Definition

The Singapore flu, commonly known as hand, foot, and mouth disease (HFMD), is a viral infection that primarily affects infants and children. The illness is usually not severe, but it is highly contagious.

Causes

HFMD is caused by viruses belonging to the Enterovirus family, such as:

• Coxsackievirus A16. This virus causes the majority of HFMD cases in the United States
• Coxsackievirus A6 can also cause HFMD with more severe symptoms
• Enterovirus 71 (EV-A71). This virus has been linked to HFMD cases and outbreaks throughout East and Southeast Asia. Although rare, this virus is associated with more severe HFMD such as encephalitis (brain tissue infection)

A person who has been infected with this virus can spread it to others. The virus can be found in:

• Nasal and throat fluids, including saliva and nasal mucus
• Fluid from blisters or scabs
• Feces

The virus is easily transmitted through:

• Contact with respiratory droplets containing virus particles released by an infected person coughing or sneezing
• Touching an infected person or close contact, such as kissing, hugging, or using personal items like cups or cutlery
• Touching an infected person's feces, such as when changing a diaper and then touching the eyes, nose, or mouth
• Touching infected objects and surfaces, such as doorknobs or toys, and touching the eyes, nose, and mouth
• Although rare, the virus can also be contracted by swallowing water in public places, such as a swimming pool. This can happen when the water is not properly chlorinated and is contaminated with the feces of a person with HFMD

People with HFMD are typically most contagious during the first week of illness. People can sometimes spread the virus to others for days or weeks after their symptoms have subsided, or even if they have no symptoms.

Risk factor

HMFD is most commonly seen in children under the age of five, but it can affect anyone. Children who attend school or daycare are more likely to contract it because the infection spreads more quickly and easily in crowded environments.

Symptoms

Symptoms of HFMD usually include fever, mouth sores, and skin rash.

• Children frequently develop fever and flu-like symptoms within 3 to 5 days of contracting the virus. Flu-like symptoms include a decrease in appetite or drinking, a sore throat, and the appearance of being sick or cranky.
• The child may develop mouth ulcers. The ulcer initially appears as small red spots on the tongue and inside the mouth. These spots will eventually develop into painful blisters or sores. Children with painful swallowing may exhibit the following symptoms:
• Not wanting to eat or drink
• Drooling more than usual
• Only wants to drink cold liquids
• The skin rash may appear on the palms of the hands or soles of the feet. It may also appear on the buttocks, legs, or arms. The rash is usually non-itchy and resembles a flat or slightly raised red bitnik, occasionally accompanied by reddish blisters. The fluid inside the blisters and the scabs that form as the blisters heal may contain the virus.

Most children experience mild symptoms that last for 7 to 10 days.

Diagnosis

Doctors can usually diagnose HFMD by performing a physical examination and looking at the rash, taking into account the child's age and symptoms. Sometimes, the doctor may take samples from the child's throat or stool and send them to the laboratory to check for the presence of the virus. However, this test is rarely done.

Management

HFMD infections are usually mild and treatable at home. Most children will recover within 7 to 10 days, with or without medical treatment. There is no specific medical treatment for HFMD.

• You can buy over-the-counter medications to lower fever and reduce pain from mouth sores. However, never give aspirin to a child
• Drink enough fluids. Thrush can cause painful swallowing, so your child may not want to drink much. Make sure your child drinks enough to prevent dehydration
• Keep the blisters clean, and avoid touching them

Complications

HFMD rarely causes complications. If they do, they may include:

• Some people, particularly young children, may become dehydrated as a result of painful mouth sores that prevent them from swallowing enough fluids. Parents can prevent dehydration by making sure their child drinks enough fluids
• Fingernail and toenail damage. Although it is extremely rare, a child suffering from HFMD may sustain damage or even lose fingernails or toenails. In this case, a child's nail loss usually occurs within a few weeks of illness. The nail usually grows back
• Meningitis (infection of the lining of the brain). Although very rare, a small number of children will develop viral meningitis. This disease causes fever, headache, neck stiffness, and back pain. In this case, the child will require intensive care in a health facility
• Encephalitis (brain tissue infection). Although very rare, a small number of children will develop encephalitis which is accompanied by brain swelling or body weakness (paralysis)

Prevention

You can prevent contracting or transmitting HFMD by taking simple measures such as:

• Hand washing. Regularly wash your hands with soap and water for at least 20 seconds. If soap and water are not available, try an alcohol-based hand sanitizer. Always wash your hands when:
• After changing diapers
• After using the toilet
• After coughing, sneezing, or blowing your nose
• Before and after caring for someone who is sick
• Teach children how to properly wash their hands and ensure that they do so regularly
• Regularly clean and disinfect frequently touched surfaces and shared items, such as toys and doorknobs
• Avoid touching your eyes, nose, and mouth as you can contract HFMD if you have the virus on your hands and touch your eyes, nose, or mouth
• Avoid close contact with people who are sick, such as hugging or kissing them. You should stay at home if you have HFMD. Ask your doctor when you or your child can return to normal activities

When to see a doctor?

You should consult a doctor if:

• The child is unable to drink normally or you are concerned that the child is dehydrated
• The child is not active or responsive.
• Fever lasts for more than 3 days
• Symptoms do not improve after 10 days
• The child's immune system is weakened, making the body less capable of fighting off disease-causing microbes.
• Severe symptoms
• Children under 6 months of age

If you are pregnant and have been exposed to HFMD or are experiencing symptoms of HFMD, you should consult your doctor. Although complications of HFMD in pregnancy are rare, your medical history and gestational age will affect your condition. If you suspect your child has HFMD, consult a pediatrician.

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