Information on the following diseases can be found in the Related Disorders section of this report:

• Varicella Zoster Virus
• Herpangina
• Encephalitis

Hand-Foot-Mouth syndrome is an infectious disease characterized by blister-like sores (lesions) that appear on the palms of the hands, soles of the feet and in the mouth. The lesions in the mouth most commonly affect the lining of the cheeks (buccal mucosa), tongue, lips, and hard palate. The lesions occasionally may appear on the buttocks, extremities or genitals. Lesions may group together and eventually ulcerate. Symptoms may also include a sore throat, headache, low-grade fever, vomiting, loss of appetite or refusal to eat due to the lesions in the mouth, especially those on the cheek and tongue. The symptoms of the disease last for about one week.

In most cases, the Hand-Foot-Mouth syndrome is not associated with serious complications. However, according to the medical literature, some cases of the disease caused by enterovirus 71 have been associated with the accumulation of fluid in the lungs (pulmonary edema) and neurological complications such as mild inflammation of the membranes (meninges) that surround the brain (aseptic meningitis).

The principal cause of Hand-Foot-Mouth syndrome is believed to be the coxsackie virus A16. However, some cases have been described that were caused by the coxsackie virus A4, A5, A7, A9, A10, B2, and B5 and by enterovirus 71.

Hand-Foot-Mouth syndrome is affects males and females in equal numbers. The disease is most common in young children and is seen more frequently in the summer and fall. The disorder is contagious.

Symptoms of the following disorders can be similar to those of Hand-Foot- Mouth Syndrome. Comparisons may be useful for a differential diagnosis:

The varicella-zoster virus is a herpes virus that causes chickenpox during childhood, and shingles (herpes zoster) during adulthood. It is characterized by a sore throat, runny nose, a general feeling of discomfort and a blister-like rash. (For more information on this disorder, choose "Varicella" as your search term in the Rare Disease Database.

Herpangina is a viral infection that usually affects infants and young children. It is characterized by a sore throat with fever, headache, loss of appetite, and pains in the abdomen, neck and extremities. Vomiting and convulsions may occur in infants. Within two days a small number (usually less than 12) of elevated pimple-like lesions appear on the tonsils, soft palate, uvula or tongue. These lesions eventually become shallow ulcers and will heal within 5 days.

Diagnosis
The diagnosis of Hand-Foot-Mouth syndrome maybe confirmed by a thorough clinical evaluation and a detailed patient history. Several tests may be conducted to analyze the liquid portion of the blood (serum) to determine which type of virus is present in a particular cause of Hand-Foot-Mouth syndrome (serological tests).

Treatment
There is no specific treatment for Hand-Foot-Mouth syndrome. Calamine lotion may have a soothing effect on the rash and acetaminophen (e.g., Tylenol), given every 4 hours, will help reduce the fever and headache. Aspirin should NOT be given to children with viral diseases, because it can cause Reye Syndrome. (For more information on this disorder, choose "Reye" as your search term in the Rare Disease Database.) Other treatment is symptomatic and supportive.

According to the medical literature, some affected individuals have been treated with the anti-viral drug acyclovir. More studies are needed to determine the long-term safety and effectiveness of this drug for the treatment of Hand-Foot-Mouth Syndrome.

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. Government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com

Beers MH, Berkow R. eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck, Research Laboratories; 1999:2343.

Fields BN, Knipe DM, Editors-In-Chief. Fields Virology, 2nd ed. New York, NY: Raven Press; 1990:565.

Nelson WE, Sr. ed., Behrman RE, et al., eds. Nelson Textbook of Pediatrics. 15th ed. Philadelphia, PA: W. B. Saunders Company; 1996:880-81.

Oxman MN. Enteric viral infections. In: Bennett JC, Plum F., eds. Cecil Textbook of Medicine. 20th ed. Philadelphia, PA: W. B. Saunders Company; 1996:1790.

Ho M, et al., An epidemic of enterovirus 71 infection in Taiwan. N Engl J Med. 1999;341:929-35.

Huang C, et al., Neurological complications in children with enterovirus 71 infection. N Engl J Med. 1999;341:936-42.

Chang LY, et al., Clinical features and risk factors of pulmonary oedema after enterovirus-71-related Hand, Foot, and Mouth disease. Lancet. 1999;354:1682-86.

Kitamura A, et al., Serotype determination of enteroviruses that cause Hand-Foot-Mouth disease; identification of enterovirus 71 and coxsackievirus A16 from clinical specimens by using specific probe. Kansenshogaku Zasshi. 1997;71:715-23.

Shelley WB, et al., Acyclovir in the treatment of Hand-Foot-Mouth disease. Cutis. 1996;57:232-4.

Kushner D, et al., Hand-Foot-Mouth disease. J Am Podiatr Assoc. 1996:86:257-9.

Sala F, et al., Hand-Foot-Mouth disease: its course in the city of Milan (1980-86). Epidemiologic study gathered from the records of the community and scholastic ambulatory services of the istituto di clinica dermatologic I and dermatologia pediatrica of the university. G Ital Dermatol Venereol. 1989;124:63-6.

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INTERNET

http://www.cdc.gov/ncidod/dvrd/revb/enterovirus/hfhf.htm

http://www.emedicine.com/EMERG/topic383.htm