Hand Foot Mouth disease inside the mouth

This is the first of what will be an on going series of articles about healthcare/medical in SE Asia

We are not doctors so will rely of resources that we trust and sometimes on our own personal experience

my experience

My son (2 yrs old) just had a case of hand/foot/mouth disease in Thailand.  At first I thought he just had an accident because his lips were swollen.  That evening was running fever and not eating very much which did not alarm me.  Baby tylenol and all was OK. Next day still running fever, not eating, but what worried me was not drinking.  That evening confused, very fussy, and fever.  This was sunday so thought we could wait till Monday to go to the clinic.  He was confused and I believe dehydrated.  I spent 6 yrs in Iraq were dehydration can be life serious.  So off we go to to the hospital  Phuket International Hospital .  Its about 22:00 so not many patients and so not long to wait.  They did the normal stuff and prescribe medicine for us to leave.  I am thinking “what about the dehydration”?  I asked the doctor if he thought my son was dehydrated?  he said yes, Do you think he needs to be admitted. The doctor said up to you!   Wow!  So we admit my son, go to his room and they quickly add an IV!  GOOD!  He is 2  crying scared dehydrated confused and was not going to relax or go to sleep. Fighting us trying to pull out the IV.  I went to the doctor and ask for something to sedate him just a little.  He said we dont do that for kids his age.  I am not a doctor just a parent but was not buying what the doctor said.  After some strong words from me the doctor agreed.  Good! my son was sleeping and the next morning after the medication in the mouth to ease the pain, IVs  was much better. Before I finish my experience at the hospital will give some information on hand/foot/mouth disease.

the medical

Source is CDC USA Gov http://www.cdc.gov/hand-foot-mouth/about/index.html

overview

Hand, foot, and mouth disease is a common viral illness that usually affects infants and children younger than 5 years old. However, it can sometimes occur in adults. Symptoms of hand, foot, and mouth disease include fever, blister-like sores in the mouth (herpangina), and a skin rash.

Hand, foot, and mouth disease is caused by viruses that belong to the Enterovirus genus (group). This group of viruses includes polioviruses, coxsackieviruses, echoviruses, and enteroviruses.

• Coxsackievirus A16 is the most common cause of hand, foot, and mouth disease in the United States, but other coxsackieviruses have been associated with the illness.
• Enterovirus 71 has also been associated with hand, foot, and mouth disease and outbreaks of this disease.

Hand, foot, and mouth disease is often confused with foot-and-mouth disease (also called hoof-and-mouth disease), a disease of cattle, sheep, and swine. However, the two diseases are caused by different viruses and are not related. Humans do not get the animal disease, and animals do not get the human disease. For more information, see the U.S. Department of Agriculture National Agricultural Library, Foot-and-Mouth Disease.

Signs & Symptoms

Hand, foot, and mouth disease usually starts with a fever, poor appetite, a vague feeling of being unwell (malaise), and sore throat. One or 2 days after fever starts, painful sores usually develop in the mouth (herpangina). They begin as small red spots that blister and that often become ulcers. The sores are often in the back of the mouth. A skin rash develops over 1 to 2 days. The rash has flat or raised red spots, sometimes with blisters. The rash is usually on the palms of the hands and soles of the feet; it may also appear on the knees, elbows, buttocks or genital area.

Some people, especially young children, may get dehydrated if they are not able to swallow enough liquids because of painful mouth sores.

Persons infected with the viruses that cause hand, foot, and mouth disease may not get all the symptoms of the disease. They may only get mouth sores or skin rash.

For my sons case, the blisters were in the back of the mouth and few bumps or red spots on his soles of his feet.

Diagnosis

Hand, foot, and mouth disease is one of many infections that cause mouth sores. Health care providers can usually tell the difference between mouth sores caused by hand, foot, and mouth disease and other causes by considering —

• how old the patient is,
• what symptoms the patient has, and
• how the rash and mouth sores look.

Depending on how severe the symptoms are, samples from the throat or stool may be collected and sent to a laboratory to test for the virus.

Complications

Health complications from hand, foot, and mouth disease are not common.

Some complications include:

• Viral or “aseptic” meningitis can occur with hand, foot, and mouth disease but it is rare. It causes fever, headache, stiff neck, or back pain.
• Inflammation of the brain (encephalitis) can occur, but this is even rarer.
• Fingernail and toenail loss have been reported, occurring mostly in children within 4 weeks of their having hand, foot, and mouth disease. At this time, it is not known whether nail loss was a result of the disease. However, in the reports reviewed, the nail loss was temporary and the nail grew back without medical treatment.

Prevention & Treatment

Prevention

There is no vaccine to protect against the viruses that cause hand, foot, and mouth disease.

A person can lower their risk of being infected by

• Washing hands often with soap and water, especially after changing diapers and using the toilet.
• Cleaning and disinfecting frequently touched surfaces and soiled items, including toys.
• Avoiding close contact such as kissing, hugging, or sharing eating utensils or cups with people with hand, foot, and mouth disease.

If a person has mouth sores, it might be painful to swallow. However, drinking liquids is important to stay hydrated. If a person cannot swallow enough liquids, these may need to be given through an IV in their vein.

Treatment

There is no specific treatment for hand, foot and mouth disease. However, some things can be done to relieve symptoms, such as

• Taking over-the-counter medications to relieve pain and fever (Caution: Aspirin should not be given to children.)
• Using mouthwashes or sprays that numb mouth pain

Persons who are concerned about their symptoms should contact their health care provider.

Transmission

The viruses that cause hand, foot, and mouth disease (HFMD) can be found in an infected person’s:

• nose and throat secretions (such as saliva, sputum, or nasal mucus),
• blister fluid, and
• feces (stool).

An infected person may spread the viruses that cause hand, foot, and mouth disease through:

• close personal contact,
• the air (through coughing or sneezing),
• contact with feces,
• contaminated objects and surfaces.

For example, you might get infected by kissing someone who has hand, foot, and mouth disease or by touching a doorknob that has viruses on it then touching your eyes, mouth or nose.

It is possible to get infected with the viruses that cause hand, foot, and mouth disease if you swallow recreational water, such as water in swimming pools. However, this is not very common. This is more likely to happen if the water becomes contaminated with feces from a person who has hand, foot, and mouth disease, and is not properly treated with chlorine.

Generally, a person with hand, foot, and mouth disease is most contagious during the first week of illness. People can sometimes be contagious for days or weeks after symptoms go away. Some people, especially adults, who get infected with the viruses that cause hand, foot, and mouth disease may not develop any symptoms. However, they may still be contagious. This is why people should always try to maintain good hygiene (e.g. handwashing) so they can minimize their chance of spreading or getting infections.

You should stay home while you are sick with hand, foot, and mouth disease. Talk with your healthcare provider if you are not sure when you should return to work or school. The same applies to children returning to daycare.

Hand, foot, and mouth disease is not transmitted to or from pets or other animals.

Outbreaks

Individual cases and outbreaks of hand, foot, and mouth disease (HFMD) occur around the world. In countries with temperate (varying) climates, cases occur more often in the spring to fall.

Since 1997, large outbreaks of HFMD caused by enterovirus 71 have been reported mostly in children in east and Southeast Asia. In these outbreaks, most children have typical symptoms of HFMD and recover without health complications. However, a small number of people with this disease develop severe complications requiring hospitalization or even causing death.

Studies are being done to understand why these outbreaks occur and why some people have severe disease. Research is also being done to develop treatments and vaccines to help prevent HFMD in the future.

To learn more about outbreaks occurring in some countries in Asia, visit the World Health Organization.

Our doctor said that in Thailand foot/mouth/hand disease is very common

source wikipedia

major outbreaks

• In 1998, there was an outbreak in Taiwan, affecting mainly children.^[16] There were 405 severe complications, and 78 children died.^[17] The total number of cases in that epidemic is estimated to have been 1.5 million.^[4]
• In 2008 an outbreak in China, beginning in March in Fuyang, Anhui, led to 25,000 infections, and 42 deaths, by May 13.^[4] Similar outbreaks were reported in Singapore (more than 2,600 cases as of April 20, 2008),^[18] Vietnam (2,300 cases, 11 deaths),^[19] Mongolia (1,600 cases),^[20] and Brunei (1053 cases from June–August 2008)^[21]
• In 2009 17 children died in an outbreak during March and April 2009 in China’s eastern Shandong Province, and 18 children died in the neighboring Henan Province.^[22] Out of 115,000 reported cases in China from January to April, 773 were severe and 50 were fatal.^[23]
• In 2010 in China, an outbreak occurred in southern China’s Guangxi Autonomous Region as well as Guangdong, Henan, Hebei and Shandong provinces. Until March 70,756 children were infected and 40 died from the disease. By June, the peak season for the disease, 537 had died.^[24]
• The World Health Organization reporting between January to October 2011 (1,340,259) states the number of cases in China had dropped by approx 300,000 from 2010 (1,654,866) cases, with new cases peaking in June. There were 437 deaths, down from 2010 (537 deaths).^[25]
• In December 2011, the California Department of Public Health identified a strong form of the virus, coxsackievirus A6 (CVA6), where nail loss in children is common.^[26]
• In 2012 in Alabama, United States there was an outbreak of an unusual type of the disease. It occurred in a season when it is not usually seen and affected teenagers and older adults. There were some hospitalizations due to the disease but no reported deaths.^[27]
• In 2012 in Cambodia, 52 of 59 reviewed cases of children reportedly^[28] dead (as of July 9, 2012) due to a mysterious disease were diagnosed to be caused by a virulent form of HFMD.^[29] Although a significant degree of uncertainty exists with reference to the diagnosis, WHO report states, “Based on the latest laboratory results, a significant proportion of the samples tested positive for enterovirus 71 (EV-71), which causes hand foot and mouth disease (HFMD). The EV-71 virus has been known to generally cause severe complications amongst some patients.”^[30]
• Hand, foot and mouth disease infected 1,520,274 people with 431 deaths reported up to end of July in 2012 in China.^[3

source WPRO

as 29 December 2014

Singapore
The weekly trend has remained stable since week 41 and the number of cases reported was lower than cases
reported in the same period of time in 2013. (Graph 5)
As of 20 December:
 Cumulative cases reported in 2014: 21,420
 Cumulative deaths reported in 2014: NA
Graph 5: HFMD cases reported per week

Personal

My son was released the next day and after couple days back to his happy self.  Our next article will be about a review of Phuket International Hospital.

additional resources:

http://www.webmd.com/children/guide/hand-foot-and-mouth-disease-topic-overview

http://www.medicinenet.com/image-collection/hand-foot-and-mouth_disease_in_mouth_1_picture/picture.htm

http://en.wikipedia.org/wiki/Hand,_foot_and_mouth_disease

we always welcome comments or if would like to share your experience