2
INI CET 2021 May
Patient reported to the OPD with a chief complaint of fever and loss of appetite. He has severe pain while swallowing. He develops blisters on hands, feet and mouth after the initial symptoms. Identify the diagnosis:
HAND, FOOT AND MOUTH DISEASE
• Hand, foot and mouth disease is an epidemic infection, first reported by Robinson and coworkers in 1958.
• It is caused by the enterovirus Coxsackie A16 and has been reported to be caused less frequently by types A5 and A6, and occasionally even by B2, B5 or enterovirus 71.
• This first recognized outbreak of the disease occurred in Toronto, Canada, but since then it has appeared in many parts of the United States, as well as in many other countries around the world. Despite the similarity in names, it bears no relationship to foot-and mouth (hoof-and-mouth) disease, another viral disease with an animal vector.
Clinical Features
• The disease is primarily one affecting young children, the majority of cases occurring between the ages of six months and five years.
• It is characterized by the appearance of maculopapular, exanthematous, and vesicular lesions of the skin, particularly involving the hands, feet, legs, arms, and occasionally the buttocks.
• The patients commonly manifest anorexia, low-grade fever, coryza and sometimes lymphadenopathy, diarrhea, nausea, and vomiting.
Oral Manifestations
• A sore mouth and refusal to eat is one of the most common findings in the disease. This is due to the small, multiple vesicular, and ulcerative oral lesions that are more numerous than seen in herpangina.
• In the series of cases reported by Adler and his associates, sore mouth was the principal symptom in 90% of the patients, and oral lesions were present in 100% of the patients.
• The most common sites for the oral lesions were the hard palate, tongue, and buccal mucosa, with a much smaller percentage of patients showing involvement of the lips, gingiva and pharynx, including the tonsils.
• The tongue may also become red and edematous. Treatment
• No specific treatment is necessary since the disease is self-limiting and generally regresses within one to two weeks.