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The Informed Parent

Hand Foot And Mouth…Not Hoof And Mouth

by Louis P. Theriot, M.D., F.A.A.P.
Published on Apr. 30, 2001

Mrs. Z. brought 22-month-old Chelsea to the office with the complaint that for the past two days she had been running a fever as high as 101.5 degrees, and was very fussy. “I wasn’t going to be a panicky mom,” she said, in a worried voice. “I read all of my baby books and thought I had it under control—but since last night she has barely had anything to drink. And now she has these awful looking sores…or blisters on her fingers,” she went on.

Chelsea’s chart indicated that she did in fact have a fever. It was 101.2 degrees. She was none too pleased about being undressed and examined, but the tears rolling down pink cheeks assured me that Chelsea was not dehydrated. Mom held the baby on her lap while I did the examination. This was comforting enough to allow me to finish the exam without any further tears. Chelsea seemed intrigued by my stethoscope and otoscope, and insisted on being allowed to hold the stethoscope herself to her own chest. This playful interaction assured me that she was probably not seriously ill.

On Chelsea’s exam I found a number of “canker sores” inside the mouth and on the tongue. These looked very painful. She had small pustular blisters on her fingers and toes, the majority on the fingers. They were all about the same size, 3-4 millimeters, and resembled superficial blisters with fluid. She had some solitary red lesions on her buttocks, but none contained fluid. The rest of her exam was completely normal.

Mom watched intently as I inspected Chelsea’s skin. “What do you think, doctor?” she asked in a concerned voice. In a reassuring tone I said, “What Chelsea has is very common in children, and this is the first case I have seen this season. She has Hand Foot and Mouth disease.”

Well, one would have thought that I had zapped mom with a stun gun. She shot up to attention and leaned forward in the seat. The color rushed from the face and eyes bugged out of the sockets. “You mean it made it here from England already?” she asked in a desperate voice. Her reaction caught me totally by surprise. As I started to ask what she meant, it struck me. She was referring to Hoof and Mouth disease that has ravaged the cattle industry of Great Britain. I chuckled to myself because of the play on words.

I promised her that these were two entirely different illnesses—apples and oranges, or I should say, people and cattle. Hand Foot and Mouth disease is a common viral illness that is caused by a certain group of viruses, the enteroviruses. The most common one that causes Hand Foot and Mouth is Coxsackie A 16. It usually is seen in the summer and fall, being seasonal, and is very contagious. It has a short incubation period of 4-6 day, and would easily explain all of the findings that Chelsea has. It is self-limiting, which means that it will go away on it’s own without any treatment, usually within a week. It tends to occur in little outbreaks, so I expect to see more cases in the next few weeks.

Hoof and Mouth disease, on the other hand, is a highly contagious viral infection of cloven-hoofed animals, such as cattle, pigs, sheep, goats and deer, that does occur in epidemics. It should not be confused with Mad Cow disease, which is an entirely different illness. Hoof and Mouth disease causes fever, eruption of blisters in the mouth and tender areas of skin such as the nostrils, udders and feet. Affected animals are unable to eat because of the sores in the mouth. The blisters grow large and then burst, leaving raw and sensitive skin exposed. When this happens to the hooves, the animals are unable to stand or walk. Animals with Hoof and Mouth disease must be destroyed because it is highly contagious and can wipe out a large population of valuable livestock. The cattle industry of Great Britain has nearly been decimated by the outbreak of Hoof and Mouth that they are currently experiencing. The United States has had nine epidemics of Hoof and Mouth disease. The most recent was in California in 1932, and the most severe was in 1914. This affected an entire 22 states. So far, the outbreak in England has not reached North America.

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