Hand, Foot, and Mouth Disease: A Narrative Review

Abstract

Background: Hand, foot, and mouth disease is a common viral disease in childhood. Because the disease has the potential to reach epidemic levels and the mortality is high in some countries, early recognition of this disease is of paramount importance. Objective: This purpose of this article is to familiarize pediatricians with the clinical manifestations and management of hand, foot, and mouth disease. Methods: A search was conducted in February 2022 in PubMed Clinical Queries using the key term " hand, foot, and mouth disease". The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. Results: Hand, foot, and mouth disease is characterized by a painful oral enanthem and asymptomatic exanthem on the palms and soles. Children younger than 5 years are most commonly affected. Hand, foot, and mouth disease caused by enterovirus A71 is more severe and has a higher rate of complications than that attributed to other viruses such as coxsackievirus A16. Circulatory failure secondary to myocardial impairment and neurogenic pulmonary edema secondary to brainstem damage are the main causes of death. Fortunately, the disease is usually benign and resolves in 7 to10 days without sequelae. Given the self-limited nature of most cases, treatment is mainly symptomatic and supportive. Intravenous immunoglobulin should be considered for the treatment of severe/complicated hand, foot, and mouth disease and has been recommended by several national and international guideline committees. Currently, there are no specific antiviral agents approved for the treatment of the disease. Drugs such as ribavirin, suramin, mulberroside C, aminothiazole analogs, and sertraline have emerged as potential candidates for treatment of hand, foot, and mouth disease. Vaccination of susceptible individuals in high-risk areas and good personal hygiene are important preventative measures to combat the disease. Conclusion: Familiarity of the disease including its atypical manifestations is crucial so that a correct diagnosis can be made, and appropriate treatment initiated. A timely diagnosis can help avoid contact with the affected individual and decrease the risk of an outbreak.

Identification of a shared gene signature and biological mechanism between diabetic foot ulcers and cutaneous lupus erythemnatosus by transcriptomic analysis

“…In the pathological environment of high glucose, taquinmod inhibits proliferation, migration and lumen formation of human retinal endothelial cells (Jin et al, 2022). Ribavirin, as an antiviral drug, is considered as a potential candidate for the treatment of HFMD (Leung et al, 2022). Paradoxically, ribavirin combined with cyclophosphamide or interferon has a high risk of skin and appendage adverse reactions (rash, cutaneous sarcoidosis, etc.)…”

Human health implications of emerging diseases and the current situation in India's vaccine industry

“…Currently, no antiviral therapies or proven clinical care techniques have been developed for HFMD. Antiviral therapy with interferon, ribavirin, ibuprofen, acetaminophen, and IFN-α has been proven effective in managing HFMD ( Table 2 ) [ 47 ]. Three companies Chinese Academy of Medical Science, Sinovac and Vigo are developed of highly efficacious EV71 inactivated whole virus vaccine with an effectiveness rate of 97.4% (Phase 3 trial) [ 48 ].…”

Study on the epidemiological characteristics of enterovirus among pediatric patients in Hangzhou, China: A comparison between the pre‐COVID‐19, COVID‐19 pandemic, and post‐COVID‐19 periods

“…[10][11][12][13] HFMD is typically characterized by the development of small, painful sores or blisters on the palms of the hands, soles of the feet, and inside the mouth. 10 HA is characterized by the formation of small blisters or ulcers on the back of the throat and on the inside of the cheeks. Common symptoms include sore throat, difficulty swallowing, fever, general malaise, and, in some cases, headache and abdominal pain.…”

“…[6][7][8][9] Hand, foot, and mouth disease (HFMD) and herpangina (HA) are common viral illnesses that primarily affect infants and children under the age of 5 and are caused by enteroviruses, especially enterovirus 71 (EV-A71) and coxsackievirus A16 (CV-A16). [10][11][12][13] HFMD is typically characterized by the development of small, painful sores or blisters on the palms of the hands, soles of the feet, and inside the mouth. 10 HA is characterized by the formation of small blisters or ulcers on the back of the throat and on the inside of the cheeks.…”