We have two hands

Doctor is this contagious?” There were notable maculopapular and vesicular-like lesions on her 4-year-old daughter’s mouth, hands, and on the soles of her feet, with some sparsely scattered on the antecubital fossa of both arms. To help you visualize, think about pimple-like or chickenpox lesions in these areas. The antecubital fossa is that part of your anatomy midway between your upper and lower arm where blood is usually drawn for examination. Mommy and Daddy had been awake for most of the night as their precious little one had been complaining of throat pain which impacted her ability to drink and eat. They volunteered the information that the condition had started two days prior to consult with fever, which was not high-grade and resolved in 48 hours. The lesions had quickly spread and were not pruritic.

“I have difficulty fully opening my mouth po. Sorry po.“ An adolescent patient had come in for a consult. He was apologizing as I had asked him if I could examine his oropharyngeal area for clues to his throat pain. His voice was gravelly, and the lesion on the dorsum of his tongue resembled that of an ulcer. Having formulated an initial impression, I held back and completed the physical examination. There were more pronounced lesions on his hands and on his feet.

By now, you must have made your impression. Final diagnosis: Hand, foot, mouth disease or HFMD.

HFMD is a highly contagious viral illness that is primarily spread through the feco-oral route but also from direct or indirect contact with respiratory, oral secretions, or vesicular fluid from the lesions. Knowing the various modes of transmission, pause and think also about the objects that you touch that may be contaminated with the virus.

Causative agents belong to the family of enteroviruses predominantly coxsackievirus A16 and enterovirus A71, though coxsackievirus A6 has also been reported.

In a school outbreak in a northern province of the Philippines in October of last year, coxsackievirus A16 together with enterovirus were the ones isolated. A disease mostly affecting young children, particularly those less than 5 years of age, older age groups are not exempt and to witness or hear of intrafamilial spread will never come as a surprise. In a tropical country such as ours, most cases usually occur during the rainy season but may be seen throughout the year. For the majority, illness is usually confirmed based on a patient’s clinical presentation without the aid or need for further diagnostic testing, including a history of contact with someone with a similar condition. The latter, however, is not always a constant as asymptomatic individuals are also capable of transmitting the disease. In the two aforementioned cases, parents claimed that since both children were homeschooled and no one had been sick within the immediate family, where did their child get the virus?

In general, the incubation period is three to five days and maybe as long as seven days. Patients are most contagious during the first week of illness and shedding of the virus from available literature may range from less than four weeks or longer. Mild and self-limiting in a majority of cases and resolved within a period of seven to 10 days, complications such as myocarditis, encephalitis, acute flaccid paralysis, aseptic meningitis may occur but are rare as documented from published studies and mostly attributed to enterovirus A71.

Currently, there is no specific antiviral treatment. Luckily, there are tests available in the country that can document infection if and when warranted. The only catch is the cost. Management is supportive and involves ensuring that adequate hydration is maintained. In the unfortunate event of complications, subsequent treatment is individualized.

WASH YOUR HANDS. Oct. 15 is Global Handwashing Day and the theme for this year is “Clean hands are within reach.“ We all know that respiratory and diarrheal illnesses may be prevented by the simple act of handwashing. Knowing, however, does not translate into doing. From experience and available research studies on the intervention that could promote better hand hygiene adherence, lectures and provision of supplies/facilities help but do not result in overall behavioral change. Monitoring and constant motivation are the other elements that play key roles.

We always say that we need to start them young and be that role model. We can all begin at home and in school. If you are not familiar with Robert Fulghum and his essay, please take time to look it up. Not only does it include pointers on basic hygiene including washing your hands but other essentials that one needs to know to be able to be that person that this world needs.

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