​Kembara Xtra - Medicine - Hand - Foot-and-Mouth Disease

​Kembara Xtra - Medicine - Hand - Foot-and-Mouth Disease 
Typical clinical condition brought on by several enterovirus serotypes

 Oral enanthem with exanthem of hands and feet (classically) and possibly elsewhere, both in the classic appearance.

Exanthems (rashes) can be vesicular, maculopapular, or macular in appearance.
Herpangina (when it affects the oral mucosa and posterior pharynx) is a possible synonym.

Epidemiology 

Self-limiting sickness goes away in 7 to 10 days; moderately contagious; spreads through direct touch with faeces, saliva, blister fluid, or nasal secretions.
The first week of the sickness is when infected people are most contagious, although they may still spread the virus for days or weeks later. Some exposed people (particularly adults) may not have any symptoms but still be contagious.
The viruses that cause hand, foot, and mouth disease (HFMD) can continue to exist for several weeks after symptoms have subsided, most frequently in stools, allowing transmission after symptoms have subsided.
The incubation time is three to seven days.

Incidence
Children under the age of five are most frequently impacted, particularly in childcare centers; it can occur as lone instances, outbreaks, or epidemics; and it can happen anywhere in the world.
The majority of significant epidemics take place in Southeast Asia; vertical transmission is conceivable.

Pathophysiology and Etiology 

HFMD is not the same as the foot (hoof) and mouth disease that affects cattle, and there is no risk of transmission between species.

Coxsackievirus A16 and enterovirus 71, as well as coxsackievirus A5, A7, A9, A10, B2, and B5, are among the Enterovirus genus viruses that cause fecal-oral transmission as well as contact with skin lesions or oral secretions.
Enterovirus 7 is linked to more serious illnesses.

Prevention 

 Hand washing, especially before handling food or changing a baby.
Children who have open sores in their mouths or on their skin should be kept out of group settings during the first few days of their sickness to prevent the infection from spreading.
Hand hygiene practices can effectively lower transmission.
A new vaccine showing potential in clinical studies to reduce the incidence and prevalence should be avoided by expectant mothers.


A one- to two-day prodrome of fever, anorexia, malaise, stomach discomfort, and upper respiratory symptoms is presented as the history.
Fever could last for 3 to 4 days.
A maculopapular rash on the mouth, hands, and feet. Skin lesions may develop before oral ones.
 Sore throat (occurs after fever) Frequently contacts with sick people

clinical assessment 
Oral enanthem and sore vesicles that develop into ulcers on the buccal mucosa, sides of the tongue, and palate could last for up to a week.
Adults are less prone to develop cutaneous findings. Cutaneous vesicles 3 to 5 mm in diameter often start as painful maculopapular eruptions and appear on the dorsal aspects of the fingers and toes.
Be aware of central nervous system (CNS) symptoms as nail dystrophies are not uncommon and may last for weeks after the acute infection.
CNS involvement is possible, although its rarity.

Differential diagnosis includes the following conditions: Herpetic gingivostomatitis, Aphthous stomatitis, Scabies, Chickenpox, Measles, Rubella, Scarlet fever, Roseola infantum, Fifth illness, other enteroviral infections, Kawasaki disease, viral pharyngitis, Varicella.
Behçet syndrome, Pemphigus vulgaris, Stevens-Johnson syndrome, Rickettsial infection (RFSF),


Laboratory Results 
Usually, a clinical diagnosis suffices.
Initial Tests (Lab, Imaging) Oral lesions, cutaneous vesicles, nasopharyngeal swabs, feces, and CSF can all be used to isolate the virus that is causing an infection. The most effective test to run when enterovirus 71 is suspected is the polymerase chain reaction (PCR) of throat swabs and vesicle fluid.


Avoid eating foods that are spicy or acidic to reduce oral pain. In more severe cases of dehydration, IV fluids may be necessary.


Medication Soothing mouthwashes ("magic mouthwash") containing lidocaine are not recommended as they do not appear to be superior to placebo and have a risk of side effects when absorbed systemically. Antiviral treatments are not available. Symptomatic care using ibuprofen or acetaminophen for pain from oral ulcers or fever.
Child Safety Considerations
Reye syndrome, an encephalopathy linked to aspirin use in viral infection in children, is a problem when using aspirin to treat febrile sickness in children.

Admission

Patients who exhibit CNS symptoms or autonomic dysregulation ought to be hospitalized.
Accept individuals who are dehydrated and unable to keep themselves adequately hydrated orally.
Immunoglobulin intravenously is not advised.

Encourage cold beverages (such as ice cream and popsicles) as part of ongoing care to ward off dehydration.
Eat less acidic, salty, and spicy food because they will make you feel more pain.


Complications 
Dehydration is frequently caused by severe mouth ulcers.
Although it is a rare condition, aseptic meningitis is becoming more common all over the world.
Lethargy and fever lasting more than three days are linked to CSF pleocytosis.
Cardiopulmonary consequences include myocarditis, pneumonitis, and pulmonary edema. Enterovirus 71 has produced outbreaks and has been linked to more severe illness related to CNS infection.
Desquamation (loss of nails, Beau lines) and nail dystrophies are frequent.

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