Hand , foot and mouth disease is a viral and highly contagious infectious disease that often reaches epidemic proportions, particularly in the Pacific region and Southeast Asia. The disease mainly affects children and manifests itself mainly in fever and painful skin rashes as well as blisters in the mouth, on the palms of the hands and soles of the feet, although in rare cases the disease can also be accompanied by an inflammation of the brain stem.
What is hand, foot and mouth disease?
The doctor understands hand, foot and mouth disease to be a highly contagious but mostly harmless viral disease. The viral infectious disease occurs worldwide and can spread epidemically due to the high risk of infection. Children under the age of ten contract the virus particularly frequently, but adults are not immune to the infection either.
In late summer, the occurrence of the disease generally reaches a maximum value, but the occurrence is ultimately not limited to a specific season. The disease was first documented in 1948 by Dalldorf and Sickles. Although the incidence of this disease is not limited to any particular habitat, it affects Southeast Asia and the Pacific region in particular.
There, the infection is usually epidemic and much more serious than in Europe. It is estimated that six million people will contract the virus within a decade, with the infection expected to be fatal for around 2,000 of them. A fatal course is related to the western world, however, rather the rarity.
Causes
In most cases, hand, foot and mouth disease is caused by group A enteroviruses, which include in particular coxsackie A viruses and human enterovirus 71. By far the most common pathogens are Coxsackie A16 viruses. The epidemic infectious disease is transmitted from person to person via body fluids such as droplets, saliva or blister secretions, but faecal-oral transmission is also possible.
The pathogens of the virus reach the regional lymphatic system via the intestine or the oral mucosa, from where they reach the bloodstream within a few days. No direct contact with an infected person is required for transmission. This means that transmission is also possible if an affected person has contaminated a chair, table or object with saliva or other bodily fluids and a healthy person comes into contact with this contaminated object.
Symptoms, Ailments & Signs
Hand, foot and mouth disease manifests itself in the first few days with fever and general symptoms. A few days later, painful enanthema develops on the oral mucosa and blisters appear on the tongue, palate, or gums and mucous membrane of the cheeks. In the following days, the blisters turn into coated and painful aphthous ulcers, with a symmetrical skin rash often developing at the same time.
The inner surfaces of the hands, the buttocks and the soles of the feet are often affected by blisters that are accompanied by severe itching. In rare cases, there is further loss of fingernails and toenails.
If human enterovirus 71 is the cause of the disease, concomitant aseptic meningitis or brainstem encephalitis may occur. Brainstem inflammation usually manifests as flaccid paralysis due to a lesion in the lower motor neurons in the spinal cord. These motor neurons are usually completely destroyed, which often makes the symptoms of paralysis irreversible.
Diagnosis & History
The doctor initially diagnoses hand, foot and mouth disease by visual diagnostics. before he proves the pathogens via a stool sample . Laboratory diagnostics are usually not initiated because the diagnosis is relatively certain and a mild course is expected anyway, especially in the western world. In the differential diagnosis, the doctor must rule out chickenpox and foot-and-mouth disease, which he covers by simply identifying the pathogen.
In almost all cases in this country, the disease heals completely within one to two weeks without causing any complications. Even if the infection is associated with aseptic meningitis, complete healing can also be expected. If, on the other hand, brainstem encephalitis occurs, this can be assessed as a dangerous complication that often leads to neurogenic pulmonary edema with a high mortality rate. With this severe form of infection, severe neurological deficits remain in most cases.
Complications
Hand, foot and mouth disease is very dangerous for humans and in the worst case can lead to the death of the patient. For this reason, this disease must always be treated promptly by a doctor. The patient suffers from a high fever and blisters in the mouth. Rashes also appear on the skin, which in most cases are associated with severe pain.
Furthermore, the disease can spread to the brain and lead to inflammation there, which leads to limitations in the patient’s cognitive abilities. Hand, foot and mouth disease has a significant impact on quality of life. The affected person is only slightly resilient and can no longer easily carry out normal everyday activities. Inflammation in the brain often leads to paralysis and epileptic seizures.
Likewise, thought processes can no longer be carried out correctly and the person concerned suffers from confusion and coordination disorders. There is no causal treatment for hand, foot and mouth disease. Because of this, only the discomfort and the pain of this disease can be alleviated. There are no further complications. Without treatment, life expectancy decreases drastically.
When should you go to the doctor?
Hand, foot and mouth disease is highly contagious, so a doctor should be consulted at the first sign, simply because of the risk of infection for those around you. Most of those affected also have to go to the doctor because of the symptoms of the disease so that the symptoms of the disease can be alleviated. Many suffer from pain in the arms, feet and mouth area, as well as joint pain, fatigue and fever.
The disease itself does not necessarily need to be treated with medication because it usually clears up on its own without complications, but it is often necessary to alleviate the accompanying symptoms. The itching on the skin can be curbed with medication, and the fever can be reduced with paracetamol or something similar. Tinctures and mouthwashes can help against the painful sores in the mouth, e.g. B. Conditioners with chamomile, thyme or lemon balm. Sometimes an infection can become very widespread in the mouth and must then be treated with antibiotics.
Treatment & Therapy
Treatment of hand, foot and mouth disease is symptomatic. A causal treatment is not possible because the pathogens do not react to the drugs known to contain viral infections. To relieve pain, painkilling gels are applied to the areas of all skin lesions.
This is intended to prevent a secondary infection, which is particularly favored by severe scratching. Because some patients only take in little food and liquid due to the painful changes in the oral mucosa, the supply can either be made easier by using a straw or is ensured by injections.
Outlook & Forecast
Hand, foot, and mouth disease has an overall favorable prognosis. Although the disease is highly contagious, spreads quickly and primarily affects patients whose immune systems are not fully functional, the infection usually heals completely within a few days.
Hand, foot and mouth disease is characterized by healing within seven to ten days. During this time, all the complaints that occurred have receded. Some skin changes that have occurred may take a few days longer before there are no longer any traces. Under normal conditions, the patient is considered symptom-free and fully recovered after this time.
Complications or sequelae are only to be expected in isolated cases and in exceptional situations. In people with a severely weakened immune system, other diseases can occur that contribute to worsening health or prolong the healing process. Complications mostly affect newborns, infants or the elderly.
The body’s own defenses are either not yet sufficiently developed or are already weakened due to other diseases or the natural degradation process. The risk groups can suffer from meningitis. In addition, there is a risk of hand, foot and mouth disease spreading to the internal organs.
In severe cases, functional disorders or irreparable damage to the organic tissue can occur. This development of the disease is considered extremely rare when the patient seeks medical care.
Prevention
In order to prevent hand, foot and mouth disease, hygiene measures must be observed above all, such as washing hands with soap. As a preventive measure, a healthy person should not have any close contact with sick people. So far there is no vaccine against the disease. Although three monovalent human enterovirus 71 vaccines have been developed in China, they all had complications for those who were vaccinated.
Aftercare
In most cases, patients with hand, foot and mouth disease only have a few direct follow-up measures available. The person affected is primarily dependent on a quick diagnosis so that the disease can be treated properly and further complications can be avoided. Hand, foot and mouth disease cannot heal itself, so that the affected person is usually always dependent on medical treatment.
In order to prevent further infection of hand, foot and mouth disease, strict hygiene measures should be observed. The patient should also avoid unnecessary contact with other people as far as possible so that the disease cannot spread. Bedding and ordinary clothing should also be washed at a high temperature to further reduce the risk of infection.
Since the disease is usually treated with the help of medication, the patient should take care to take it regularly with the right dosage. If you have any questions, uncertainties or side effects, you should always consult a doctor first. The disease can be limited relatively well, so that there are no further complications if it is detected early. As a rule, the life expectancy of those affected is not reduced.
You can do that yourself
If hand, foot and mouth disease has broken out, the most important thing is to practice hygiene. In order to stop the viral disease and protect family members and friends, it is necessary to break the cycle of infection.
Frequent and thorough hand washing with soap is the first step. Possible contamination surfaces must be disinfected after use . This includes the toilet, the sink with all fittings or the changing table.
Cups and similarly used material should not be shared with others. You should also be careful when hugging, kissing and shaking hands. The affected child should be helped not to cough or sneeze into the area. Hands should generally be kept away from the eyes to prevent possible conjunctivitis.
Cooling measures such as cold compresses counteract the itching. Cool packs or placing cold tea bags on top have proven to be helpful. The bags of black tea, chamomile, thyme and lemon balm tea can be used for this.
When drinking, the cooled tea relieves the discomfort in the mouth, throat and throat and prevents the body from drying out. If you have difficulty swallowing or if you refuse to eat, it is worth using water ice. Staying in larger groups of people should be avoided during the course of the disease.