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Hand Foot and Mouth disease


Hand Foot and Mouth disease overview and Definition

Hand, foot, and mouth disease (HFMD) is a highly contagious infection. It’s caused by viruses from the Enterovirus genus, most commonly the coxsackievirus.These viruses can spread from person to person through direct contact with unwashed hands or surfaces contaminated with feces. It can also be transmitted through contact with a person’s infected saliva, stool, or respiratory secretions.HFMD is characterized by blisters or sores in the mouth and a rash on the hands and feet. The infection can affect people of all ages, but it usually occurs in children under age 5. It’s generally a mild condition that goes away on its own within several days

Incubation period: 3-7 days


Epidemiology

In india Mumbai and vadora are affected mostly.

Cox sackie virus  is used as an biological weapon(bioterrorism


Pathophysiology

The virus particles are implanted initially in the buccal and ileal mucosa. From here, they spread into the bloodstream via the regional lymph nodes. Within 72 hours, viremia is established and the virus reaches the skin and oral mucosa causing the characteristic lesions.

The main complication that can occur is a secondary skin infection. Rarely, cardiopulmonary and CNS complications like a cardiopulmonary failure, aseptic meningitis, etc. may occur. These are associated with outbreaks caused by Enterovirus 71


Routes of Transmission

FMD is a viral disease that spreads rapidly between animals. Virus is excreted in breath, saliva, mucus, milk and faeces. The virus can be excreted by animals for up to four days before clinical signs appear. Animals can become infected through inhalation, ingestion and direct contact. The disease spreads most commonly through the movement of infected animals. In sheep the symptoms can be absent or very mild, and undetected infected sheep can be an important source of infection. FMD virus can also be spread on wool, hair, grass or straw; by the wind; or by mud or manure sticking to footwear, clothing, livestock equipment or vehicle tyres.

Pigs are regarded as ‘amplifying hosts’ because they can excrete very large quantities of the virus in their exhaled breath. Cattle are very susceptible to, and able to be infected by breathing .


Clinical signs & symptoms

Abdominal pain and swelling

Diarrhoea

Loss of appetite

Nausea and vomiting

Sore throat with difficulty in swallowing

Swelling of the neck and neck glands

Fever

Sore throat

Painful blisters

Nausea and vomiting, flu like symptoms

Low oxygen level

Crankiness

Shock


Differential Diagnosis

Blood test:

The normal blood is necessary to check out infections and rise or decrease in total lymphocyte count.

MRI scan:

It uses the soft tissue image of the organ. It uses the both the magnet and radiowaves and aids in the view of soft tissues of the internal organs.

Immunosorbent assay- detect the virus specific IgM or IgG antibodies.

Greater than fourfold rise in titer between acute and convalescent sera  and  cerebo spinal fluid containing virus specific IgG or IgM or both are the diagnostic features.

Real time polymerase reaction (RT-PCR)- is valuable in the early confirmation of arbovirus infections, and also picornavirus which includes coxsackie virus.. However, the value of RT-PCR is limited to diagnosis in the viraemic phase, with later infection requiring serology.

Direct immunosorbent assay -to detect coxsackie virus antibody has a high sensitivity and specificity and is used in the latter stages.However, the use of these tests in the tropics may be limited by financial constraints.

A normal erythrocyte sedimentation rate  it is defined as the rate of red blood cell which are termed as erythrocytes and their deposition or sedimentation rate. The normal erythrocyte sedimentation rate is 0-22mm/hr.

ELISA: Enzyme linked immunosorbent assay can be useful in the detection of the virus.

Convalescent phase: For retrospective diagnosis, complement-fixing antibodies can be detected

 

 


Prognosis

Inhalational anthrax has worst prognosi.chance of fatality is approximately 90%.

The fatality rate is very less and it might include 40%.


Prevention

Eat the meats that has been properly slaughtered and cooked

Avoid raw contact with animals especially cattle,sheep goat

Washing hands carefully with soap and water after contact with the blister-like lesions, after handling nose and throat discharges, and after contact with faeces such as with toileting and nappy changing.

Using separate eating and drinking utensils.

Avoid sharing items of personal hygiene (e.g. towels, washers and toothbrushes) and clothing (particularly shoes and socks).

Thoroughly wash and clean any soiled clothing and surfaces or toys that may have been contaminated.

Teach children about cough and sneeze etiquette, immediate disposal of tissues, and to wash hands afterwards.