Hand-foot-mouth disease B08.4

Epidemic, endemic and sporadic, usually mild, vesicular viral exanthema on palmae, plantae and oral mucosa. Most frequently in summer or autumn.

Coxsackie viruses of group A16; also Coxsackie- A4, -A5, -A9, -A10. Transmission occurs by droplet infection or direct contact. Coxsackievirus A belongs to the genus enterovirus and the species "human enterovirus A2" of which 23 serotypes are known.

Mostly occurring in children before the 10th LJ, rarely in adults.

General: Incubation period 3-7 days, maximum 2 weeks. About 2 weeks of unspecific prodromies (fever, headache, rhinitis, gastrointestinal symptoms).

Oral mucosa: First visible symptoms are pinhead-sized intraoral erythema, which quickly turn into translucent vesicles; later yellowish-white, very painful aphthae. Abortive forms are possible.

Integument: Characteristic is a painful vesiculous exanthema on hands and feet, especially on palmae and plantae, with intermittent, disseminated, flat, angular papules which change into elongated, polygonal vesicles with a reddened courtyard, and later into pustules.

Rare papulo-vesicular (often overlooked) exanthema on the trunk and buttocks.

Besides the uncharacteristic prodromal symptoms, subfebrile temperatures and regional lymph node swelling are found. The concordant occurrence of subacute granulomatous thyroiditis de Quervain with hand-foot-mouth disease was described (Engkakul P et al. 2011).

Depending on the stage of development (papules, vesicles or erosions) and localization (skin or mucosa) of the lesions, different histological images are found. Mostly evidence of spongiosis, dyskeratotic cells and giant cells. In the dermis, uncharacteristic perivascular accentuated lymphocytic infiltrate.

Gingivostomatitis herpetica: Initial manifestation of a herpes simplex infection. Grouped vesicles enorally, usually severe clinical picture.

Herpangina: analogous clinical picture to hand-foot-mouth disease, but usually without the changes in the integument.

Zoster: segmental pattern of infestation. Zoster infections in children are however rather atypical

Varicella: disseminated (not localized) papulo-vesicular exanthema. Vesicles and pustules. Typical multifaceted efflorescence pattern (star map).

Aphthae: few lesions, no integumentary involvement (except Behçet's disease), chronic recurrent course.

Erythema exsudativum multiforme: typical cocard structure of the skin lesions (ring within a ring), foci clearly larger, no painfulness

Patients with atopic dermatitis may develop pronounced, atypical disseminations of this viral infection(eczema coxsackium).

Spontaneous healing usually within 8-12 days. Complications are rare.

Onycholyses(onychomadesis) of the finger and/or toenails are not entirely rare (probably due to a viral infection of the keratinocytes of the nail matrix). On average 4-6 nails detach. Spontaneous healing 100%.

Attempt to detect virus from fresh stool samples or vesicle contents, complement fixation reaction.

The name of the viruses comes from the US town of Coxsackie (near New York), where the first epidemic was described.

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