Hand-foot-and-mouth syndrome - Causes, symptoms and treatment. MF.

The name "hand-foot-mouth syndrome"( or enterovirus vesicular stomatitis with exanthema) originated from the English Hand-Foot-and-Mouth Disease( HFMD) and is a symptom complex consisting of a lesion of the oral mucosa - enanthema and rash on the upperand lower limbs - exanthema. It is one of the variants of "enterovirus infection", namely the Boston exanthema.

Pathogens of the "hand-foot-to-mouth" syndrome: enteroviruses Coxsacks A16, A5, A10, A9, B1, B3, enterovirus 71. These are RNA viruses that are sufficiently stable in the environment and can persist at room temperature for up to 2 weeks inviable condition.

Enteroviruses

These viruses are widespread among people of different ages, but children up to 3 years are more likely to be affected. Adults get sick less often and carry the infection also favorably.

The disease is recorded in most cases in the summer-autumn period. Mechanisms of infection - aerogenic( airborne transmission route) and fecal-oral mechanism.

The objects of use of the can be items such as toys, utensils, pastel and hygienic supplies. But still more often infection occurs when sneezing, coughing and simple conversation. Infectious not only a sick person, but also healthy carriers of enteroviruses.

Immunity after the transmitted infection is formed type-specific, resistant( that is, lifelong).However, if a person becomes infected with another serotype of enterovirus( for example, A16 was ill and B3 was re-infected), the disease may reappear.

Symptoms of enterovirus stomatitis with exanthema( hand-foot-mouth syndrome)

The incubation period( from the moment of infection to the appearance of the first signs of the syndrome) lasts 4-7 days. The patient becomes infectious with the first symptoms of the disease and remains the whole heat of the disease. The first symptom is a rise in temperature to 37.5-38º, symptoms of intoxication - weakness, headache, sore throat, muscle pain. Duration of fever to 3-5 days. That is, the onset of the disease is very similar to ARVI.However, unlike ORVI in 1-2 days on the palms of the hands( sometimes on the back of the hand) and feet( more often soles), less often on the posterior surface of the thighs and buttocks, there is a rash in the form of vesicles * of small size up to 3 mm in diameter, surroundedCorolla redness( * vesicle - cavity element with transparent contents, towering above the surface of normal skin, having around itself a ring or corolla of redness).In the dynamics of the reverse development of the rash: the elements are not opened, their contents disappear, they are compared with the surface of normal skin, reddening disappears. The rash is held by the patient for 5-7 days, then disappears completely.

Rash on the palms and feet of a child with hand-foot-mouth syndrome

Hand-foot-mouth syndrome, rash on the palms and feet

Hand-foot-mouth syndrome, rash on the feet of a child

Simultaneously with the appearance of a rash in the oral cavity appearsores( or aphthae), accompanied by soreness, sensitivity to hot, spicy food. The phenomena of aphthous stomatitis can be found on the inner surface of the cheeks, tongue, gums, hard and soft palate. When stomatitis appears, appetite decreases, irritability, moodiness, sore throat, difficulty eating, excessive salivation.

Enterovirus stomatitis in a child with hand-foot-mouth syndrome

Unlike herpangina( another variant of enterovirus infection, in which tonsils are involved in the process), in the "hand-foot-to-mouth" syndrome, sores do not reach the surface of the tonsils.

In English sources, there are indications to the fact that in 1-2 months after the syndrome has been transferred, patients may have a lesion( exfoliation) of the nails, this relationship has not been proven pathogenetically.

Complications of hand-foot-to-mouth syndrome

Most often disease forecast is favorable , spontaneous recovery occurs. However, with enterovirus 71 infection, severe and severe complications of the "hand-foot-mouth syndrome" can occur. Perhaps the development of meningitis( inflammation of the mild membranes), encephalitis( inflammation of the brain substance), which can be found in more detail in the article "enterovirus infections."

Disturbing symptoms of hand-foot-and-mouth syndrome, which will allow to suspect an unfavorable course of the disease and require an urgent call of a physician: fever above 39º, persistent high fever, the appearance of vomiting, and sometimes multiple, increased headache, pain in the eyeapples, constant crying and capriciousness of the child against a background of a fever, constant drowsiness or on the contrary psychomotor exaltation of the patient. With the appearance of such symptoms, procrastination with medical care can cost the patient's life.

Diagnosis of hand-foot-to-mouth syndrome

As a rule, the diagnosis is made based on the clinical picture and the elimination of all infectious diseases with a characteristic rash( chicken pox, rubella, measles).The reference diagnostic signs are as follows:
- beginning with a small fever and intoxication;
- after 1-2 days the appearance of exanthema( blister rash) on the feet, hands( palms);
- the simultaneous appearance of enanthema( phenomena of stomatitis) in the oral cavity;
- absence of characteristic syndromes of other infectious diseases( sore throat, pulmonary syndrome, severe lymphatic system damage and others).

Additional criteria are the laboratory methods( anasies are taken in the development of complications): a general blood test with characteristic criteria for viral infection( leukocytosis, lymphocyte increase, neutrophil reduction, ESR more often within normal limits).Specific laboratory methods that confirm the enterovirus nature of this syndrome are the virological method( isolation of enteroviruses in washings and smears from the throat), serological blood tests( detection of specific antibodies in the patient's blood serum).

Treatment of "hand-foot-mouth" syndrome

In case of a favorable course of the disease( the vast majority of patients), the symptoms of the disease pass on their own within a week, less often 9-10 days.

1) Organizational-regime measures. Most require treatment on an outpatient basis( at home).A special diet is shown - a balanced diet with mechanical and chemical sparing, that is, the food should be in a warm form, liquid or semi-liquid, to exclude too salty, hot, hot food. Must be observed drinking regime to remove toxins from the body, reduce fever( according to age, a sufficient amount of fluid).

2) Drug therapy is both etiotropic and symptomatic:
- inducers of interferon( anaferon for children and adults, aflubin and others);
- antipyretic fever - nurofen, panadol, efflergan and others, avoid taking aspirin to avoid the occurrence of Ray's syndrome;
- antihistamines with rashes - claritin, zodak, cetrine and others.

3) Local therapy ( gargle with warm solution of soda and sage, solutions of chlorhexidine, furacillin, tantum-verde spray, panthenol aerosol, to prevent the occurrence of secondary bacterial infection of the immunodon for resorption)

Prevention of hand-foot-mouth syndrome

1) Avoid contact with sneezing and coughing people.
2) Compliance with personal hygiene rules - hand washing, oral hygiene.
3) Use protective equipment( gloves) when taking care of the patient and treating the elements of the rash.

Doctor infectious diseases Bykova N.I.

According to the herpetic center of the Russian Academy of Medical and Technical Sciences, the syndrome of the hand-foot-mouth can be caused by enteroviruses in combination with VEB, CMV and HHV-6( in other words with persistent herpetic infection), which aggravates the course of the disease.