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CC March 2016 Hand, Foot and Mouth (HFM) Disease

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echoecho's version from 2016-06-22 19:24

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Question Answer
What age group are most susceptible to HFM? The majority of cases occur before ____ years of age?1-4 y.o; 15
Clinical presentation is similar for all ages, but the very young generally experience more of what 2 problems? Adult patients suffer more of what type of problems? 1) nutrition 2) hydration 3) constitutional
In the US, HFM is most commonly due to infection with the enterovirus ______?Coxsackie A16
Other Coxackie virus serotypes have been associated with HFM (altho some cases may have been atypical presentations of ______)?herpangina
Is HFM caused by Coxsackie virus rarely, if ever fatal?yes
It has a complication rate of about 6% for the deveDlopment of what?aseptic meningitis
What enterovirus has been the cause of large outbreaks in eastern Europe, Russia, Taiwan and Thailand?Enterovirus 71
In a study in Taiwan, HFM caused by enterovirus 71 had an overall complication rate of > ___%, including ______ (7.3%), _____ (10%), ______fatal pulmonary edema (6.8%) and _________ (2.3%)?30; aseptic mengingitis; encephalitis; fatal pulmonary edema; polio-like syndrome
HFM outbreaks are seasonal and occur more often in what seasons?summer; early fall
Describe what happens on initial exposure?1) exposure is via oral / respiratory routes 2) next it extends to the lymphatics 3) followed by a viremia in which the secondary viral infections of the skin of the extremities and oral mucosa produce the clinical picture
What symptoms may precede the cutaneous outbreak and generally resolve as antibody production begins about 1 week after the onset of infection?1) fever 2) malaise 3) constitutional symptoms
Describe the oral manifestations of HFM?1) all patients have oral lesions (5-10 erythematous macules that progres over several days to grayish, thin-walled vesicles that progress to shallow ulcerations that clear in 5-10 days)
Which part of the mouth are the sites most often involved in HFM?1) hard palate 2) buccal mucosa 3) tongue
Comment on the extral-oral lesions of HFM?1) appear after the oral ulcers and may be sparse or number in the dozens 2) hands involved more than feet 3) eruption affects the dorsal and lateral surfaces of hands and feet but can also affect the palms and soles 4) show gray vesicles on an erythematous base that tend to follow skin lines 5) some are macular or maculopapular 6) lesions are nonpruritic but may be painful or tender 7) lesions break down and crust w/in a few days, disappearing w/o scarring in a week or more
List the 4 atypical presentations of HFM?1) a variant with more extensive lesions 2) eczemia coxsackium in persons with atopic dermatitis where lesions resemble eczema herpeticum 3) a variant that looks like Giannotti-Crosti 4) a hemorrhagic variant with petechiae and purpura
*** Why is exclusion from school not practical?becaues virus can be shed in the feces for weeks
*** Treatment?1) supportive 2) focus on management of oral pain 3) maintenance of patient hydration and nutrition during the acute phase
Spontaneous resolution usually occurs with ___ weeks w/o complication?2
Is persistent or recurrent ulcer disease likely with HFM after the acute eruption has resolved?no
There can be recurrences of what on the cheeks and proximal extremities in response to stress or exertion? what is the pathophysiology of this?1) reticular (net-like) erythema 2) there is no clinical significance apart from cosmetic effects
What are aphthous ulcers (aphthosis)?1) shallow, well-defined ulcers that range from a few mm to cm in diameter 2) may show a thin erythematous rim with a white fibrinous base 3) etiology is uncertain but may be some sort of immune response to bacterial or viral antigens 4) called "canker sores" 5) there are no skin lesions as part of the oral eruption (lesions occur on buccal or gingival mucosa but can involve other ares of oral mucosa)
What is Behcet's disease?1) oral aphthous ulcers, genital ulcers, uveitis, skin lesions) 2) occurs in 20-40 y.o. range 3) skin lesions are usually acneiform 4) can be associated with aseptic arthritis
What is oral lichen planus?1) presents as lacelike Wickham's striae or as erosive lesions 2) lesions are usually polygonal, flat violaceous papules
What is varicella?1) chickenpox 2) oral and cutaneous lesions 3) cutaneous lesions develop over sevral days so that lesions of varying appearance are present at any given time
*** SUMMARY = HFM is most commonly due to infection with what virus?enterovirus Coxsackie A16
*** SUMMARY = All patients have oral lesions, extra-oral lesions appear later with hands more often affected than ___?feet
*** SUMMARY = Spontaneous resolution usually occurs within ___ weeks without complications?2
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