Hand foot mouth disease symptoms and treatment.
There are countless cases of Hand-Foot-Mouth Disease (DMPB) and the photographs of pimples of every kind and shape accumulate on the mobile phones of pediatricians who consult in general pediatrics. But what is DMPB?
Hand-Foot-Mouth Disease (DMPB):
what is it, how is it transmitted and what are the symptoms?
It is a viral disease, usually caused by a group of viruses – the Coxsackie (A16 in Europe, A71 in Asia, for example) – that belong to the enterovirus family.
It mainly affects children under 5 years of age and, as it can be caused by different viruses within the same group, it is not exactly a disease that only occurs once in a lifetime.
Transmission is very easy: contact with the respiratory secretions or faeces of infected people (and adults can be infected without showing any symptoms), quickly triggers an incubation period that lasts 3 to 6 days.
What are the symptoms?
Initially, the disease progresses with high fever, severe sore throat, nasal obstruction and, eventually, some gastrointestinal changes, such as increased frequency of stools, as well as softer stools.
However, the main marker of the disease is the typical rash , that is, it has a very specific cutaneous manifestation, which allows the diagnosis to be made without resorting to specific tests.
Usually, on the 3rd day of fever, pimples (red and with a small vesicle) appear that can ulcerate on the palms of the hands, soles of the feet and areas around the lips, being associated with canker sores in the oral cavity (hence the name of Disease of Hands-Foot-Mouth). Some children develop more pimples in other locations such as elbows, knees and extensor surfaces of limbs and buttocks. This form of presentation has a specific name (Gianotti-Crosti Syndrome) and was first described in 1955 by an Italian pediatrician.
Oral thrush is really an important point, because they cause immense discomfort and are often a risk factor for dehydration in children.
Treatment is purely supportive:
analgesia and fever control and increased fluid intake. In a practical and straightforward way: if you don't want to eat, don't eat, but drinking is very important.
Overview
Hand-foot-and-mouth disease — a mild, contagious viral infection common in young children — is characterized by sores in the mouth and a rash on the hands and feet. Hand-foot-and-mouth disease is most commonly caused by coxsackievirus.
There's no specific treatment for hand-foot-and-mouth disease. Frequent hand-washing and avoiding close contact with people who are infected with hand-foot-and-mouth disease may help reduce your child's risk of infection.
Hand-foot-and-mouth disease may cause all of the following signs and symptoms or just some of them. They include:
Fever
Sore throat
Feeling unwell
Painful, red, blister-like lesions on the tongue, gums and inside of the cheeks.
A red rash, without itching but sometimes with blistering, on the palms, soles and sometimes the buttocks Irritability in infants and toddlers Loss of appetite.
The usual period from initial infection to the onset of signs and symptoms (incubation period) is three to six days. A fever is often the first sign of hand-foot-and-mouth disease, followed by a sore throat and sometimes a poor appetite and feeling unwell.
One or two days after the fever begins, painful sores may develop in the front of the mouth or throat. A rash on the hands and feet and possibly on the buttocks can follow within one or two days.
Sores that develop in the back of the mouth and throat may suggest that your child is infected with a related viral illness called herpangina. Other features of herpangina include a sudden high fever and in some instances, seizure. Sores that develop on the hands, feet or other parts of the body are very rare.
When to see a doctor
Hand-foot-and-mouth disease is usually a minor illness causing only a few days of fever and relatively mild signs and symptoms. Contact your doctor if mouth sores or a sore throat keep your child from drinking fluids. And contact your doctor if after a few days, your child's signs and symptoms worsen.
Causes
The most common cause of hand-foot-and-mouth disease is infection with the coxsackievirus A16. The coxsackievirus belongs to a group of viruses called non polio enteroviruses. Other types of enteroviruses sometimes cause hand-foot-and-mouth disease.
Oral ingestion is the main source of coxsackievirus infection and hand-foot-and-mouth disease. The illness spreads by person-to-person contact with an infected person's:
Nasal secretions or throat discharge
Saliva
Fluid from blisters
Stool
Respiratory droplets sprayed into the air after a cough or sneeze
Common in child care setting
Hand-foot-and-mouth disease is most common in children in child care settings because of frequent diaper changes and toilet training, and because little children often put their hands in their mouths.
Although your child is most contagious with hand-foot-and-mouth disease during the first week of the illness, the virus can remain in his or her body for weeks after the signs and symptoms are gone. That means your child still can infect others.
Some people, especially adults, can pass the virus without showing any signs or symptoms of the disease.
Outbreaks of the disease are more common in summer and autumn in the United States and other temperate climates. In tropical climates, outbreaks occur year-round.
Different from foot-and-mouth disease
Hand-foot-and-mouth disease isn't related to foot-and-mouth
disease (sometimes called hoof-and-mouth disease), which is an infectious viral disease found in farm animals. You can't contract hand-foot-and-mouth disease from pets or other animals, and you can't transmit it to them.
Risk factors
Hand-foot-and-mouth disease primarily affects children younger than age 10, often those under 5 years. Children in child care centers are especially susceptible to outbreaks of hand-foot-and-mouth disease because the infection spreads by person-to-person contact, and young children are the most susceptible.
Children usually develop immunity to hand-foot-and-mouth disease as they get older by building antibodies after exposure to the virus that causes the disease. However, it's possible for adolescents and adults to get the disease.
Complications
The most common complication of hand-foot-and-mouth disease is dehydration. The illness can cause sores in the mouth and throat, making swallowing painful and difficult.
Watch closely to make sure your child frequently sips fluid during the course of the illness. If dehydration is severe, intravenous (IV) fluids may be necessary.
Hand-foot-and-mouth disease is usually a minor illness causing only a few days of fever and relatively mild signs and symptoms. A rare and sometimes serious form of the coxsackievirus can involve the brain and cause other complications:
Viral meningitis. This is a rare infection and inflammation of the membranes (meninges) and cerebrospinal fluid surrounding the brain and spinal cord.
Encephalitis. This severe and potentially life-threatening disease involves brain inflammation caused by a virus. Encephalitis is rare.
Prevention
Certain precautions can help to reduce the risk of infection with hand-foot-and-mouth disease:
Wash hands carefully. Wash your hands frequently and thoroughly, especially after using the toilet or changing a diaper and before preparing food and eating. When soap and water aren't available, use hand wipes or gels treated with germ-killing alcohol.
Disinfect common areas. Get in the habit of cleaning high-traffic areas and surfaces first with soap and water, then with a diluted solution of chlorine bleach and water. Child care centers should follow a strict schedule of cleaning and disinfecting all common areas, including shared items such as toys, as the virus can live on these objects for days. Clean your baby's pacifiers often.
Teach good hygiene. Show your children how to practice good hygiene and how to keep themselves clean. Explain to them why it's best not to put their fingers, hands or any other objects in their mouths.
Isolate contagious people. Because hand-foot-and-mouth disease is highly contagious, people with the illness should limit their exposure to others while they have active signs and symptoms. Keep children with hand-foot-and-mouth disease out of child care or school until fever is gone and mouth sores have healed. If you have an illness, stay home from work.
What are the possible complications for DMPB?
In addition to dehydration, there are rarer complications that we should be aware of. Like any other virus in the enterovirus family, coxsackie are capable of infecting the Central Nervous System. So it is obviously an ominous sign if the child with this rash begins to experience changes in behavior, excessive prostration or severe headache.
Regarding contagion, the truth is that children are mainly contagious in the first week of the illness, however the virus excretion can remain in the faeces for several weeks. From a formal point of view, this implies that children must go a week without going to school.
However, they can continue to be contagious and, as such, infect other children. This implies great care in the hygiene of changing rooms and going to the bathroom, with increased hand hygiene (which is why the occurrence of outbreaks is so frequent in the context of nurseries).
Finally, I would like to point out that often around 6 to 8 weeks after this infection, children may experience a painless nail change, with the sensation that the nail breaks (onychomadesis). It just symbolizes that the infection is finally controlled by the immune system. And it doesn't require any special therapeutic measures.
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