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Hand, foot and
mouth disease (Differentials (Autoimmune/inflammatiory
…
Hand, foot and
mouth disease
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Pathophysiology
Transmission
Direct contact with nasal/throat secretions, blisters, faecal-oral
Vertical (mother-foetus)
Mechanism
Incubation 3-7d; prodrome then rash; lasts 7-10d;
infectious upto 8 weeks after
Not related to foot and mouth disease of animals (different virus)
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Clinical
presentation
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Rash
Mucocutaneous, vesicular lesions, tender
Mouth (enathem), hands and feet (exanthem)
Become yellow/grey ulcers with erythematous halo
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Diagnosis
Examination
Derm examination
Typical erythematous, vesicular rash
on hands, palms and feet
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History
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DH
Current meds, allergies
PC/HPC
Prodrome: fever, malaise, cough, sore throat
Rash: mouth and hands, vesicular and red
Recent contacts, travel
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SH
Living arrangements, work/school
Differentials
Autoimmune/inflammatiory
Pompolyx eczema
Lichen planus
Bechet's disease
Pemphigous vulgaris/bullous pemphigoid
Kawasaki disease
Infection
Viral: herpangina, pharyngitis
Bacterial: impetigo
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Trauma
Traumatic ulcers (dentures, thermal)
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Management
Conservative
Information, advice, support
Self care (fluids, soft diet, reducing transmission)
Medical
Analgesia
Indication: pain/fever
E.g. paracetamol, ibuprofen
Complications
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CNS
If enterovirus infection
RARE
Encephalitis, aseptic meningitis, acute
flaccid paralysis, neurogenic pulmonary oedema
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Prognosis
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If enterovirus, higher risk of complications