Hand, Foot, and Mouth Disease in Adults

Epidemiology and Transmission

• Adults are most infectious during the first week of illness, with viral shedding continuing for up to five days after symptom onset 1

Clinical Presentation in Adults

• Initial symptoms typically include fever, malaise, and general discomfort, with fever usually being low-grade but can be higher than 102.2°F/39°C 2
• The differential diagnosis includes drug hypersensitivity reactions, infective endocarditis 4
• Other conditions with palmar/plantar rash such as syphilis and meningococcal infection should also be considered 2

Diagnosis

• Diagnosis is primarily clinical, based on the characteristic distribution of lesions 3
• Laboratory confirmation can be achieved through reverse transcriptase PCR (RT-PCR) of vesicle fluid samples, which have high viral loads 3

Complications

• Rare but serious complications can occur, including neurological complications such as encephalitis/meningitis 3
• Acute flaccid myelitis or paralysis can also occur 3

Management

• Treatment is primarily supportive and focused on symptom relief, with acetaminophen or NSAIDs recommended for pain and fever 3
• Gentle oral hygiene and mild toothpaste for oral lesions are also recommended 3
• Moisturizing creams for skin lesions can help alleviate symptoms 3
• Zinc oxide may help reduce itchiness in skin lesions by forming a protective barrier 3

Prevention and Infection Control

• Hand hygiene is the most important preventive measure, and adults with HFMD should avoid close contact with others until fever resolves and mouth sores heal 3
• Environmental cleaning of potentially contaminated surfaces is also crucial 3
• Continued hand hygiene is important as some viral shedding may continue even after returning to normal activities 1

Return to Normal Activities

• Adults can generally return to work or normal activities once fever has resolved, mouth sores have healed, and no new lesions have appeared for 48 hours 3
• Even after returning to normal activities, continued attention to hand hygiene is important 1

Important Considerations

• Immunocompromised adults may experience more severe disease and should be monitored closely 3