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
- Any age, usually age <7 c
Clinical features
- Herpangina:
- Prodrome: High-grade fever, severe sore throat, odynophagia, irritability.
- Enanthem: Hyperemic macules -> painful 1-2 mm vesicles -> shallow ulcers with red halos.
- Location: Strictly POSTERIOR oral cavity (soft palate, tonsillar pillars, uvula, posterior pharynx).
- Exanthem: ABSENT (no skin rash).
- Hand, Foot, and Mouth Disease (HFMD):
- Prodrome: Low-grade fever, malaise, sore throat, anorexia.
- Enanthem: Painful vesicles/ulcers on ANTERIOR oral cavity (buccal mucosa, tongue, labial mucosa).
- Exanthem: Erythematous macules/papules -> oval, gray “football-shaped” vesicles on an erythematous base.
- Distribution: Palms, soles, interdigital spaces, buttocks, groin.
Differential Diagnostics
- Herpetic Gingivostomatitis (HSV-1):
- Differs by ANTERIOR oral cavity & lip involvement, marked gingivitis (bleeding/swollen gums), and perioral crusting; lacks palm/sole exanthem.
- Aphthous Stomatitis (Canker Sores):
- Differs by recurrent, solitary/few painful ulcers on non-keratinized mucosa without systemic fever/prodrome or skin exanthem.
- Streptococcal Pharyngitis:
- Differs by tonsillar exudates, palatal petechiae, anterior cervical LAD; lacks oral vesicles/ulcers and palm/sole lesions. c
- Varicella Zoster Virus (Chickenpox):
- Differs by lesions in various stages of evolution (“dew drops on a rose petal”), generalized itchy distribution; spares palms/soles initially.