Please enable JavaScript.
Coggle requires JavaScript to display documents.
Hand Foot and Mouth - Coggle Diagram
Hand Foot and Mouth
differential diagnosis
herpangina
herpes stomatitis
aphthous ulcer
chicken pox
viral pharyngitis
erythema multiforme/Stevens Johnson syndrome
kawasaki disease
pomphholyx eczema
lichen planus
traumatic ulcer
gingivitis
behcets disease
pemphigus vulgaris
management
arrange urgent admission if there are symptoms or signs of CNS involvement such as: persistent or severe headache or fever, myoclonus with sleep disturbance, confusion, weakness, lethargy, drowsiness, irritability, seizures, and coma.
where features are typical reassure person/parent, disease is usually self limiting, provide patient information leaflet or resources
advise on self care measures: adequate fluid intake, monitor for signs of dehydration, consider admission If this is suspected
advise on soft diet if mouth ulcers are painful, avoid food that may cause pain such as spicy. salty or acidic. consider using analgesia or NSAIDS for pain or fever
advise on measures to prevent and reduce risk of transmission, do not PX ABX or antivirals
women who are pregnant and have suspected HFMD should generally be manged as for non pregnant women, consider seeking advice from obstetrician if the women is immunosuppressed or is within 3 weeks of delivery
routine follow up is not routinely required
if oral ulcers are persistent use clinical judgement to determine whether to refer using the 2 week wait pathway
measures to reduce risk of transmission
advise on general hygiene measures: ensure hands an washed and dried thoroughly after using the toilet and before eating
ensure mouth and nose are covered when coughing and sneezing, tissues should be used and hands washed
care should be taken when handling nappies, soiled clothes and bedding should be washed on a hot cycle, cut and eating utensils should not be share
blisters should not deliberately pierced and the fluid is infectious
pregnant women should avoid close contact with person with HFMD
children should not attend nursery or school if too unwell. there is no need to isolate the child or investigate close contacts
contact public health if there are a large number of children affected or an outbreak is suspected
when to suspect
HFMD mild illness usually presents with: sore throat, with or without low grade fever, tender lesions in mouth and or rash on the body
ask about prodromal symptoms within the last 12-36 hours, fever, malaise, loss of appetite, cough, abdominal pain, sore mouth, rarely, vomiting
Examine the mouth: scattered ulcerative lesions of the oral cavity occur within 1-2 days, typically begin as 2-8cm erythematous macules and papules and appear on the hard palate, tongue and buccal mucosa, and can be on the lips and pharynx. Lesions progress rapidly to vesicles which readily erode leaving shallow yellow-grey ulcers surrounded by erythematous halo.
examine the rash for macules and papules of hands and feet, usually soon follow the oral lesions, typically 2-5mm sparse erythematous macules and papules often with a central greyish vesicles. . Sides of fingers and dorsum of the hands, margins of the heels are more frequently affected. Frequently elliptical running parallel to the skin lines. Buttocks and groin may also be affected. Lesions can be asymptomatic or painful.
lab investigations are not usually necessary in primary care owing to the self limiting nature of the illness
Definition
Hand foot and mouth disease is an acute viral illness. presents with vesicular eruption in the mouth and papulovesicular lesions of the distal limbs. usually mild and self limiting. (not to be confused with foot and mouth disease of animals)