Hand, Foot, and Mouth Disease: Diagnosis, Treatment, and Prevention

Diagnosis

Hand, foot, and mouth disease is usually diagnosed clinically without testing because the symptoms and signs are very distinctive. However, if the symptoms or signs are not severe and it is difficult to make a clinical diagnosis, a specialist's diagnosis may be needed, and in cases of severe hand, foot, and mouth disease, laboratory diagnosis is necessary. The laboratory diagnostic methods are as follows.

1. Serologic testing

If blood is collected twice during the acute and recovery phases of the illness and the antibody level against enterovirus increases fourfold or more, diagnosis is possible. However, this method does not distinguish between enterovirus serotypes, so it is not used much these days.

2. Viral isolation through cell culture

This is the standardized method for diagnosing enterovirus infection. Among body fluids, the virus can be detected in cerebrospinal fluid, blood, stool, skin vesicles, and throat swabs, and testing multiple specimens increases the detection rate. Viruses detected through cell culture are identified by serotype using neutralizing antibodies. The detection rate of viruses through cell culture is about 60-75%.

3. Viral detection through molecular biology testing

Polymerase chain reaction, which extracts the viral gene and amplifies it to confirm whether the virus is present, is the most commonly used method recently. Compared with isolating the virus through cell culture, it provides results very quickly, has a very high detection rate, and has several advantages, including the rapid differentiation and detection of enterovirus 71, the causative virus associated with a poor prognosis, from coxsackievirus. However, it has the disadvantage of requiring various laboratory instruments and being costly. Still, this method has recently become more common than cell culture, and it is also routinely used by Korea's National Institute of Health. In addition, sequence analysis can be performed on the viral genes amplified by polymerase chain reaction to analyze the characteristics of infection at that time. To further increase the detection rate of viruses in hand, foot, and mouth disease, it is better to test two or more specimens together, and it is desirable to use a throat swab and fluid from blisters in the mouth or on the skin, or stool, as specimens.

4. Cerebrospinal fluid test

This test is performed when meningitis or encephalitis is suspected due to hand, foot, and mouth disease. It is not as simple as a blood test, but it is commonly performed in hospitals. With the collected cerebrospinal fluid, the presence or absence of inflammatory cells and biochemical tests can diagnose meningitis or encephalitis, and virus detection may also be possible.

Treatment

There is no fundamental treatment for hand, foot, and mouth disease; only treatment to reduce symptoms is available. Because ulcers develop in the mouth, pain is accompanied, and the amount of food intake may drop sharply, leading to dehydration. Therefore, adequate fluid intake is essential, and cold water or drinks are better than hot ones. Spicy or sour foods can irritate the ulcers in the mouth and cause pain, so they should be avoided as much as possible.

If food intake decreases significantly and dehydration becomes severe, fluids must be given at the hospital. When severe dehydration occurs, urine volume and frequency decrease sharply, tears do not come out even when crying, the tongue and lips become very dry, the eyes may appear sunken, and when the skin is pinched and released, it takes longer to return to normal.

If there is a fever, wipe the body with lukewarm water or reduce the fever with an antipyretic, and to reduce mouth pain, pain relievers such as Tylenol or Brufen can be given. If the child is very fussy, refuses even to drink water, drools a lot, and has a greatly reduced food intake, a spray-type pain reliever may also be sprayed directly into the mouth. In addition, if itching occurs because of skin blisters, an antihistamine is given.

Prevention

It would be good if there were a vaccine to prevent the disease, but a vaccine against enterovirus, the causative agent of hand, foot, and mouth disease, has not yet been developed. Korea has a very high population density and a tendency to place children in childcare facilities from an early age, making it an environment where hand, foot, and mouth disease can spread rapidly. Therefore, along with personal hygiene management such as handwashing, thorough hygiene management is needed in families, childcare facilities, playgrounds, summer camps, orphanages, hospitals, and other places where a patient with hand, foot, and mouth disease has appeared.

Hands should be washed diligently with soap for a long time, and the surfaces of toys and household items used by the patient should be thoroughly cleaned with detergent. The risk of infection can be reduced by limiting kissing and hugging of children with hand, foot, and mouth disease and by using separate household items. If a child with the disease participates in group activities, the infection can spread to other children, so the child should refrain from group activities until recovery.

So far, I have explained the diagnosis, treatment, and prevention of hand, foot, and mouth disease.

In the next part, we will learn about eating disorders.

Source: Korea Disease Control and Prevention Agency, National Health Information Portal