Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease (HFMD) is a contagious infection caused by non-polio enteroviruses. Coxsackievirus A16 is a common cause; enterovirus 71 is less common in many settings but is more strongly associated with severe neurological disease. Young children are affected most often, although older children and adults can also become infected. The pattern is usually recognizable: fever followed by painful shallow ulcers inside the mouth and a papulovesicular eruption on the palms and soles, with lesions sometimes appearing on the buttocks. Lesions may also involve the backs of the hands and feet. They are often small and surrounded by a red halo. Unlike many allergic or nonspecific viral rashes, the acral distribution is a useful diagnostic clue. Transmission occurs through stool, respiratory and oral secretions, fluid from vesicles, and contaminated hands or objects. A child may remain capable of transmitting the virus through stool for weeks after feeling well, so recovery of the rash does not eliminate the need for careful hand hygiene. Most uncomplicated illness resolves without specific treatment over approximately 7 to 10 days. Some coxsackievirus A6...