Hand Foot and Mouth Disease

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DEBAPRIYA on Oct 10, 2010 Says :

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Slide 1 :

Dr Varsha Atul ShahConsultantSingapore General HospitalNeonatal & Developmental Medicine Hand Foot Mouth Disease

Slide 2 :

Introduction HFMD is a viral syndrome with a characteristic exanthem/ rash Causative agent: enteroviruses (RNA viruses of Picornaviridae family; coxsackievirus (A16, A5, A9, A10, B1, B3), echovirus, enterovirus (70, 71) etc..) Cause of several outbreaks in region (Malaysia 1997, Taiwan 1998, Singapore 2000, Malaysia/ Brunei 2006)

Slide 3 :

Epidemiology Very common viral infection (EV71: 40-50% seropositivity by 5y; Ooi 2002) Affects both sexes equally More commonly affects children under 5 (absence of protective antibodies from previous infections of similar strains), but can affect all age groups Seasonal variation in temperate countries (summer/ fall) but not in tropics

Slide 4 :

Seroprevalence of anti-HEV71 antibodies (from Ooi et al, EID 2002, with permission)

Slide 5 :

Transmission Direct: Excreta, saliva, vesicular fluid, droplet Indirect: Objects contaminated by secretions Very hardy on surfaces (Sobsey 2003) Resistant to alcohols/ phenolics (use chlorhexidine, 0.5% hypochlorite) Shed for up to 4 weeks in stools

Slide 6 :

Slide 7 :

Clinical Manifestations Incubation period: 2-6 days Outcomes of infection: (dependent on age, immune status) Asymptomatic/ silent Clinical disease without complications Clinical disease with complications (including death) Overwhelming sepsis (neonates)

Slide 8 :

Typical Clinical Features Prodrome (~2 days): Fever, malaise, anorexia, pharyngitis Mucous membrane vesicles Classical Features: Vesicles burst, leaving painful ulcers Rashes develop on hands/ feet; also trunk, perineum, thigh, buttocks Self-limiting illness, resolves in 7-10 days

Slide 9 :

Complications (1) Dehydration (mild to severe): Most common reason for hospital stay Rx by oral or IV rehydration Monitor for other complications 2 important pitfalls: 1) Dehydration is recognized late 2) Vomiting can be a sign of serious complications (lessons from 2000)

Slide 10 :

Complications (2) Aseptic Meningitis/ Encephalitis: Occasionally seen Typical Features : headache, nausea, vomiting, photophobia, neck stiffness, confusion, altered sensorium/ behaviour; may have seizures Requires admission to rule out other causes for encephalopathy; supportive management and/ or rehabilitation

Slide 11 :

Complications (3) Myocarditis: Most dreaded, high risk of mortality (mode 5 days in 2000 outbreak) Suggestive features may include pallor, cyanosis, vomiting, tachycardia, tachypnoea, cool/ clammy peripheries, cardiomegaly and/ or hepatomegaly Management is supportive (inotropes, ECMO); trial of IVIG/ pleconaril may be attempted

Slide 12 :

Complications (4) HFMD in pregnant women/ neonates: Usually asymptomatic or self-limiting disease; not known to be teratogenic However, if mother develops HFMD around delivery, newborn may develop overwhelming sepsis and death (estimated 70%) Older infants may also be at risk

Slide 13 :

Investigations Most cases do not require laboratory confirmation; diagnosis is primarily clinical NPA (nasopahryngeal aspirate) or throat swab for EV PCR Other fluids (vesicle, CSF) for EV PCR Stool for EV isolation/ culture (take weeks, but permit characterisation of virus)

Slide 14 :

Management Notify! No specific antivirals Advice re: complications and warning signs Symptomatic: Antipyretics (eg. paracetamol, ibuprofen) Oral analgesics (eg. Soragel®, Oracort®) Supportive: Adequate fluids (eg. ORS, IV drip) Severe cases: assisted ventilation, inotropes etc., KIV IVIG, pleconaril

Slide 15 :

Prevention of Transmission Infected individual: (MOH regulation) Stay at home for 7-10 days after onset of illness AND completely symptom-free AND certified free from HFMD by registered medical practitioner Practise strict personal hygiene (handwashing, avoid sharing utensils/ towels/ toys etc.) Regular cleaning/ disinfection of toys, utensils, towels etc. in proper solution

Slide 16 :

General Health Precautions Wash your hands frequently Cover your mouth when you cough/ sneeze Try not to touch your eyes, nose, mouth Avoid close contact with people who are sick – stay at home if you’re sick Watch what you eat Get enough exercise and rest Clean/ disinfect household items regularly Get the necessary vaccinations!

Slide 17 :

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	varsha.atul.shah@sgh.com.sg 5 Years ago.



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