H-F-M Disease is one of the more distinctive rash syndromes caused by
enteroviruses. It is most frequently caused by coxsackie A virus A 16,
but can also be caused by enterovirus 71; coxsackie A viruses 5, 7, 9,
and 10; and coxsackie B viruses 2 and 5. It is usually a mild illness,
with or without low-grade fever. The orophrarynx is inflamed and contains
scattered vesicles on the tongue, buccal musoca, posterior pharnyx, palate,
gingiva, and/or lips. These may ulcerate, leaving 4~8 mm shallow lesions
with surrounding erythema. Maculopapular, vesticular, and/or pustular
lesions may also occur on the hands and fingers, feet, and buttocks and
groin; hands are more commonly involved than the feet. Lesions on the
hands and feet are usually tender and vesicular and vary in size from
3~7 mm; they are generally more common on the dorsal surfaces but frequently
occur on the palms and soles as well. Vesicles resolve in about 1 wk.
Buttock lesions do not usually progress to vesiculation. Disseminated
vesticular rashes may complicate preexisting eczema.
Hand-foot-and-mouth disease caused by enterovirus 71 is frequently
more severe than that due to coxsackievirus A 16, with high rates
of associated neurologic disease including aseptic menigitis,
encephalitis, and paralysis. Recent outbreaks in Malaysia, Japan, and
Taiwan have been notable for brainstem encephalomyolitis, neurologic
pulmonary edema, pulmonary hemorrhage, shock, and rapid death,
especially in young children.
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