Hand-foot-mouth syndrome

Hand-foot-mouth syndrome, or enterovirus vesicular stomatitis with exanthema is a contagious viral infection, most commonly occurring in young children under 5 years old. The disease is a certain complex of symptoms, manifested in the form of enanthema (the appearance of sores on the oral mucosa) and exanthema (the occurrence of rashes on the legs and hands).

[1],

Causes of the hand-foot-mouth syndrome

The cause of the syndrome are Coxsackie enteroviruses of the following types: A16, A5, A10, A9, B1, B3, 71, and olivoviruses and echoviruses. These RNA-containing viruses, they are quite viable in the external environment - can survive for 14 days at a temperature of 20-25 degrees.

Outbreaks of the disease most often occur in the summer-autumn. Infection occurs by airborne droplets or by a fecal-oral route. Transmission of the virus can occur through any household item - for example, through dishes, children's toys, as well as hygiene and bedding. But basically the infection is carried out during a simple conversation, as well as when coughing or sneezing. Healthy carriers of the virus are as contagious as those who are ill.

Typically, a person with hand-foot-mouth syndrome is most contagious during the first week of the illness, sometimes for several days or weeks after the symptoms have disappeared. Some people, especially adults, endure the disease without any symptoms, but can transmit the virus to others. That's why people should always try to follow the rules of personal hygiene (for example, washing their hands), thus minimizing their chances of getting infected.

[2], [3]

Risk factors

Children in children's institutions are especially susceptible to outbreaks of hand-foot-mouth disease, since the infection spreads contact from person to person.

[4], [5], [6], [7], [8]

Pathogenesis

The hand-foot-mouth syndrome appears under the influence of enterovirus (usually a Coxsackie A16 virus). It penetrates the body through the mucous membrane of the mouth, as well as the intestine, and then reaches the regional lymph nodes. Viralemia occurs after 48-72 hours.

[9], [10], [11], [12],

Symptoms of the hand-foot-mouth syndrome

The first symptom of hand-foot-mouth syndrome is the temperature, which rises to 37.5-38º. Further, there are signs of an intoxication syndrome - headache and muscle pain, general weakness, a choking occurs in the throat. The fever lasts for 3-5 days. In general, the disease at first very much resembles ARVI.

But among other symptoms on the 1st / 2nd day of the disease on the palms or the back of the hand, as well as the soles or feet (sometimes on the buttocks and the posterior surface of the thighs) there are rashes no more than 3 mm in diameter with a rim of redness around, having type of vesicles. A transparent cavity element is called a vesicle, which slightly rises above the skin surface. They develop not as an ordinary rash, but in reverse order - vesicles do not open, but disappear, comparing with healthy skin. Such a rash lasts about 5-7 days, after which it completely disappears.

Along with rashes on the skin there are also small sores in the mouth - they are quite painful and very sensitive to hot and hot food. Aphthous stomatitis can also appear on the gums, the inner surface of the cheeks, soft and hard palate. Because of stomatitis, appetite disappears, the child becomes moody, irritable. Also, there are difficulties with eating, strong salivation and sore throat.

[13]

First signs

The syndrome has an incubation period that lasts an average of 3-6 days. In this case, the child becomes listless, indifferent to what is happening around. Also among the first signs of the disease - rumbling in the stomach and a worsening of appetite.

People of any age can infect this virus, but usually hand-foot-mouth syndrome affects small children - at the age of not more than 3 years.

[14],

Complications and consequences

Enterovirus infection 71 in the case of hand-foot-and-mouth syndrome can have rather serious consequences and complications. These can be encephalitis, as well as aseptic meningitis.

Among the symptoms of complications - fever over 39º, vomiting (can be repeated), headache, pain in the eyeballs, the child is naughty and crying during fever, he has drowsiness, or on the contrary, there is a psychomotor agitation. If you notice that your baby has such symptoms, you should immediately call a doctor.

[15], [16], [17], [18]

Diagnostics of the hand-foot-mouth syndrome

Usually, the disease is diagnosed according to the clinical picture, when all infectious diseases, at which characteristic rashes (such as rubella, chicken pox, or measles) are eliminated. Among the main diagnostic signs of the hand-foot-mouth syndrome are the following:

• The disease begins with mild intoxication with fever;
• After 1-2 days at the same time there are exanthema on the skin of the legs and hands (feet, palms), as well as enanthem in the mouth;
• Characteristic for other infectious infections (pulmonary syndrome, angina, disorders in the lymphatic system, etc.) are absent.

[19], [20], [21],

Analyzes

1. General blood analysis. Typical for the virus infection changes: leukocytosis, a decrease in neutrophils, an increase in lymphocytes, ESR is usually within normal limits.
2. Virological studies, PCR diagnostics (enteroviruses are isolated in washings, as well as smears taken from the throat).
3. Serological tests (specific antibodies are detected in the blood serum).

[22], [23], [24], [25], [26]

Differential diagnosis

Differential diagnosis is performed with the following diseases: aphthous stomatitis, herpes, Stevens-Johnson syndrome, herpagina. With the last disease (this is another type of enterovirus infection), the ulcers in the mouth also spread to the tonsils, which makes it possible to differentiate it from the hand-foot-and-mouth syndrome.

Treatment of the hand-foot-mouth syndrome

If the disease occurs without complications, its symptoms disappear on their own in a week (very rarely prolonged to 9-10 days).

Most patients will have enough outpatient treatment. They are prescribed a special diet - it must be balanced and sparing, both chemically and mechanically. Food should be warm and liquid (or semi-liquid) too sharp, salty and hot foods are prohibited. It is also necessary to comply with drinking regimen to reduce fever and remove toxins from the body.

The treatment of hand-foot-and-mouth syndrome with drugs can be symptomatic or etiotropic.

There is also a local treatment - gargling with a warm solution of sage with soda, solutions of substances such as furacillin or chlorhexidine.

Medications

To reduce pain due to sores that appear in the oral cavity, and if weakness, chills, pain in the joints and muscles are observed together with the temperature of the baby, the antipyretic preparation is excellent - it may be Ibuprofen or Paracetamol. In addition, panadol, nurofen, and efferalgan (aspirin should not be taken - it can cause Reye's syndrome) will help with high temperature.

When skin rashes are prescribed antihistamines - zodak, klaritin or cetrine.

To prevent the emergence of a second bacterial infection, sprays Pantenol and Tantum Verde are used. For resorption, they take Immunon.

Inductors of interferon may also be prescribed - adult or pediatric anaferon, as well as aflubin, etc.

Correction of a metabolism at the child consists in carrying out of a vitaminotherapy. So it is necessary from the first days of the appearance of the syndrome and after recovery to give him vitamins B1 and B2, as well as nootropics (pyracetam) and calcium glycerophosphate.

With hand-foot-mouth syndrome, physiotherapy is not performed.

Alternative treatment of hand-foot-and-mouth syndrome

Take 1 tsp. Mint and marigold, pour 1 stack. Boiled water. After half an hour strain the tincture. You need to take half a cup three times a day.

Within 10 minutes, boil in 1 liter of water, 250 g of calyx berries. After this, strain and add to the tincture 3 spoons of honey. Take necessary for 100 ml 3 times / day.

Pour 1 stack. Boiling water 1 tbsp. And boil for 10 minutes. The solution should be taken three times a day for 1 tablespoon.

Pour 1 cup boiling water willow branches, birch buds and bark elm (all components - 2 tsp) and cook the mixture for 20 minutes. Then the solution must be cooled and filtered. Drink it should be three times a day for 1 tablespoon.

[27], [28], [29], [30]

Herbal Treatment

This syndrome can also be treated with herbal treatments.

1 tbsp. Collection, consisting of 2 parts of violet grass and linden flowers, as well as 1 part of elderberry, fennel and fenugreek seeds, pour a glass of water. Leave the mixture to infuse for 2 hours. After this, boil it and let it stand on the stove for another 2 minutes. Tincture should be drunk during the day.

Take the elderberry and lime blossom (2 parts), chamomile, peony, licorice root (1 part) and nettles (3 parts), cut them and mix. After that, pour 2 tablespoons. Resulting mixture of 0.5 liters of boiling water. Allow the solution to stand for 15 minutes, then drain. During the day, the broth should be drunk in small portions.

Pour a pinch of herbs Voronets 1 stack. Boiling water, then drain the broth and drink 150 ml, previously diluting it in milk.

Take equal portions of the following herbs: lemon balm, grass, cotton grass, oregano, lime blossom, hop cones, coriander seed, valerian root, and motherwort and chop them. One tbsp. Mixture to fill it in a thermos, pour it 0.5 liters of boiling water and leave for 1 hour. The resulting broth should be drunk 3 times / day for 100 g.

Homeopathic remedies for hand-foot-mouth syndrome do not apply.

Prevention

As a preventive measure of the disease, it is necessary not to take the child to places where there is usually a large crowd of people (for example, in polyclinics) during the epidemic. If you need to go necessarily, lubricate his nose with oxolin ointment. In addition, you should regularly ventilate the room in which the child stays for a day and often wash his hands.

[31], [32]

Forecast

Hand-foot-mouth syndrome has a favorable prognosis - usually after recovery the child has lifelong type-specific immunity. But in some cases it is possible to re-infection if another serotype of enterovirus becomes the causative agent of infection (for example, a secondary infection with the Coxsackie type B3 virus after a disease that began due to the A16 virus) is possible.

[33], [34], [35], [36], [37], [38], [39]