Overview

Etiology

• Route of transmission
  • Airborne droplets
  • Fecal‑oral route
  • Vertical transmission

Clinical features

• Group A coxsackieviruses more commonly cause:
  • Hand, foot, and mouth disease
  • Herpangina
  • Viral conjunctivitis
• Group B coxsackieviruses more commonly cause:
  • Pleurodynia
  • Viral myocarditis
  • Viral pericarditis
  • Dilated cardiomyopathy

Hand, foot, and mouth disease and herpangina

Definition

Hand, foot, and mouth disease (HFMD) and herpangina are highly contagious febrile infections most commonly caused by group A coxsackieviruses.

• HFMD manifests with a cutaneous rash and painful oral lesions.
• Herpangina manifests with painful lesions limited to the oral cavity. (basically HFMD without cutaneous rash)

Epidemiology

• Most commonly affects children < 5 years of age

Clinical features

• Fever, malaise
• Painful oral lesions
  • Initially manifest as discrete small papules that develop into 1–2 mm vesicles with surrounding erythema
  • Enlarge over several days to form 3–4 mm ulcers that do not coalesce
  • Typically affect the posterior oral cavity (e.g., tonsils, uvula, soft palate, oropharynx)
  • Occasionally involve the perioral area and tip of the tongue
• Cutaneous lesions: macular, papular, and partially vesicular rash
  • Predominantly on palmar surface of the hands and feet
  • Typically 2–6 mm in diameter
  • May also affect:
    • Buttocks
    • Genitals
    • Knees
    • Elbows