para>Avoid aspirin use in treating febrile illness in children.
INPATIENT CONSIDERATIONS
- Patients with CNS manifestations or autonomic dysregulation should require hospitalization.
- Admit those with dehydration unable to maintain adequate oral hydration.
ONGOING CARE
DIET
- Encourage cold liquids (e.g., ice cream, popsicles) to prevent dehydration.
- Avoid acidic, salty, and spicy foods, as they will increase pain.
COMPLICATIONS
- Dehydration most common due to painful oral ulcerations
- Rarely, aseptic meningitis or other neurologic complications
- Fever >3 days and lethargy are associated with CSF pleocytosis.
- Concomitant CNS disease may occur when HFM syndrome is caused by Enterovirus 71. In Southeast Asia, this results in a mortality rate of 3 deaths per 10,000 cases.
- Cardiopulmonary complications include myocarditis, pneumonitis, and pulmonary edema.
- Temporary loss of fingernails or toenails may occur rarely.
REFERENCES
11 Centers for Disease Control and Prevention. Hand, Foot, and Mouth Disease (HFMD). http://www.cdc .gov/hand-foot-mouth/22 Centers for Disease Control and Prevention. Notes from the field: severe hand, foot, and mouth disease associated with coxsackievirus A6-Alabama, Connecticut, California, and Nevada, November 2011-February 2012. MMWR Morb Mortal Wkly Rep. 2012;61(12):213-214.33 A Guide to Clinical Management and Public Health Response for Hand, Foot and Mouth disease (HFMD) World Health Organization: Western Pacific Region. http://www.wpro.who.int/publications/docs/GuidancefortheclinicalmanagementofHFMD.pdf
CODES
ICD10
- B08.4 Enteroviral vesicular stomatitis with exanthem
- B34.1 Enterovirus infection, unspecified
- B08.5 Enteroviral vesicular pharyngitis
ICD9
- 074.3 Hand, foot, and mouth disease
- 079.2 Coxsackie virus infection in conditions classified elsewhere and of unspecified site
- 074.0 Herpangina
SNOMED
- 266108008 hand foot and mouth disease (disorder)
- 186658007 Coxsackie virus disease (disorder)
- 186659004 Herpangina
CLINICAL PEARLS
- Most common: May to October
- Children <5 years of age tend to have worse symptoms than older children.
- Hand-foot-and-mouth disease is the most common cause of mouth sores in pediatric patients.
- Usually self-limiting, resolving in 7 to 10 days
- Careful handwashing to limit dissemination.