Hand, Foot, and Mouth disease and Herpangina are two common ailments of childhood that cause oral lesions.  They are both caused by Enteroviruses but particularly the various strains of Coxsackievirus A.  Even though immunity is conferred after infection, a child can get the disease again if they encounter another strain.  HFMD usually occurs in the spring, summer, and fall and Herpangina is usually seen in the summer.  Both diseases are similar as they are caused by similar pathogens.  Transmission of the illnesses is the same being respiratory droplets and via fecal/oral contamination.  The incubation period is about 3-4 days with the duration after onset of symptoms of 7-10 days.  Diagnosis for these ailments is based on clinical exam.  No lab tests are warranted.

HFMD

Fever is usually the first sign of illness (up to 104).  This is followed by a sore throat/mouth with blistering lesions in the mouth.  A blistering rash usually follows in 1-2 days on the hands, feet and possibly buttocks.  Other symptoms include:

• Feeling of being unwell (malaise)

• Loss of appetite

• Irritability

Potential complications:

Dehydration, meningitis and encephalitis.

Treatment is supportive only.  Try to keep a close accounting of fluid intake.  Avoid hot or spicy fluids.  Cold fluids are more soothing.  Rest and fever control are important as well.  Antibiotics and anti-viral meds are not helpful.  Occasionally oral rinses may provide some pain relief.

Methods of Prevention

• Wash hands carefully. Be sure to wash your hands frequently and thoroughly, especially after using the toilet or changing a diaper and before preparing food and eating. When soap and water aren’t available, use hand wipes or gels treated with germ-killing alcohol.

• Teach good hygiene. Show your children how to practice good hygiene and how to keep themselves clean.

• Clean your baby’s pacifiers often.

• Isolate contagious people. Because hand-foot-and-mouth disease is highly contagious, people with the illness should limit their exposure to others while they have active signs and symptoms. Keep children with hand-foot-and-mouth disease out of child care or school until fever is gone and mouth sores have healed. If you have the illness, stay home from work.

When to see a doctor:

There are four warning signs to watch for.

• Fever lasting longer than three days.

• Your child complains of a stiff neck.

• You child is acting very sick or seems extremely sleepy.

• Your child has not urinated in eight hours.

Herpangina

The pathology, symptoms and treatment options with Herpangina are the same as with HFMD with the caveat that herpangina does not involve the body rash.  The complications, treatment and warning signs are the same.