Hand foot mouth disease Case study

What is the likely diagnosis? INTRODUCTION Hand foot mouth disease (HFMD) is a common disease in children than in adults. The main causative organism Enterovirus 71 and CV-A16 though the latter is less common. Infected children may complicate and develop neurological complications or death (Li, 2013). The most affected children are under 5 years of age (Lei, 2015). Pathophysiology A person is infected through close contact with aerosols from an infected person, ingesting fecal matter from an infected person, touching contaminated objects then contaminating mucus membranes (CDC,2017). The release of proinflammatory cytokines leads to the development of brain stem encephalitis, autonomic nervous system dysregulation, and pulmonary edema. SCRB2 receptors play a major role in infection and disease process compared to other receptors that play a role in tropism of EV 71 (Lei, 2015).

Epidemiology Seddon a New Zealand scientist was the first person to describe a case of HFMD in 1957. Robinson et al. discovered CV-A16 in 1958, another causative agent of HFMD. The highest risk of infection occurred during periods of extremely high relative humidity (Yang, 2018). Young age is another risk factor. Children under 5 suffered HFMD than any other age group (Zhao, 2016). Children between 1-2. 9 years had the highest risk. GI symptoms include nausea, vomiting, and diarrhea. History of seizure and drowsiness on CNS examination have been reported (Zhao, 2016). Differential diagnosis • Herpes simplex infection • Chickenpox infection • Oral aphthous ulcers in children. Herpes simplex infection and chicken pox disease are viral infections and will present with flu-like conditions accompanied by rash just like HFMD. The difference occurs where rash due to herpes simplex, chicken pox does not affect palms and soles, but rather, it is limited to the trunk and extremities.

Similarly, CDC recommends good hygiene practice and isolation of children during the first few days of illness. Vaccination has not been effective for prevention because of the cyclic pattern of infection by different causative viruses (EV 71 and CV-A16) coupled with a constant modification of their molecular patterns (Esposito, 2018). Treatment Non-pharmacological: HFMD is a mainly a self-limiting illness. Symptomatic management at home will include oral hydration to prevent dehydration, maintaining good hygiene practices and good nutrition. Pharmacological management; per oral analgesics and antipyretics e. Adequate patient and family education helps ensure minimal risk for complication and reduces spread of the disease. Education is critical in ensuring that the families will make informed decisions and deliberate actions such as hand hygiene to prevent the occurrence of the infection.

Proper supportive care such as hydration and good nutrition ensures resolution of the infection within 10 days. It is imperative that the management of patients includes the nutrition care and a holistic approach that ensures long-term prevention and remission of the illness. Appropriate infection control measures that aim to limit the spread of the infection in populations through effective separation of the infected from the healthy population such as in schools and disinfection of schools regularly (Ministry of Health Jamaica, 2018). Health education has and remains an integral part to mitigating and limiting the spread of many diseases including HFMD. Education and sensitization of the public is critical and one of the best practices that remains important in primary health and primary prevention.

The community ought to be educated on the condition, its risk factors and the prevention of the condition. Questions 1. How is HFMD transmitted? Transmission of HFMD is mainly through contact of mucous membranes with contaminated surfaces, ingestion of contaminated water, food or fecal matter and contact with aerosols from a contaminated person. Viremia causes symptoms for instance mouth lesions and rashes. Oral lesions and rashes last up to 10 days and may resolve spontaneously. Pro-inflammatory cytokines released by T cells during infection contribute to manifestations of symptoms such as fever, rash, brainstem encephalitis, autonomic nervous system disturbance and pulmonary edema. References Di, B. , Zhang, Y. 1186/1743-422x-11-157 Esposito, S. , & Principi, N. Hand, foot and mouth disease: current knowledge on clinical manifestations, epidemiology, aetiology and prevention.