Hand Foot Mouth Disease

Hand Foot Mouth Disease (Šistockphoto.com/Mustafa Arican / February 11, 2013)

When Jonah Posner developed a fever last spring, his mother, Tracy, didn’t think much of it. The then-2-year-old was eating, drinking and sleeping as he usually did.

“He had no other symptoms besides the fever,” Tracy Posner says. “He didn’t complain about anything else.”

Within two days, the fever disappeared. But a day later, when he came home from preschool, the Catonsville mom and her husband, Jon, noticed small red spots on the bottom of Jonah’s feet.

“I thought he got bit or was irritated from running around,” Posner says.

As a precaution, Jon Posner called the family pediatrician. The diagnosis: Hand, Foot and Mouth Disease, also known as HFMD.

HFMD is a common viral illness that often affects infants and children younger than 10 years old. Pediatricians say the illness makes the rounds regularly in summer and fall. But this winter, some pediatricians say they are seeing more cases than usual, as well as evidence of newer strains of the illness that affect adults.

At St. Joseph Medical Center, pediatrician Dr. Nardine Assaad says she has seen three times as many cases of HFMD over the past year in the emergency department and inpatient unit, compared to recent years.

“It sounds like it is a more virulent strain,” she says. “Usually, the adults don’t have it. This year, a lot of adults do. It’s very uncomfortable.”

Signs, Symptoms and Treatment

When Tracy Posner heard her son’s diagnosis she says she was petrified.

“I had heard horror stories,” she says. “I was really worried about it initially.”

But the illness’s moniker, as well as the myths surrounding it, can often be misleading, doctors say. For example, HFMD is not Foot and Mouth Disease (FMD) — a disease that affects animals like cattle, pigs and sheep.

HFMD is caused by viruses belonging to the Enterovirus group. Coxsackievirus A16 is the most common cause, says Dr. Tim Doran, chairman of pediatrics at Greater Baltimore Medical Center. Enterovirus 71 can also lead to the disease. There are at least 40 or 50 different strains, Doran says.

Most strains are relatively benign, but all are contagious, spreading through saliva and fecal matter.

The first noticeable symptom is usually a fever, Doran says. For some children, that is the only symptom. But for others, sores appear one or two days after the fever starts. Mouth sores tend to show up first. They begin as small, red spots and then begin to blister, causing sore throat and pain with swallowing, Doran says.

A skin rash with red spots can also show up on the palms and soles of the feet. The rash can also appear on the buttocks or in the genital area.

For Jonah, the spots only appeared on his feet. And when his sister Avery, then nine months old, came down with HFMD a few days after Jonah, she didn’t have any spots. But she did have a fever — and lost a toenail as a result of the illness, Posner says.

It’s not uncommon for children to lose a toenail or fingernail after experiencing HFMD, Doran says. The skin under and around the spots may also shed as children recover from the illness — a move that surprised Posner.

“I would not have thought the spots on (Jonah’s) feet were blisters,” Posner says. “They weren’t raised. But then his skin started shedding, and it was like a blister popped.”

Children with HFMD can get all or only some of the symptoms, doctors say. While they are most contagious during the first week of illness, the virus can remain in the body for several weeks after the fever has disappeared, Doran says.