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Hand-foot-and-mouth disease

Background

Overview

Definition
HFMD is a common viral illness caused by enteroviruses, primarily affecting infants and children, although it can occasionally occur in adults.
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Pathophysiology
HFMD is caused by enteroviruses, most commonly Coxsackievirus A16 and Enterovirus 71. It transmitted through direct contact with the saliva, nasal mucus, blister fluid, and feces of infected individuals.
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Epidemiology
The incidence of HFMD in China is estimated at 197 per 100,000 person-years. HFMD shows seasonal variation, with a peak in cases typically occurring in spring and early summer, and possesses the potential to escalate to epidemic levels.
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Risk factors
Risk factors for HFMD include young age, having close contact with infected individuals, being in group settings like schools or daycare centers, the summer and early fall seasons, and poor hygiene practices.
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Disease course
The clinical manifestations of HFMD typically include fever, sore throat, and a characteristic skin rash that presents as small, red, painful papules progressing to blisters on the hands, feet, and sometimes in the mouth, which can subsequently develop into ulcers.
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Prognosis and risk of recurrence
The disease course is generally self-limiting, with symptoms resolving within a week without specific treatment. However, in rare cases, severe cardiac and neurologic complications can occur.
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Guidelines

Key sources

The following summarized guidelines for the evaluation and management of hand-foot-and-mouth disease are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2019).
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Screening and diagnosis

Diagnosis: as per AAFP 2019 guidelines, diagnose HFMD based on the presence of a maculopapular or papulovesicular rash on the hands and soles of the feet and painful oral ulcerations.
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Medical management

Supportive care: as per AAFP 2019 guidelines, provide supportive care to patients with HFMD. Consider offering weight-based acetaminophen or ibuprofen for the management of fever and pain. Do not use oral lidocaine.
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Preventative measures

Hand hygiene: as per AAFP 2019 guidelines, advise proper handwashing to decrease the risk of transmitting HFMD.
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