A 3-Year-Old Girl with Vesicles on Her Palms and Soles

Differential Diagnosis
A. Varicella
B. Chikungunya
C. Hand-foot-and-mouth disease
D. Erythema multiforme

Diagnosis
The little girl was diagnosed with hand-food-and-mouth disease (HFMD), an acute, self-limited viral illness predominantly caused by Coxsackievirus or other Enteroviruses. It is often characterized by an oral enanthem, accompanied by macular, papular, or vesicular rash on the hands, feet, buttocks, genitalia and thighs.

Learnings

• Typically, HFMD lasts from 7 to 10 days. The incubation period is approximately 3-6 days
• The course usually starts with mild fever, sore throat and mouth, cough, headache, malaise, diarrhea/vomiting, and occasional arthralgias. Small oral macules can develop into vesicles and ultimately ulcerate 1 to 2 days after the start of systemic symptoms
• HFMD is highly contagious and is commonly transmitted in daycare centers, schools, summer camps, and hospitals. Most often, outbreaks usually occur from June to October
• Transmission occurs via the fecal-oral route and through secretions, including secretions of vesicular fluid and nasal/oral fluid
• Following infection, individuals can shed the virus via gastrointestinal passage for 4-6 weeks or via the upper respiratory tract for 3 weeks
• While HFMD affects children primarily, adults can also develop the disease

Pearls for Urgent Care Management and Considerations for Transfer

• Given that the infection is self-limiting, supportive care includes management of prodromal symptoms that may include fever, abdominal pain, fussiness, emesis, and diarrhea