Hand-Foot-And-Mouth Syndrome

Hand-Foot-and-Mouth Syndrome (HFM)

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Medical Author: Jay Mersch, MD, FAAP
Medical Editor: William C. Shiel Jr., MD, FACP, FACR

• What is hand-foot-and-mouth syndrome (HFM)?
• What are the symptoms of hand-foot-and-mouth syndrome?
• What causes hand-foot-and-mouth syndrome?
• What is the incubation period for hand-foot-and-mouth syndrome?
• When does hand-foot-and-mouth syndrome usually occur?
• What is the expression of the syndrome?
• What is the course of the disease?
• Why haven't we heard more about this condition?
• How is HFM diagnosed?
• Hand-Food-and-Mouth Syndrome At A Glance

What is hand-foot-and-mouth syndrome?

Hand-foot-and-mouth syndrome (HFM) is a viral infection characterized by fever and a typical rash most frequently seen on the palms of the hands, soles of the feet, and inside the mouth. It should not be confused with foot (hoof) and mouth disease that affects cattle, sheep, and swine.

What are the symptoms of hand-foot-and-mouth syndrome?

HFM is most commonly an illness of the spring and fall seasons. Initial symptoms of mild fever (101-102 degrees) and malaise are followed within one or two days by a characteristic rash. Small (2-3 mm) red spots that quickly develop into small vesicles (blisters) appear on the palms, soles, and oral cavity. The gums, tongue, and inner cheek are most commonly involved. The foot lesions may also involve the lower calf region and rarely may appear on the buttocks. Oral lesions are commonly associated with a sore throat and diminished appetite.

What causes hand-foot-and-mouth syndrome?

HFM is caused by several members of the enterovirus family. The most common cause is Coxsackie virus A-16; less frequently Enterovirus 71 is the infectious agent. The clinical manifestations of routine HFM are the same regardless of the responsible virus. However, patients infected with Enterovirus 71 are more likely to experience rare complications (for example, viral meningitis or cardiac muscle involvement).

What is the incubation period for hand-foot-and-mouth syndrome?

HFM is moderately contagious and spreads from person to person. It cannot be spread by animals. Usually the virus is passed via oral secretions (nasal discharge, saliva, etc.) or via stool. There is a short four- to six-day incubation period between exposure and development of initial symptoms (fever and malaise). A person is most contagious during the first week of illness.

When does it usually occur?

Spring and fall are the most frequent seasons for community epidemics of HFM. While anyone exposed to the viral causes of HFM may develop disease, not everyone infected will develop symptoms.

What is the expression of hand-foot-and-mouth syndrome?

Commonly HFM is an illness of children less than 10 years of age; adults generally were exposed during childhood and maintain a natural immunity. Information regarding fetal exposure to HFM during pregnancy is limited. No solid evidence exists that maternal enterovirus infection is associated with complications such as spontaneous abortion or congenital defects. However, should a baby be born to a mother with active HFM symptoms, the risk of neonatal infection is high. Typically, such newborns have a mild illness. Rarely, overwhelming infection involving vital organs such as liver, heart, and brain can be lethal.