What Is Hand, Foot, and Mouth Disease?
Hand, foot, and mouth disease is a global disease that is moderate to highly contagious and most commonly affects young infants and children. It can occur possibly in adults as well. It is an infectious disease and can spread through direct contact with secretions like mucus, saliva, or the feces of an infected person with the Coxsackie virus.
The current research and several epidemiologic studies show that during epidemic outbreaks, this virus is spread from person to person by horizontal transmission. The major outbreak of HFMD (Hand, foot, and mouth disease) dates back to its preliminary occurrence and spread in Sarawak, Malaysia in the year 1997 affecting parts of the Asia Pacific region. The largest outbreak of HFMD known till now is in 2007 in eastern parts of India. Therefore, the risk of horizontal transmission and complications due to disease severity, timely diagnosis, and management by healthcare providers plays a crucial role in the long-term prognosis of the infected individuals.
The disease also has several complications in advanced stages capable of progression to severe dehydration, meningoencephalitis infection, myocarditis, pulmonary edema, and even death in severe cases mainly in infected young children (below 10 years) who suffer from HFMD. According to the CDC (Centre for Disease Prevention and Control), the ideal preventive measures that should be implemented to maintain hand hygiene in children is to make them wash their hands thoroughly with soap and water for at least 20 seconds after an outdoor visit. Also, after visiting recreational areas like swimming pools or beaches (common grounds for viral spread ), it is essential to bathe again and also sanitize the hands and feet thoroughly to prevent viral infections that can be contracted easily from public spaces.
What Is the Incidence of Hand, Foot, and Mouth Disease?
HFMD typically occurs during epidemic outbreaks within the summer and autumn months. The most common strain known to cause hand, foot, and mouth disease (HFMD) is identified as the Coxsackie A16 precisely an enterovirus type. This affects the age group of children below ten years of age commonly.
What Are the Clinical Symptoms of Hand, Foot, and Mouth Disease?
The earliest signs of Coxsackie infection are fever, sore throat, loss of appetite, general malaise, or weakness. The clinical symptoms occur on the first and second days wherein fever would be accompanied by painful mouth sores or oral lesions that may extend to or involve the throat. Additionally, apart from mouth and tongue ulcers, a person may also observe rashes on the hands, feet, buttocks, knees, genitalia, or elbow regions.
What Is the Pathophysiology of Hand, Foot, and Mouth Disease?
-
The spread of the infection is by the human enterovirus entry through oral ingestion by the causatives.
-
The shed virus gains entry eventually into the host gastrointestinal or even the upper respiratory tract and can be possible mostly through vesicle fluid or oral secretion that has a horizontal transmission from individual to individual and is hence highly contagious.
-
The highly infectious phase in the infected individuals of hand foot and mouth disease tends to be in the first week of the disease. The incubation period of the enterovirus ranges primarily between three to six days.
-
The viral replication occurs within the lymphoid tissue in the lower intestine, and the pharynx, and also eventually spreads to lymphatics, and the regional lymph nodes.
-
In severely infected individuals, the disease, when left untreated, eventually has the potential for multiorgan involvement mainly in the central nervous system, heart, liver, and skin.
What Are the Oral Manifestations of HFMD?
In the oral cavity, once the initial implantation of any virus occurs within the buccal mucosa region, the lymphatic spread usually starts within 24 hours. Oral lesions may tend to appear as erythematous eruptions or macules which subsequently transform into vesicles possessing an erythematous base with 0.08 to 0.12 inches of diameter. The oral vesicles commonly involve the soft tissue regions of the palate, tongue, buccal mucosa, gingiva, and lip. However, even though these vesicular eruptions may be a common clinical feature, the patient may not complain of any symptoms till these vesicles turn ulcerated. It is because of the ulcerated vesicles that affected patients complain of oral pain and may interfere further causing moderate to severe oral discomfort during mastication and swallowing.
As per research, more than 44 percent of the affected patients have shown tongue involvement in most of the reported cases of HFMD.
How Are Diagnosis and Management Strategies Established for HFMD?
Diagnosis: Oral lesions of HFMD can be easily mistaken for aphthous ulcers, hence the dentist should investigate thoroughly in the clinic or hospital setting to establish both differential and confirmative diagnosis upon observation of the lesions. Similarly, varicella or herpangina lesions also have similar appearances. In varicella viral infections, oral manifestations are uncommon, hence the dentist should suspect HFMD upon the clinical symptoms orally. In herpangina infections (viral infections caused by type A coxsackie virus), though clinical features would be similar to the Coxsackie virus oral manifestations, the ulcers occurring in herpangina are more extensive with a spread to the tonsils, pharyngeal mucosa, the posterior part of buccal mucosa, or to the soft palate.
Management: Treatment strategies include multidisciplinary management by both the physician and oral surgeon. For reducing fever and high infectious spread in the initial phases or days of infection, antipyretic, antibiotic, and analgesic therapies may be advocated by the physician. Similarly, to relieve the intraoral pain of the patient due to mouth ulcers, viscous or anesthetic topical gels with Lidocaine or Diphenhydramine can be recommended by the dentist.
The recent advent and advances in the application of low-level laser therapies in dentistry have also helped shorten the treatment duration for the elimination of persistent and painful oral ulcers in this disease.
Conclusion
Thus, the general and pediatric dentist needs to be aware of the oral manifestations of HFMD that closely resemble aphthous ulcers of the mouth. Timely establishment and confirmative diagnosis are crucial to faster oral and general treatment by the dentist and physician. This will also aid in the long-term recovery of the infected individual.
