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Seen These Spots On Your Kid’s Hands And Feet?

It is late spring/early summer and I’ve been fielding daily calls about an illness going around daycares and preschools. The bug is Coxsackie Virus, which causes “Hand, Foot, and Mouth Disease” or “Herpangina” (if it’s limited to just the mouth). It’s a miserable illness that all parents should know about, since you’re likely to be affected by it at some point.

Top 10 Coxsackie virus highlights (or more appropriately deemed low-lights):

  1. It’s a relatively benign disease (rarely do kids have serious complications from it).
  2. It causes a seriously sore throat that typically looks like little canker sores on the very back of the throat.
  3. Complications happen when kids do not want to eat or drink and they get dehydrated.
  4. Other symptoms include: headache, fever, and overall feeling crummy.
  5. It usually affects little kids (usually older kids and grown-ups have already had it and consequently develop immunity to it).
  6. It’s possible to get it multiple times, but most people only get it once.
  7. There is no cure. Antibiotics do NOT help.
  8. Treatment is all supportive (meaning keep the child hydrated and as comfortable as possible). Things like cold popsicles and Motrin can really help.
  9. The peak/worst of the illness happens about day 3 and lasts about a week.
  10. It is very contagious.

What it looks like (the pic)

Thanks so my cute patient who let me snap a pic of his affected hand. While the one sore on the knuckle of his index finger looks the most impressive (it’s a pustule), that isn’t the most typical looking lesion. The little grouping of vesicles (tiny little blisters) further down the finger (toward the nail) are more in line with typical lesions in the beginning. As the illness progresses, the spots look more like the red spots at the base of his index finger (kind of flat and dark red). The spots will often be on the palm side of the hands and soles of the feet.

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The Sore Throat Going Around: Coxsackievirus

This miserable little summer bug is making an early debut in the spring this year (at least in our neck of the woods). I’ve seen a few cases each day for the last week or two, clearly indicating to me that it is now “going around.”

Coxsackievirus (group A subtype) is the virus that causes (among other things) “Hand, Foot, and Mouth disease,” as well as “Herpangina.” The difference between the two is essentially where the infection is. The first is, as the name implies, on the hands, feet, and in the mouth; herpangina is only in the mouth. It is characterized by little sores (that kind of look like canker sores) all on the back of the throat. As you might imagine, it causes a wicked sore throat.  The other symptoms are sort of non-specific.

Coxsackievirus Symptoms

Can include some or all of the following:

  1. Painful throat (with ulcerative sores on the back of the throat)
  2. Decreased appetite
  3. Sores on hands and feet which look like little blisters when they start (a newer strain is causing sores to extend up legs and sometimes onto buttocks)
  4. Fever
  5. Generally feeling crummy (called malaise)
  6. Headache
  7. Joint pains
  8. Muscle aches

How Coxsackievirus is passed?

The virus is very easily spread from person to person. Essentially everything in the infected person is swimming with virus (the snot, spit, fluid in blisters, and feces). Contact with any of the infected fluids (breathing in someone’s cough, touching an infected surface and then touching your face, etc.) will spread it. The infected person is most contagious (there are more viral particles being replicated) early on in the illness. The bug typically lasts a week.

Who gets Coxsackievirus?

Generally, hand, foot, and mouth disease is considered a disease of the very young (think early school-aged kids and younger). While it can happen at any age, it usually happens in toddler and preschool-aged kids. Adults don’t usually get it because they had it when they were younger and the body has created protective antibodies. With that said, I’ve had plenty of patients who have had it more than once though. It’s unclear if that is because the body didn’t mount a lasting response, the virus has mutated, or it’s a different strain altogether.

Coxsackievirus Treatment

Unfortunately, there isn’t a cure. Because it is a virus, an antibiotic won’t do any good (it can actually make things worse due to antibiotic resistance). There isn’t a vaccine. Treatment is all supportive. The treatment is to manage pain (sometimes docs will prescribe oral rinses/mouth washes or numbing suckers) and keep the patient hydrated. As for over-the-counter pain management, I think ibuprofen (Motrin) works better than acetaminophen (Tylenol) for this particular bug because there is an anti-inflammatory effect with the ibuprofen which can really help the inflamed throat.

Coxsackievirus Complications

While there can be serious complications like meningitis and myocarditis (a heart problem), the virus is usually self-limited and resolves on its own without complications. If a child ends up in the hospital or ER, it is usually because the child wouldn’t drink due to the severe sore throat and consequently ended up getting dehydrated. So watch to make sure your child is getting enough to drink and is still peeing.

Hopefully, you can manage to escape this particular bug. But if you don’t, you now know what to look for and how to manage it (and could potentially save yourself a trip to the doctor).