectious disease occurs worldwide and may spread epidemically because of the high risk of infection. Children under the age of ten are particularly likely to contract the virus, but adults are not immune to infection either. The incidence of the disease generally peaks in late summer, but it is not limited to a particular time of year. The disease was first documented in 1948 by Dalldorf and Sickles. Although the occurrence of this disease is not limited to a specific habitat, it affects Southeast Asia and the Pacific region in particular. There, the infection is usually epidemic and significantly more severe than within Europe. Six million people are estimated to contract the viral disease within a decade, with the infection being fatal for around 2000 of them. However, a fatal course is rather the rarity in relation to the Western world.
Causes
In most cases, hand-foot-and-mouth disease is due to group A enteroviruses, which include, in particular, Coxsackie A virus and human enterovirus 71. By far the most common pathogens are Coxsackie A16 viruses. From person to person, the epidemic infectious disease is transmitted via body fluids such as droplets, saliva or vesicular secretions, but fecal-oral transmission is also possible. The virus pathogens enter the regional lymphatic system via the intestine or oral mucosa, from where they reach the bloodstream within a few days. No direct contact with an infected person is required for transmission. That is, transmission is also possible if an affected person has contaminated a stool, table, or object with saliva or other body fluids and a healthy person comes into contact with that contaminated object.
Symptoms, complaints, and signs
Hand-foot-and-mouth disease manifests itself during the first few days via fever and general symptoms. A few days later, painful enanthema develops on the oral mucosa and vesicles on the tongue, palate, or gums and mucosa of the cheeks. In the following days, the vesicles turn into coated and painful aphthae, and a symmetrical skin rash often develops at the same time. Often the inner surfaces of the hands, the buttocks and the soles of the feet are also affected by vesicles, which are accompanied by severe itching. In rare cases, loss of finger and toe nails may occur. If human enterovirus 71 is the causative agent, aseptic meningitis or brainstem encephalitis may accompany the disease. Brainstem encephalitis usually manifests as flaccid paralysis due to a lesion of the lower motor neurons in the spinal cord. In most cases, these motor neurons are completely destroyed, often making the paralysis symptoms irreversible.
Diagnosis and progression
The physician initially diagnoses hand-foot-and-mouth disease by visual diagnosis. before detecting the pathogens via a stool sample. Laboratory diagnostics are usually not initiated because the diagnosis is so relatively certain and, especially in the Western world, a mild course is expected anyway. Differentially, the physician must exclude chickenpox as well as foot-and-mouth disease, which he covers by the mere detection of the pathogen. In virtually all cases in this country, the disease heals completely within one to two weeks without causing complications. Even if the infection is associated with aseptic meningitis, complete healing can also be expected. On the other hand, if brainstem encephalitis occurs, it can be considered a dangerous complication, often resulting in neurogenic pulmonary edema with high lethality. In this severe form of infection, severe neurological deficits remain in most cases.
Complications
Hand-foot-and-mouth disease is very dangerous for humans and, in the worst case, can lead to the death of the patient. For this reason, this disease must always be treated immediately by a doctor. The affected person suffers from severe fever and blisters in the mouth. Rashes also appear on the skin, which in most cases are associated with severe pain. Furthermore, the disease can spread to the brain and cause inflammation there, which leads to restrictions in the patient’s cognitive abilities. The quality of life is considerably reduced by hand-foot-mouth disease. The affected person has only little resilience and can no longer perform ordinary everyday activities without further ado. The inflammation in the brain often leads to paralysis and epileptic seizures. Likewise, thought processes can no longer be performed properly and the affected person suffers from confusion and coordination disorders. There is no causal treatment for hand-foot-mouth disease. For this reason, only the discomfort and pain of this disease can be alleviated. No further complications occur. Without treatment, life expectancy decreases drastically.
When should you go to the doctor?
Hand-foot-and-mouth disease is highly contagious, so a doctor should be seen at the first signs, simply because of the risk of infection to those around you. Most sufferers also need to see a doctor for relief of the symptoms of the disease. Many suffer from pain in the arms, feet and mouth area, often accompanied by pain in the limbs, fatigue and fever. The disease itself does not necessarily need to be treated with medication, because it usually heals on its own without complications, but it is often necessary to relieve the accompanying symptoms. The itching of the skin can be controlled with medication, and the fever can be lowered with paracetamol or similar. Tinctures and mouth rinses can help against the painful inflammation in the mouth, e.g. rinses with chamomile, thyme or lemon balm. Sometimes inflammation can spread very far in the mouth and must then be treated with antibiotics.
Treatment and therapy
Treatment of hand-foot-and-mouth disease is symptomatic. Causative treatment is not possible because the pathogens do not respond to the known drugs used to control viral infections. To relieve pain, analgesic gels are applied to the areas of all skin lesions. This is to prevent secondary infection, which is particularly favored by vigorous scratching. Because some patients have limited intake of food and fluids due to the painful changes in the oral mucosa, nutrition can be facilitated either by a straw or is provided by injections.
Outlook and prognosis
Hand-foot-and-mouth disease has an overall favorable prognosis. Although the disease is highly contagious, spreads rapidly, and primarily affects patients whose immune systems are not fully functional, the infection usually heals completely within a few days. Characteristically, hand-foot-and-mouth disease heals within seven to ten days. During this time, any symptoms that have occurred will have receded. Some skin lesions that have appeared may take a few days longer to disappear. Under normal conditions, the patient is considered to be symptom-free and fully recovered after this time. Complications or sequelae are to be expected only occasionally and in exceptional situations. In people with a severely weakened immune system, other conditions may occur that contribute to a deterioration of health or prolong the healing process. Complications mostly affect newborns, infants or the elderly. The body’s defenses are either not yet sufficiently developed in them or already weakened due to other diseases or the natural degradation process. The risk groups can suffer from meningitis. In addition, there is a risk of hand-foot-and-mouth disease spreading to the internal organs. In severe cases, dysfunction or irreparable damage to the organic tissues may occur. This development of the disease is considered highly rare if the patient seeks medical care.
Prevention
To prevent hand-foot-and-mouth disease, hygiene measures must be observed first and foremost, such as washing hands with soap. As a preventive measure, a healthy person should not have any close contact with people who have the disease. There is currently no vaccine against the disease. Three monovalent vaccines against human enterovirus 71 have been developed in China, but they were all associated with complications for those vaccinated.
Follow-up
Few measures of direct follow-up are available to the patient in most cases of hand-foot-and-mouth disease. The affected person is primarily dependent on a quick diagnosis so that the disease can be properly treated and further complications can be avoided. A self-healing of the hand-foot-mouth disease can not occur, so that the affected person is usually always dependent on medical treatment. To prevent further infection of hand-foot-and-mouth disease, high hygiene measures should be observed. The patient should also avoid unnecessary contact with other people as far as possible, so that the disease cannot spread. Likewise, bed linen and ordinary clothes should be washed at a high temperature to further reduce the risk of infection. Since the treatment of the disease is usually carried out with the help of medication, the patient should pay attention to a regular intake with a correct dosage. In case of questions, uncertainties or side effects, a doctor should always be consulted first. The disease can be relatively well limited, so that it does not come to further complications, if it is recognized early. In this case, the life expectancy of the affected person is also usually not reduced.
What you can do yourself
If the hand-foot-and-mouth disease has broken out, the main thing is to maintain hygiene. To stop the viral disease and protect family members, as well as friends, it is necessary to break the cycle of infection. Frequent and thorough hand washing with soap is the first step. Potentially contaminated surfaces must be disinfected after use. These include the toilet, the sink with all its fixtures, or even the changing table. Cups and similarly used material should not be shared with others. Care should also be taken when hugging, kissing and shaking hands. The affected child should be helped not to cough or sneeze into the environment. Hands should generally be kept away from the eyes to prevent possible conjunctivitis. Cooling measures such as cold compresses counteract the itching. Cool packs or the application of cold tea bags prove helpful. Black tea, chamomile, thyme and lemon balm tea bags can be used for this purpose. When drunk, the cooled tea relieves discomfort in the mouth, throat and pharynx and prevents dehydration of the body. In case of difficulty in swallowing or refusal to eat, it is worthwhile to use water ice. During the course of the disease, stays in large groups of people should be avoided.
