HAND-FOOT-AND-MOUTH DISEASE (HFMD)
Most cases of HFMD are due to coxsackievirus A16 or enterovirus 71.
After an incubation of 4-6 days, patients present with fever, anorexia and malaise followed by a sore throat with vesicles involving, variably, the buccal mucosa, tongue, palate, uvula, tonsillar pillars (herpangina) and the skin - typically of the hands and feet. The vesicles are tender and may evolve into pustules and bullae (see photo). The lesions usually resolve in one week.
Severe complications can include CNS disease (aseptic meningitis, flaccid paralysis, and rhomboencephalitis with myoclonus and tremor or ataxia), myocarditis, and pulmonary edema or hemorrhage. The mean age for CNS disease is 2.5 years. Death in infants is usually due to pulmonary edema or hemorrhage.
The infection is highly contagious, with attack rates of nearly 100% among young children.