History and exam
Key diagnostic factors
common
low-grade fever
The fever is usually <101.3°F (<38.5°C).
oral vesicles and ulcers
The oropharynx is inflamed, with scattered papules, macules, or vesicles, or more commonly yellowish ulcers on an erythematous base are present on the tongue, pharynx, buccal mucosa, gingiva, and occasionally the lips. Lesions heal within 1 week.
[Figure caption and citation for the preceding image starts]: Hand, foot and mouth disease. Rash around the mouth of a 1 year old boy with hand foot and mouth disease (HFMD). HFMD is caused by intestinal viruses of the picornaviridae family. The most common strains causing HFMD are coxsackie A virus A16 and enterovirus 71 (EF-71).Dr P. Marazzi/Science Photo Library [Citation ends].
rash and/or vesicles on the hands and feet
The rash consists of small oval or linear gray-white vesicopustules. The vesicles are flaccid and thin-walled, with an erythematous halo. They may occasionally be painful or pruritic. They tend to ulcerate and become crusted. Lesions may last up to 10 days.
[Figure caption and citation for the preceding image starts]: Hand, foot and mouth disease. Close-up of a blisters (known as vesicles) on the hand of a 3 year old boy with hand foot and mouth disease (HFMD). HFMD is caused by intestinal viruses of the picornaviridae family. The most common strains causing HFMD are coxsackie A virus A16 and enterovirus 71 (EF-71).Dr P. Marazzi/Science Photo Library [Citation ends].
Other diagnostic factors
common
malaise
Patient may present with general malaise.
sore mouth
Oral lesions may be painful.
loss of appetite
Symptoms may include loss of appetite.
sore throat
Patient may have a sore throat.
uncommon
rash and/or vesicles on the buttocks
A maculopapular rash may be seen on the buttocks.[13] Lesions may last up to 10 days.
abdominal pain
Symptoms may include abdominal pain.
diarrhea
Symptoms may include diarrhea.
cough
Symptoms may include cough.
tongue erythema/edema
Erythema and edema of the tongue may occur.
arthralgia
This occurs occasionally.
Risk factors
strong
immunosuppression
Immunocompromised children or children on immunosuppressive treatment are more prone to infection.
age <10 years
Children <10 years of age are most commonly affected.
family or school contacts with infection
Infection is spread by direct contact with nose and throat discharges, saliva, vesicle fluid, or fecal material from an infected person. The virus may persist in fecal material for up to 1 month.
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