Enteroviral vesicular stomatitis or hand-foot-mouth syndrome. Coxsackie virus - all about the treatment of hand-foot-mouth syndrome

Enteroviral vesicular stomatitis with exanthema (hand-foot-mouth rash syndrome) is a complex of symptoms caused by a viral infection. It appears as extremely painful sores in the mouth and small vesicles (grayish blisters) on the extremities. In some cases, vesicles are also observed in the area of the buttocks and genitals. These are the main distinguishing symptoms of the disease.

Hand-foot-mouth syndrome primarily affects children under 10 years of age and is contagious. It is transmitted by airborne droplets, fecal-oral and contact routes and is activated in the summer-autumn period. Adults can also suffer from the syndrome, however, this happens much less frequently and the disease is more easily tolerated.

Causative agents of the syndrome

Medicine is well aware of the causes of this disease. The causative agents are several strains of resistant Coxsackie viruses that can live for up to 2 weeks at room temperature in the external environment, and also for some time in water.

After suffering from the disease, a person develops lifelong immunity to the specific strain of the virus that causes hand-foot-mouth syndrome. A person who has recovered from the disease may get it again, but we can say with confidence that it will be a different causative virus.

The disease occurs when communicating with infected people, as well as when hygiene rules are not followed. Treatment for this disease is usually not required, or it is aimed at its symptoms.

Symptoms of the disease

The disease has a short incubation period of about a week. The patient becomes dangerous from the moment of infection, even before the onset of symptoms, and remains so throughout the entire disease. You can suspect hand-foot-mouth syndrome in a child if:

Fever. Fever is characteristic of many infectious diseases. The temperature rarely rises above 38.5 degrees.
Itching. It occurs in areas where foci of infection appear.
Intoxication. Its signs are headaches, weakness, muscle pain, and other symptoms may be observed.
Rash. It is the main sign of the syndrome, but occurs 1-2 days after the first signs appear. At the same time, painful ulcers appear in the mouth, on the inner surface of the cheeks, tongue, gums and palate.

The onset of the disease (before the rash appears) is very similar to ARVI. The doctor must conduct a differential diagnosis, excluding the possibility of ARVI, stomatitis, allergies, herpangina and some other diseases. Blood tests and throat swab tests help in diagnosis.

Treatment

First of all, the sick person must be placed under strict quarantine conditions. In most cases, there is no reason to consult a doctor: the disease is not dangerous and treatment of the disease is not required. Usually the fever goes away within 1-2 days, the rash begins to disappear on the 5th day and completely disappears by the 10th day.

Treatment is aimed at reducing the pain of mouth ulcers, since this is the main cause of the patient’s discomfort, interfering with normal food intake. For this purpose, local anesthetics such as lidocaine are used.

If the temperature is high, you can bring it down with antipyretics. If there are ulcers in the patient’s mouth, the oral cavity should be treated with an antiseptic. For severe sore throat, gargling with decoctions of medicinal herbs such as chamomile, linden blossom, St. John's wort, burdock, and yarrow is recommended.

Complications

One of the strains of viruses that cause hand-foot-mouth syndrome, enterovirus 71, can seriously threaten the health and even the life of the patient. It is urgent to call a doctor if:

the temperature stays around 39 degrees;
severe pain appears in the chest and upper abdomen;
breathing problems are detected;
convulsions occur, coordination of movements is impaired;
vomiting occurs;
pain in the head intensifies, pain occurs in the eyeballs;
inhibition of the reaction appears or, on the contrary, nervous excitability increases.

The manifestation of such symptoms suggests that the disease should not develop without medical supervision and urgent treatment is necessary. Complications can include such serious diseases as meningitis, encephalitis, and inflammation of the lining of the heart and pleura of the lungs. Such diseases can make a person disabled and even lead to death.

Fortunately, enterovirus 71 affects people extremely rarely, and for the development of a syndrome of this severity, absolutely unsanitary conditions are necessary.

Patient care

Since the disease is highly contagious and can be treated at home, it is necessary to strictly follow all recommendations for caring for a patient with hand-foot-mouth syndrome. The virus can spread through particles of saliva and feces, which means that the greatest importance should be given to washing your hands, both the patient’s and your own.

You cannot share dishes, towels, or personal hygiene items with the patient.
You should not finish eating food for a sick person or finish drinking.
There is no need to have extra contact with a sick person or take his things.
Wash your hands with soap as often as possible.

In nature, there are dozens of viruses that multiply in the human gastrointestinal tract and are therefore called enteroviruses. They can cause a number of diseases - from conjunctivitis to serious damage to the nervous system. One of these ailments is quite common, but not always diagnosed due to its similarity with other infectious pathologies, hand-foot-mouth syndrome. Such an unusual name for the disease is due to the appearance of specific rashes on the patient’s limbs, in the mouth, and around the lips.

Reasons for the development of the syndrome

Several viruses belonging to the group of enteroviruses can cause hand-foot-mouth syndrome:

Coxsackie viruses type A (5, 9, 10, 16) and type B (1, 3).
71 types.

All of these viruses are quite resistant to environmental conditions, and at room temperature they can remain viable even for up to two weeks. Particular activity of pathogens of the “hand-foot-mouth” syndrome is observed in the summer-autumn time, and accordingly, the incidence increases in this period.

In the human body, these enteroviruses are concentrated in saliva and feces (since their reproduction occurs in the gastrointestinal tract). Therefore, infection with pathogens of the hand-foot-mouth syndrome occurs in three ways: food (fecal-oral mechanism), airborne droplets, and household contact. That is, infection is possible through close contact, conversation, playing together, or using the same utensils with a sick person or carrier.

Who is sick?

Most often, children suffer from this syndrome. This is due, firstly, to the mechanisms of transmission of infection (children are in close contact with each other in a group and do not always follow hygiene rules), and, secondly, to the peculiarities of the formation of immunity to the pathogen.

After the first contact with the enterovirus that causes hand-foot-mouth syndrome, the body develops immunity that remains for life. Therefore, a child, having encountered the virus for the first time in his life and having been ill, subsequently receives protection from it and no longer gets sick as an adult. But there may be exceptions, for example, when infected with a new enterovirus, with which there was no contact in childhood. In such situations, an adult can also get sick and have the same symptoms of the disease as a child.

On average, 5-7 days pass from the moment of infection to the manifestation of the disease, and the patient becomes dangerous to others already when the first symptoms of the disease appear. By the way, they are very reminiscent of a normal one: a person’s temperature rises (which returns to normal after 3-4 days), weakness occurs, the throat becomes redder and begins to sore, etc. After about a day, more specific manifestations of the syndrome develop: vesicular (enanthema), as well as a rash on the extremities and on the skin around the lips (exanthema). Visually it looks like this:

Small bubbles with liquid appear on the oral mucosa (gums, cheeks, palate), which burst and leave behind ulcers that disappear over time without a trace.
On the skin of the arms, legs (usually the soles of the feet and palms), less often on the buttocks, as well as around the lips and nose, very small blisters with a red inflamed border or simply red spots form. After they disappear (after 7-10 days), the skin may peel off, and in some patients, after 4-5 weeks, nails may peel off.

In addition to these objective symptoms of the disease, patients experience increased salivation, soreness in the mouth when eating food, decreased appetite, weakness, and in young children - tearfulness, anxiety and poor sleep. Babies may also experience vomiting and short-term diarrhea, especially against the background of elevated body temperature.

In general, hand-foot-mouth syndrome has a favorable course, and patients recover completely in 7-10 days. In rare cases (in particular, when infected with enterovirus type 71), more severe forms of the disease and complications (meningitis, encephalitis, etc.) may develop. You can suspect that the course of the disease is becoming unfavorable based on the following signs:

Persistent fever (especially body temperature above 39 degrees).
Increasing headache.
Multiple.
Severe drowsiness or, conversely, unreasonable agitation.
Pain in the eye area.
The incessant crying of a child.

Doctors do not always diagnose this disease in a timely manner, since at the beginning of its development it resembles a typical acute respiratory viral infection. In addition, even the resulting stomatitis may not be expressed, and the skin rash often imitates allergic manifestations (which parents and doctors often regard as an allergy to antipyretics taken) or other infectious diseases . But it is still possible to identify diagnostic criteria for this disease. These include:

Moderate fever and intoxication.
Simultaneous appearance of vesicular stomatitis and skin rashes with predominant localization on the feet and hands.
Absence of symptoms characteristic of other infectious diseases (tonsillitis, enlarged and painful lymph nodes, severe cough, etc.).

There are also specific methods for diagnosing this enterovirus infection (they are used rarely and mainly in severe cases of the disease):

Virological research (isolation of viruses from material taken from a patient).
Serological tests (detection of antibodies to enteroviruses in the blood).

General clinical studies (for example, a blood test from a finger) provide only presumptive information that a disease of a viral nature is developing in the patient’s body.

Treatment of hand-foot-mouth syndrome

There is no specific antiviral treatment for this disease. Patients are prescribed a diet that spares the oral mucosa (maximum crushed, liquid and warm food is recommended, spicy, sour and salty foods are excluded), drinking plenty of fluids to eliminate intoxication, as well as medications to reduce inflammatory changes in the oral cavity and lower body temperature. For severe itching, patients are prescribed antihistamines.

Treatment of stomatitis, the main and most unpleasant manifestation of this disease, includes:

After each meal, it is also advisable to rinse your mouth so that leftover food does not irritate the inflamed mucous membrane, cause additional discomfort to the patient, and do not provoke a secondary bacterial or fungal infection.

Among antipyretics, preference should be given to paracetamol and ibuprofen.

As for the treatment of skin rashes, they go away on their own without the use of any medications.

Preventive measures for hand-foot-mouth syndrome should be the same as for other infections transmitted by airborne droplets, contact and food. That is, you should avoid contact with people who cough, sneeze or have any rashes on their faces, use only individual utensils, and carefully observe hygiene rules.

Parents of sick children should also remember the dangers, especially when caring for the baby’s skin, treating rashes in the mouth, washing the potty, changing diapers, etc.

Zubkova Olga Sergeevna, medical observer, epidemiologist

The most common disease caused by enteroviruses is hand-foot-mouth syndrome. The disease received this name because of the characteristic symptoms manifested in the mouth, arms and legs. Enteroviral vesicular stomatitis with exanthema disappears after 10 days. There is no specific immunity left after recovery.

Reasons

Hand-foot-mouth disease can be caused by the following pathogens:

Enterovirus type 71;
Coxsackie virus A (5, 9, 10, 16) and B (1.3).

Enteroviruses are stable in the environment and live up to 2 weeks at room temperature. Experts note an increase in incidence in summer and autumn.

Symptoms

What are the symptoms of childhood hand-foot-mouth infection? The disease develops 5-7 days from the moment the Coxsackie virus enters the body. Further, EVI is manifested by symptoms similar to a cold: the temperature rises to 38 ° C, weakness and headache, unpleasant, painful sensations in the throat and its redness occur. The child does not want to play, his appetite disappears. In some cases, runny nose and diarrhea are possible. Then, after a day or two, specific symptoms of enterovirus infection appear: stomatitis and exanthema.

Stomatitis is characterized by the appearance of small ulcers (ulcers) in the mouth. They are painful, especially when coming into contact with hot or spicy foods. Aphthae are localized on the gums, soft and hard palate and the inside of the cheeks. Such changes in the mouth lead to decreased appetite, moodiness in children, and excessive salivation.

The rash with hand-foot-mouth syndrome in a child is localized on the extremities. It is more common on the palms and soles of the feet. It is rare to find rashes on the thighs and buttocks, around the nose and lips. The rash is characterized by vesicles up to 0.3 cm with liquid contents inside, rising above the skin. A corolla of hyperemia forms around them.

Within a week, the rashes resolve: the vesicles do not open, the fluid in them disappears, and they no longer rise above the skin. The rash goes away without a trace, but sometimes the skin in its place may peel off. According to some reports, nails may peel off 5 weeks after recovery.

Transmission routes

How is the hand-foot-mouth symptom transmitted? The Coxsackie virus multiplies most intensively in saliva and feces. Therefore, you can become infected through the fecal-oral, contact-household and airborne routes. That is, you can get sick not only through dirty hands, but also through contact with the patient or surrounding objects.

Infection with enterovirus infection can occur even from a recovered person, since he is still a carrier for some time.

Those who have recovered from a viral infection of the hand, foot, mouth do not acquire lasting immune protection. This is explained by the fact that a person has only been ill with one strain of the pathogen, and the disease can subsequently be caused by another variety of the same virus.

Who gets sick more often: children or adults?

Children are more often affected by hand-foot-mouth syndrome due to transmission mechanisms. The fact is that in children's groups, children often come into contact with each other during games, without observing hygiene rules. This infection also occurs in children due to weak immunity.

The virus, which affects the hands, feet and mouth, can also cause illness in adults. This situation occurs in the event of infection with a strain to which a person has not developed immunity.

Which doctor treats hand-foot-mouth syndrome?

After the pediatrician diagnoses symptoms characteristic of a hand-foot-mouth infection, the child is referred to an infectious disease specialist. If complications develop, you may need the help of a resuscitator.

Diagnostics

In some cases, it is not immediately possible to identify hand-foot-mouth syndrome in a child. This is due to the similarity of the clinical picture with ARVI in the initial stage of the disease. The rash may not be bright, so it is often mistaken for an allergic reaction to taking antipyretic medications. Doctors may also suspect other infectious pathologies (measles, etc.).

But the Coxsackie virus and hand-foot-mouth disease can be diagnosed based on the presence of the following criteria:

the disease begins with a slight fever and intoxication;
the appearance after 1-2 days of a vesicular rash on the palms and soles of the feet;
aphthous stomatitis in the oral cavity;
absence of damage to the lymph nodes, lung disease, and throat disease.

Laboratory methods help confirm the diagnosis of hand-foot-mouth syndrome (if a complicated course occurs):

CBC - increased number of leukocytes, decreased neutrophils;
virological method - detection of the virus in washings and throat swabs;
serological test - detection of antibodies to the virus in the patient’s blood serum.

Treatment

How to treat hand-foot-mouth infection? Etiotropic treatment for this pathology is not provided. With a favorable course, the disease disappears after 10 days.

Treatment of hand-foot-mouth syndrome in a child should begin with diet. The food taken should be crushed or liquid, at a comfortable temperature. Spicy, salty and sour foods are excluded from the diet. These measures are necessary to reduce exposure to the oral mucosa. To reduce intoxication, the patient should drink large amounts of water.

To treat stomatitis in hand-foot-mouth syndrome it is necessary:

apply antiseptic and anti-inflammatory drugs to lesions in the oral cavity;
rinse your mouth with herbal decoctions (chamomile, sage). For these purposes, you can use plant-based solutions. The procedure is carried out several times a day;
treat ulcers with Chlorophyllipt or sea buckthorn oil;
rinsing your mouth after meals. This will reduce the likelihood of irritation of the mucous membrane and infection.

Drug treatment for the virus that causes hand-foot-mouth disease in a child should include:

interferon inducers (Aflubin, Anaferon for children);
to reduce temperature Panadol, Nurofen, Efferalgan. Do not take Aspirin to avoid Reye's syndrome;
if a child is bothered by itching, it makes sense to prescribe antihistamines.

Traditional methods

To treat hand-foot-mouth disease, you can use the following folk recipes:

to reduce inflammation and quickly heal rashes, aloe juice is suitable, which is applied to gauze and applied to the affected areas;
Yarrow is suitable for the same purposes. A compress of crushed leaves is applied to the rash for 15 minutes;
To eliminate ulcers in the oral cavity, decoctions of herbs are used: St. John's wort, yarrow, chamomile, sage. 1 tablespoon of the herb is poured into a glass of boiling water and left for an hour. After filtering with this infusion, you can rinse your mouth up to 4 times a day. The procedure is carried out only after eating;
To speed up wound healing, you can use sea buckthorn and corn oil. Olive and sunflower oil are also suitable.

Complications

More often, the hand-foot-mouth disease has a favorable outcome, the patient recovers on his own. But infection with enterovirus type 71 can lead to serious complications: encephalitis and meningitis.

Their development is evidenced by the following clinical picture:

fever over 39 °C;
repeated vomiting that does not bring relief;
severe headache;
a feeling of soreness in the eyeballs;
moodiness and crying;
drowsiness or agitation.

If these symptoms develop, you should immediately consult a doctor. Otherwise, death is possible.

Prevention

To prevent the disease, you need to take preventive measures:

wash your hands after visiting the toilet and returning from the street;
wash vegetables and fruits;
do not touch your mouth with dirty hands;
use an individual towel;
Drink exclusively boiled or purified water. Drinking tap water is strictly prohibited.

Hand-foot-mouth syndrome is predominantly a childhood infection caused by enteroviruses and the Coxsackie virus. The disease has clear clinical symptoms. However, the diagnosis is often not made immediately, since the onset of the disease is similar to ARVI.

There is no specific treatment for enterovirus infection, so symptomatic therapy is prescribed. More often, the pathology proceeds favorably, but in some cases complications may develop. To prevent the disease, it is necessary to follow preventive measures.

At the same time, a rash appears in the mouth and on the skin of the hands and feet. Most often, the development of enteroviral vesicular stomatitis is noted in children under 3 years of age. The causative agent of the infection is the Coxsackie virus. This virus is easily transmitted from one child to another through airborne droplets, contact or through household objects.

In most cases, the disease is unpleasant, but not dangerous and goes away on its own after 10 days. Therapy for the disease is aimed at strengthening the baby’s immunity and alleviating the symptoms of the pathology. The disease can be treated using traditional methods. This therapy is safe and does not have any negative side effects on the baby’s body.

Causes of pathology

Enteroviral stomatitis is a childhood infectious disease. Children under three years of age are most often affected, but older children can also become infected. Most often, outbreaks of hand-foot-mouth syndrome occur in the summer and autumn.

The causative agent of the infection is Coxsackie enterovirus, which is easily transmitted from one person to another. Viruses remain viable in the external environment for up to two weeks. You can become infected not only through direct contact with a sick baby, but also through contact with surrounding objects, toys, and through dirty hands.

It is also important to remember that after recovery, the child is a carrier of the virus for some time and remains contagious, even if he does not show symptoms of the disease.

Enterovirus infection does not provide lasting immunity. Resistance develops to only one strain of the virus, and the child can be re-infected with another strain.

Symptoms of hand-foot-mouth syndrome

Signs of the disease begin to appear after an incubation period, which ranges from several days to a week. At the first stage, the baby develops signs of a cold:

body temperature rises to 38°C;
symptoms of intoxication of the body increase: general weakness, lethargy, drowsiness, reluctance to play, pain in muscles and joints, headache;
sore and sore throat;
runny nose, sometimes diarrhea.

These symptoms last up to 5 days, then the baby’s temperature drops and his condition improves.

2–3 days after the onset of the infectious process, the child develops rashes characteristic of hand-foot-mouth syndrome. Initially, the rash develops in the oral cavity, then the legs and arms are affected. The rash most often affects the foot and palm. Sometimes the rash appears on the back of the hand, around the joints of the arms and legs, and on the buttocks.

Small, up to 3 mm in diameter, vesicles filled with liquid appear on the oral mucosa and skin surface. The mucous membrane and skin around them are hyperemic and slightly swollen. The vesicles may rupture to form ulcers. These ulcerations cause pain to the patient. A sore throat may also accompany these symptoms. When such wounds form in the mouth, eating becomes difficult, and the baby may refuse to eat and drink. The baby becomes capricious, irritable, and whiny. His salivation increases.

The rash with hand-foot-mouth syndrome lasts about a week, then disappears, and the child recovers.

Diagnosis of the disease

The diagnosis is made based on the symptoms characteristic of hand-foot-mouth syndrome. However, a similar rash is also typical for other childhood viral infections. Accurate diagnosis is carried out using an immunological blood test and detection of specific antibodies against enterovirus antigens.

Treatment of the disease

With the development of enteroviral vesicular stomatitis in children, treatment with antiviral drugs is not carried out. The child’s body is able to cope with the infection on its own. In most cases, this disease proceeds without complications and ends with the baby’s complete recovery. Taking antiviral drugs has a negative toxic effect on the child’s liver. There is no need for such therapy.

Treatment is aimed at improving the patient's condition. In therapy, folk medicines are used that have an anti-inflammatory effect and strengthen the baby’s immunity. Also, external folk remedies with antimicrobial and wound-healing effects are used to treat skin wounds. Herbal decoctions are used to rinse the mouth. This treatment will relieve the baby’s pain and prevent bacterial infection.

Aloe and nettle juice. The leaves of these plants are crushed into pulp and the juice is squeezed out. A sterile gauze pad is soaked in this juice and applied to the wound surface. The drug has an anti-inflammatory and wound-healing effect, prevents the development of microbial infection.
Yarrow. Fresh leaves of this plant are crushed and applied to the wounds, covered with gauze on top. Compresses are applied for 10–15 minutes 2–3 times a day. Instead of yarrow, you can use wormwood, plantain or lilac leaves.
Sea buckthorn oil. Lubricate the wound surface with this oil. This remedy promotes rapid tissue regeneration. Instead of sea buckthorn oil, you can use corn, olive or sunflower oil.
Nut. An oil tincture of the nut is also prepared. The leaves of this plant are crushed and poured with vegetable oil (olive, corn or sea buckthorn). Infuse the drug in a glass container in a dark, warm place for three weeks, then filter. This product can also be used to treat a child's leg or arm with ulcers.
Folk ointment. Chop and mix onion, garlic, hot pepper, salt and honey in equal proportions. This mixture is kept in the oven at a temperature of 170 0C for 15 minutes, then cooled. The ointment is stored in the refrigerator and applied to the patient’s wounds 2-3 times a day.
Decoctions for rinsing. To speed up the healing of mouth ulcers, rinse your mouth with infusions of medicinal herbs: chamomile, calendula, yarrow, sage, St. John's wort and others. Steam 1 tbsp in 200 ml of boiling water. l. dried herbs, leave for an hour, then filter. Allow the child to rinse his mouth 3-4 times a day, always after meals.

Folk remedies for immunity:

Herbal collection No. 1. Mix 1 part each of fenugreek seeds, fennel and elderberry flowers and 2 parts each of linden flowers and violet grass. 1 tbsp. l. pour 200 ml of cold water into this mixture, leave for 2 hours, then put on fire, bring to a boil and boil for 2 minutes. The broth is cooled and filtered. Give the baby 1/3 cup 3 times a day.
Herbal collection No. 2. Mix 1 part each of licorice and peony roots and chamomile flowers, 2 parts each of linden and elderberry flowers and 3 parts each of nettle leaves. In half a liter of boiling water, steam 2 tbsp. l. such a mixture, leave for a quarter of an hour, then filter. Give the child 50 ml 3-4 times a day.
Herbal collection No. 3. Mix the colors of linden, elderberry, blackthorn, mullein and chamomile and willow bark in equal proportions. Steam 1 tbsp in 200 ml of boiling water. l. such a mixture, leave for 4 hours, then filter. Give the baby 100 ml 2-3 times a day.
Mint and calendula. Mix fresh or dried mint leaves and calendula flowers. Steam 2 tsp in 1 glass of boiling water. such collection, leave for half an hour and filter. Give the child half a glass 2 times a day.
Viburnum color. Steam 1 tbsp in 200 ml of boiling water. l. viburnum color, boil over low heat for 5 minutes, cool and filter. Give the patient 1 tbsp. l. decoction three times a day. You can also treat a viral infection with a decoction of viburnum berries.
Radish. A hole is cut out of the radish root vegetable and filled with honey and covered with a lid. Leave in a warm place for 4 hours, then pour in the released juice. This juice is given to the child 1 tsp. three times a day. The next day a new portion is prepared.

Particular attention should be paid to the patient's nutrition. The sores in his mouth make it difficult for him to eat. If the disease develops in an infant, it is recommended to temporarily abandon complementary feeding and transfer the child completely to breastfeeding. You need to feed your baby more often than usual, since he is often capricious, eats less, and refuses to breastfeed.

For older children, he gives boiled semi-liquid food: pureed soups, pureed porridge. Food should be at room temperature; hot food only worsens the pain. It is important to make sure your child drinks enough as not drinking can lead to dehydration. For drinking, the baby is given herbal infusions with honey, non-acidic juices and compotes.

Prognosis and complications of the disease

Enterovirus infection is not dangerous and goes away without a trace in most children. Recovery occurs 7–10 days after the onset of the infectious process. However, in some cases, the baby may develop complications of hand-foot-mouth disease.

meningitis - inflammation of the soft membrane of the brain;
encephalitis - inflammation of brain tissue.

Meningitis and encephalitis are serious diseases that can lead to the death and disability of a child, and impairment of mental and physical development.

Symptoms that indicate an unfavorable course of the disease:

increase in baby's body temperature above 39°C;
severe headache;
pain in the eyes;
vomit;
crying, irritability;
drowsiness or, conversely, increased excitability of the baby.

These signs indicate brain damage.

Complications of enteroviral stomatitis can occur against the background of a child’s reduced immunity or, more often, when infected with a particularly dangerous serotype of enterovirus.

Prevention of infection

Enteroviruses are widespread and infection is difficult to prevent. Almost 100% of children suffer from this disease.

avoid contact with sick children and objects they may have touched;
teach your child the rules of personal hygiene and strictly observe them;
strengthen the child's immunity.

To prevent the disease from spreading within the family, it is necessary to isolate the sick baby from other children. Use gloves when caring for it. It is best to change clothes or put on a robe when entering the patient's room. A sick child should have separate toys, books, dishes, and a towel. It is necessary to carry out daily wet cleaning with disinfectants in the patient’s room and in common areas: toilet, bathroom, kitchen.

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Hand-foot-mouth disease: how not to catch an enterovirus infection

The disease, codenamed Hand-foot-and-mouth disease (HFMD), most often affects infants and preschool-age children. It usually presents with fever, painful sores in the mouth, and a rash on the arms and legs. It is the localization of the most characteristic symptoms that explains the name of this disease.

The most common cause of HFMD is Coxsackievirus A16 (enterovirus family). This disease mainly affects infants and children under 5 years of age because they have not yet developed immunity to the pathogens of this disease. However, teenagers and adults can also contract and develop HFMD. In the United States, the peak incidence occurs during the warmer seasons—spring, summer, and fall.

Symptoms of HFMD typically include the following:

fever;
decreased appetite;
sore throat;
poor health, general weakness;
painful mouth sores that usually start as flat, red spots;
a rash that appears as flat, red spots that may blister on the palms of the hands, soles of the feet, and sometimes the knees, elbows, buttocks, and/or genital area.

These symptoms often appear in stages, not all at once. In addition, not all patients exhibit all of the listed signs of infection. Some people may be sick without any symptoms at all, but during this time they are still carriers of the virus and pass it on to others.

HFMD is usually mild—almost all sufferers recover within 7–10 days without treatment. Complications develop extremely rarely.

Occasionally, an infected person may develop viral meningitis (characterized by fever, headache, stiff neck, significant weakness and lack of energy, drowsiness, or trouble sleeping) and may require hospitalization for several days. Even rarer complications are polio-like paralysis or encephalitis (inflammation of the brain). It is these complications that can be fatal without treatment.

Are patients with HFMD contagious?

Yes. Viruses that cause HFMD are found in an affected person in:

secretory secretions of the nose and throat (saliva, sputum or mucus that is located on the nasal mucosa);
the contents of blisters that the sick person may have on the arms, legs or groin;
faeces (feces).

HFMD spreads from an infected person to other people through:

close contact such as kissing, hugging, or sharing cups and utensils;
cough and sneezing;
contact with feces, for example when changing a diaper;
contact with blister fluid;
touching objects or surfaces that have the virus on them.

People with HFMD are most contagious during the first week of illness, although they can sometimes remain contagious for several weeks after symptoms have resolved. Some people, especially adults, can be sick without any symptoms, but at the same time spread the virus, which can affect others. That is why you should always follow the rules of hygiene - at least wash your hands often with soap, especially in public places. By doing this, you can minimize the likelihood of infection and spread of infection.

For whom is HFMD particularly dangerous?

As mentioned above, HFMD mainly affects infants and children under 5 years of age. However, schoolchildren and adults can also get sick because after suffering from HFMD, they develop immunity to the specific virus that caused the disease, and since HFMD can be caused by various viruses, infection with one of them and further illness is not excluded.

What is the treatment for HFMD?

There is no specific treatment for HFMD. Fever and pain can be controlled with over-the-counter fever and pain relievers such as acetaminophen (paracetamol) or ibuprofen. It is very important for people with HFMD to drink enough fluids to prevent dehydration.

Is it possible to avoid getting HFMD?

There is no vaccine to protect against HFMD, but you can reduce your risk of contracting the viruses that cause HFMD by following a few simple rules:

wash your hands frequently with soap and water for 20 seconds, especially after changing diapers, and help young children do the same;
do not touch your eyes, nose and mouth with unwashed hands;
Avoid close contact such as kissing, hugging, and sharing cups and food with people affected by HFMD;
Disinfect frequently used surfaces and objects such as toys and doorknobs, especially if someone is sick.

Hand-foot-mouth syndrome

Reasons for the development of the syndrome

Several viruses belonging to the group of enteroviruses can cause hand-foot-mouth syndrome:

Who is sick?

Most often, children suffer from this syndrome. This is due, firstly, to the mechanisms of transmission of infection (children are in close contact with each other in a group and do not always follow hygiene rules), and, secondly, to the peculiarities of the formation of immunity to the pathogen.

Manifestations of hand-foot-mouth syndrome

On average, 5-7 days pass from the moment of infection to the manifestation of the disease, and the patient becomes dangerous to others already when the first symptoms of the disease appear. By the way, they are very reminiscent of an ordinary acute respiratory viral infection: a person’s temperature rises (which returns to normal after 3-4 days), weakness, headache occurs, the throat becomes redder and begins to sore, etc. After about a day, more specific manifestations of the syndrome develop: vesicular stomatitis (enanthema), as well as a rash on the extremities and on the skin around the lips (exanthema). Visually it looks like this:

Small bubbles with liquid appear on the oral mucosa (gums, cheeks, palate), which burst and leave behind ulcers that disappear over time without a trace.
On the skin of the arms, legs (usually the soles of the feet and palms), less often on the buttocks, as well as around the lips and nose, very small blisters with a red inflamed border or simply red spots form. After they disappear (after 7-10 days), the skin may peel off, and in some patients, after 4-5 weeks, nails may peel off.

In general, hand-foot-mouth syndrome has a favorable course, and patients recover completely in 7-10 days. In rare cases (in particular, when infected with enterovirus type 71), more severe forms of the disease and complications (meningitis, encephalitis, etc.) may develop. You can suspect that the course of the disease is becoming unfavorable based on the following signs:

Persistent fever (especially body temperature above 39 degrees).
Increasing headache.
Repeated vomiting.
Severe drowsiness or, conversely, unreasonable agitation.
Pain in the eye area.
The incessant crying of a child.

Doctors do not always diagnose this disease in a timely manner, since at the beginning of its development it resembles a typical acute respiratory viral infection. In addition, even the resulting stomatitis may not be expressed, and the skin rash often imitates allergic manifestations (which parents and doctors often regard as an allergy to antipyretics taken) or other infectious diseases. But it is still possible to identify diagnostic criteria for this disease. These include:

Moderate fever and intoxication.
Simultaneous appearance of vesicular stomatitis and skin rashes with predominant localization on the feet and hands.
Absence of symptoms characteristic of other infectious diseases (tonsillitis, enlarged and painful lymph nodes, severe cough, etc.).

There are also specific methods for diagnosing this enterovirus infection (they are used rarely and mainly in severe cases of the disease):

Virological research (isolation of viruses from material taken from a patient).
Serological tests (detection of antibodies to enteroviruses in the blood).

General clinical studies (for example, a blood test from a finger) provide only presumptive information that a disease of a viral nature is developing in the patient’s body.

There is no specific antiviral treatment for this disease. Patients are prescribed a diet that spares the oral mucosa (maximum crushed, liquid and warm food is recommended, spicy, sour and salty foods are excluded), drinking plenty of fluids to eliminate intoxication, as well as medications to reduce inflammatory changes in the oral cavity and lower body temperature. For severe itching, patients are prescribed antihistamines.

Treatment of stomatitis, the main and most unpleasant manifestation of this disease, includes:

Rinse with decoctions of plants (chamomile, sage) or solutions prepared from pharmaceutical preparations several times a day.
Treatment of inflammatory elements with sea buckthorn oil, chlorophyllipt oil solution.
Spraying the oral cavity with special sprays with antiseptic and anti-inflammatory effects.

Among antipyretics, preference should be given to paracetamol and ibuprofen.

As for the treatment of skin rashes, they go away on their own without the use of any medications.

Prevention

Parents of sick children should also remember the dangers, especially when caring for the baby’s skin, treating rashes in the mouth, washing the potty, changing diapers, etc.

Zubkova Olga Sergeevna, medical observer, epidemiologist

Hand-foot-mouth syndrome 🎥

The name “hand-foot-mouth” syndrome (or enteroviral vesicular stomatitis with exanthema) comes from the English Hand-Foot-and-Mouth Disease (HFMD) and is a symptom complex consisting of damage to the oral mucosa - enanthema and the appearance of a rash on the upper and lower extremities - exanthema. It is one of the variants of “enteroviral infection,” namely Boston exanthema.

The causative agents of the “hand-foot-mouth” syndrome: enteroviruses Coxsackie A16, A5, A10, A9, B1, B3, enterovirus 71. These are RNA-containing viruses, quite stable in the external environment, capable of surviving at room temperature for up to 2 weeks in a viable state .

These viruses are widespread among people of all ages, but children under 3 years of age are most often affected. Adults get sick less often and tolerate the infection also favorably.

The disease is registered in most cases in the summer-autumn period. The mechanisms of infection are aerogenic (airborne transmission) and the fecal-oral mechanism. Transmission factors can include household items such as toys, dishes, pastels and hygiene items. But still, infection most often occurs through sneezing, coughing and simple conversation. Not only a sick person is contagious, but also healthy carriers of enteroviruses.

Immunity after an infection is formed type-specific, persistent (that is, lifelong). However, if a person is infected with a different serotype of enterovirus (for example, he was ill with A 16, and was re-infected with B3), then the disease can occur again.

Symptoms of enteroviral stomatitis with exanthema (hand-foot-mouth syndrome)

The incubation period (from the moment of infection until the first signs of the syndrome appear) lasts 4-7 days. The patient becomes contagious from the first symptoms of the disease and remains so throughout the duration of the disease. The first symptom is an increase in temperature to 37.5-38º, symptoms of intoxication are weakness, headache, sore throat, muscle pain. The duration of fever is up to 3-5 days. That is, the onset of the disease is very similar to ARVI. However, unlike ARVI, after 1-2 days on the palms of the hands (sometimes on the back of the hands) and feet (usually the soles), less often on the back of the thighs and buttocks, a rash appears in the form of small vesicles* up to 3 mm in diameter, surrounded by a halo of redness (*vesicle is a cavity element with transparent contents, rising above the surface of normal skin, having a ring or a halo of redness around it). In dynamics, the reverse development of the rash occurs: the elements do not open, their contents disappear, they are compared with the surface of normal skin, and the redness disappears. The rash lasts for 5-7 days, then disappears without a trace.

Rash on the hands and feet of a child with hand-foot-mouth syndrome

Hand-foot-mouth syndrome, rash on the palms and soles of the feet

Hand-foot-mouth syndrome, rash on the feet of a child

Simultaneously with the appearance of the rash, ulcers (or aphthae) appear in the oral cavity, accompanied by pain and sensitivity to hot, spicy foods. The phenomena of aphthous stomatitis can be found on the inner surface of the cheeks, tongue, gums, hard and soft palate. When stomatitis appears, appetite decreases, irritability and moodiness appear, a sore throat may appear, difficulty eating, and excessive salivation occur.

Enteroviral stomatitis in a child with hand-foot-mouth syndrome

Unlike herpangina (another type of enterovirus infection in which the tonsils are involved), with hand-foot-mouth syndrome the ulcers do not come to the surface of the tonsils.

In English-language sources there are indications of the fact that 1-2 months after suffering the syndrome, patients may experience damage (detachment) of the nails; this relationship has not been pathogenetically proven.

Complications of hand-foot-mouth syndrome

Most often, the prognosis of the disease is favorable, spontaneous recovery occurs. However, when infected with enterovirus 71, serious and severe complications of hand-foot-mouth syndrome can occur. It is possible to develop meningitis (inflammation of the soft meninges), encephalitis (inflammation of the brain substance), which can be found out in more detail in the article “Enteroviral infections”.

Alarming symptoms of “hand-foot-mouth” syndrome, which will allow you to suspect an unfavorable course of the disease and require an urgent call to a doctor: fever above 39º, persistent high temperature, vomiting, and sometimes repeated, increased headache, pain in the eyeballs, constant crying and capriciousness of the child against the background of fever, constant drowsiness or, conversely, psychomotor agitation of the patient. When such symptoms appear, delay in seeking medical help can cost the patient's life.

Diagnosis of hand-foot-mouth syndrome

As a rule, the diagnosis is made on the basis of the clinical picture and the exclusion of all infectious diseases with a characteristic rash (chickenpox, rubella, measles). The basic diagnostic signs are as follows:

Starts with a slight fever and intoxication;

After 1-2 days, the appearance of exanthema (blistering rash) on the feet, hands (palms);

Simultaneous appearance of enanthema (stomatitis phenomena) in the oral cavity;

Absence of characteristic syndromes of other infectious diseases (angina, pulmonary syndrome, severe damage to the lymphatic system and others).

Additional criteria are laboratory methods (analyses are taken when complications develop): a general blood test with characteristic criteria for a viral infection (possible leukocytosis, an increase in lymphocytes, a decrease in neutrophils, ESR is often within normal limits). Specific laboratory methods that allow confirming the enteroviral nature of this syndrome are the virological method (isolation of enteroviruses in washings and smears from the throat), serological blood tests (detection of specific antibodies in the blood serum of patients).

Treatment of hand-foot-mouth syndrome

With a favorable course of the disease (the vast majority of patients), the symptoms of the disease disappear on their own within a week, less often 9-10 days.

1) Organizational and routine measures. Most require treatment on an outpatient basis (at home). A special diet is indicated - balanced nutrition with mechanical and chemical sparing, that is, food should be warm, liquid or semi-liquid, and avoid too salty, spicy, hot foods. A drinking regime must be observed to remove toxins from the body and reduce fever (according to age, a sufficient amount of fluid).

2) Drug therapy is both etiotropic and symptomatic:

Interferon inducers (anaferon for children and adults, aflubin and others);

Antipyretics for fever - Nurofen, Panadol, Efferalgan and others, avoid taking aspirin to avoid Reye's syndrome;

Antihistamines for rashes - claritin, zodak, cetrin and others.

3) Local therapy (gargling with a warm solution of soda and sage, solutions of chlorhexidine, furatsillin, tantum verde spray, panthenol aerosol, to prevent the occurrence of secondary bacterial infections, immudon for resorption)

Prevention of hand-foot-mouth syndrome

1) Avoid contact with people who are sneezing or coughing.

2) Compliance with personal hygiene rules - hand washing, oral hygiene.

3) When caring for a patient and treating elements of the rash, use protective equipment (gloves).

Infectious disease doctor N.I. Bykova

According to the herpetic center of the Russian Academy of Medical and Technical Sciences, hand-foot-mouth syndrome can be caused by enteroviruses in combination with EBV, CMV and HHV No. 6 (in other words, with persistent herpetic infection), which aggravates the course of the disease.

Among enteroviral diseases, the two most common forms are hand-foot-mouth disease and herpangina.

Atypical manifestations of enterovirus rashes are much less common and can imitate rubella, scarlet fever, Kawasaki disease, sudden exanthema and many other diseases, however, even with an atypical course, upon closer examination the child still has aphthae in the mouth or pharynx, and/or typical dense blisters on flexor surfaces of the palms and feet. It is these typical manifestations that allow a correct diagnosis to be made.

The subject of our consideration will be the typical forms of manifestation of these enteroviral diseases.

HAND-FOOT-MOUTH DISEASE

The name of this disease comes from the English Hand, Foot and Mouth Disease (HFMD).

Hand-foot-mouth disease (HFMD) is caused by the Coxsackievirus, a member of the enterovirus family. HFMD most often affects children under 10 years of age, but people of any age can get the infection.

Symptoms

The disease is manifested by fever (high temperature) and red spots with blisters in the center. Most often, the rash with HFMD is located in the mouth (tongue, gums), arms and legs (hence the name of the disease), but can also affect the buttocks, especially the perianal area, and appear as single elements on any part of the body. Typically, HFMD lasts about 10 days, with incidence typically peaking in late summer and fall.

Contrary to popular belief, your child cannot get HFMD from animals.

Treatment

A child's fever can be relieved with drugs based on ibuprofen or paracetamol, and they can also be taken to relieve pain in the mouth. You just need to consult your doctor about the optimal dose and method of administering the drug.

Never give your child aspirin without a doctor's permission - aspirin provokes the development of an extremely serious disease - Reye's syndrome.

Daily routine

If your child feels tired or sick, you should allow him to rest as much as possible. If the child is energetic and cheerful, then you should not insist on rest; let him play and spend the day as usual.

Nutrition

If a child has painful mouth sores, he or she will likely eat less or stop eating and drinking completely. It is important not only to relieve pain from the rash, but also to offer him pureed, easily digestible foods that do not irritate the oral mucosa. These include yoghurts, puddings, milkshakes, jellies, purees, etc. It's best to eat these foods cool or at room temperature, not hot.

Do not give your child spicy, salty or sour foods. There is no need to feed him citrus juices and carbonated drinks. These fluids can make your child's mouth feel worse. Offer to drink from a cup rather than a bottle—negative sucking pressure also increases pain and promotes mucosal trauma and bleeding. Drinking through a straw is safe - it can be a complete alternative to a bottle, especially for aphthae on the lips and tip of the tongue.

Children's institutions

The child can return to the children's group after normalization of body temperature and general condition, but the main indicator will be the disappearance of elements of the rash. Until this moment, going out in public is not advisable, since the child may be contagious to others.

Contact your doctor if:

The blisters filled with pus or became sharply painful. This may be a sign of a secondary infection.
Your child's mouth sores are so painful that they won't open their mouth and completely refuse to eat or drink.

See a doctor immediately or call an ambulance if:

Your child is dehydrated due to complete refusal to eat or drink. You can talk about dehydration if:
- the child has not urinated for more than 8 hours
- the baby can feel a sharply sunken fontanel on the head
- baby crying without tears
- his lips are cracked and dry.
Also, don't waste another minute if your child has a stiff neck (difficulty bringing the chin to the chest), severe headache or back pain, and these symptoms are combined with a fever above 38°C.

GERPANGINA

Herpangina is a viral disease that is caused by the same Coxsackie viruses and is manifested by the formation of painful ulcers (ulcers) in the throat and mouth, as well as severe sore throat and fever.

Herpangina is one of the common childhood infections. It most often occurs in children aged 3 to 10 years, but can affect people in any age group.

Herpangina symptoms:

Usually no additional diagnostic methods are required - the doctor makes a diagnosis based on a physical examination and medical history.

Treatment

Treatment and care are similar to those described for hand-foot-mouth disease. Herpangina usually goes away within a week.

As with hand-foot-mouth disease, and with herpangina, the main complications are considered to be dehydration and aseptic meningitis. Therefore, you should closely monitor your child for signs of dehydration and headache levels, and consult a doctor immediately if complications are suspected.

Fortunately, complications are quite rare and most children recover within 10 days.

During a child’s illness, all family members must maintain careful hygiene: wet cleaning more often than usual, using dishes separately, frequently washing their hands and treating them with antiseptics.