what is HFMD or hand foot mouth disease.pptx

A ppt describing hfmd or hand foot mouth disease

1. HFMD BY MOHAMMED YASEEN

2. HFMD Typically, benign  and common illness among infants and children characterised by rapidly ulcerating painful vesicles in the mouth and vesicular lesions on the hand, feet and diaper region. Hand-foot-and-mouth disease (HFMD) is an acute viral illness that presents as a vesicular eruption in the mouth, hands, feet, buttocks, and/or genitalia. Hand-foot-and-mouth disease is a common and potentially but infrequently fatal in children under 5 years of age.    Coxsackievirus A type 16 (CVA16) is the etiologic agent involved in most cases of HFMD, but the illness is also associated with coxsackievirus A5, A7, A9, A10, B2, and B5 strains. Coxsackievirus A6 may have become the commonest enterovirus in seasonal outbreaks of hand-foot-and-mouth disease in children in France and Finland. Enterovirus 71 (EV-71) has caused outbreaks of HFMD with associated neurologic involvement in the western Pacific region and Southeast Asia.

3. EPIDEMIOLOGY Epidemics of HFMD generally occur in the summer to early fall months, although cases can occur sporadically all year. Hand, foot and mouth disease (HFMD) has become a societal burden in parts of Asia with pandemic potential.     HFMD epidemics associated with EV-71 have been more frequent in Southeast Asia in recent years, including the Republic of China (1998) and Singapore (2000).

4. RISK FACTORS Age is the main risk factor for hand-foot-and-mouth disease. The disease mostly affects children younger than ages 5 to 7 years. Children in child care settings are especially vulnerable because the infection spreads by person-to-person contact

5. COXSACKIEVIRUS - M/C Coxsackieviruses  are a few related  enteroviruses  that belong to the  Picornaviridae  family of  nonenveloped , linear,  positive-sense single-stranded RNA viruses , as well as its genus  Enterovirus , which also includes  poliovirus  and  echovirus . Enteroviruses are among the most common and important human pathogens, and ordinarily its members are transmitted by the  fecal–oral route . Coxsakievirus A16 is the most common cause HFMD

6. ENTEROVIRUS 71 – SECOND M/C  Enterovirus 71  ( EV71 ), also known as  Enterovirus A71  ( EV-A71 ), is a  virus  of the genus  Enterovirus  in the  Picornaviridae   family,notable for its role in causing epidemics of severe neurological disease and  hand, foot, and mouth disease  in children. It was first isolated and characterized from cases of neurological disease in  California  in 1969.  Enterovirus 71 infrequently causes  polio-like syndrome  permanent paralysis

7. PATHOPHYSIOLOGY

8. SIGNS AND SYMPTOMS The history in patients with HFMD is as follows: Sore mouth or throat Malaise Rarely, vomiting occurs in HFMD cases caused by EV-71 Physical findings include the following: Initially, macular lesions appear on the buccal mucosa, tongue, and/or hard palate These mucosal lesions rapidly progress to vesicles that erode and become surrounded by an erythematous halo Lesions may also be found on the hands, feet, buttocks, and genitalia A fever of 38-39°C may be present for 24-48 hours

9. COMPLICATIONS Atypical clinical features include concomitant aseptic meningitis in HFMD caused by coxsackievirus strains (rare).  [ 3 ]  HFMD caused by EV-71 has a higher incidence of neurologic involvement These neurological complications have been attributed to either immunopathology or virus-induced damage to gray matter., including the following   A poliolike syndrome Aseptic meningitis Encephalitis Encephalomyelitis Acute cerebellar ataxia Acute transverse myelitis (TM) Guillain-Barré Opsomyoclonus syndrome- In older children or teens, viral infections are the most frequent apparent cause of OMAS. Benign intracranial hypertension

10. DIAGNOSIS The diagnosis of HFMD is typically based on clinical grounds. Laboratory studies are usually unnecessary, but the following may be done: The virus can be isolated and identified via culture and immunoassay from cutaneous lesions, mucosal lesions, or stool samples; oral specimens have the highest isolation rate In patients with vesicles, vesicle swabs are also a good source for viral collection In patients without vesicles, rectal swabs can be collected For viral isolation, 2 swab collections are recommended: From the throat and from either vesicles or the rectum Serologic testing ( eg , acute and convalescent antibody levels) may be obtained Differentiating coxsackievirus-associated HFMD from EV-71–associated HFMD may have prognostic significance PCR and microarray technology are among the various ways of identifying the causative virus  

11. MANAGEMENT There is no antiviral agent specific for the etiologic agents of HFMD. Instead, the treatment is mainly supportive, as follows: Ensure adequate fluid intake to prevent dehydration; cold liquids are generally preferable Spicy or acidic substances may cause discomfort Intravenous hydration may be necessary if the patient has moderate-to-severe dehydration or if discomfort precludes oral intake Fever may be treated with antipyretics Pain may be treated with standard doses of acetaminophen or ibuprofen Direct analgesia may also be applied to the oral cavity via mouthwashes or sprays IVIG and milrinone have shown some efficacy in a few report

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