Introduction
Hand- foot- mouth disease is one of the most common and unique syndrome associated with Coxsackie virus A16. Other Coxsackie virus such as A5, A10, B2 and B5 can also cause similar infection. In outbreaks,  in children under 5 years of age suffer the highest rate of attack although adults can also be frequently infected.

Symptoms
The disease is usually mild and onset is characterized by sore throat with or without low grade fever. Scattered vesicular lesions occur randomly on the oral structures, on the pharynx and the lips. These vesicular lesions ulcerate leaving painful oral ulcers, usually on the tongue, gums and inside of the cheeks. Other vesicular rash also appear on the hand and feet, usually on the palms and soles.

The disease is self-limiting and resolves within one week to 10 days. However, serious illness with involvement of the heart and central nervous system may occur in children below 5 years of age.

Etiology
Coxsackie virus is an enterovirus which belong to the Picornavirus family. It can be divided into 2 subgroups; A and B.  Morphologically the virus is spherical in shape and relatively stable in suspension and can be stored at 20° C to 70° C for months without lost of infectivity.

Epidemiology
The disease is transmitted through direct contact. It can also be transmitted through contaminated body secretions such as saliva, nasal droplets, vesicular fluid and excretion.  Incubation period ranges from 2 to 5 days and infectious state lasts throughout the duration of illness.

Diagnosis
Virus isolation from stool specimen. Other specimens of choice are CSF, swab from the mouth and vesicular lesions may be used.

Specimens must be sent in Hank’s virus transport medium to a virology laboratory.

Treatment
Symptomatic treatment. If vesicular lesions appear to be pustular or haemorrhagic with signs and symptoms suggestive of severe illness, patient should be referred to the nearest hospital for management.

Prevention and Control

• Infected children should stay away from school for one week after rash appears.
• Hygienic practices such as hand washing should be practiced.
• All articles and utensils that come in contact with the infected patient should be properly disinfected.
• Avoid taking raw food and ensure that food is properly cooked.
• Avoid going to crowded areas.

 Written by Prof Soo Hoo Tuck Soon.