hot & spotty…

the case.

A mother brings her 18 month old child to your emergency department with a 24 hour history of fevers. She is now worried that her daughter has developed these little red spots.

On examination, she is well appearing & happy but febrile to 38.6*C.
This rash is found on her hands (amongst other places)….

Spotty#1      Spotty#2

[DDET What’s the diagnosis ??]

Hand, Foot & Mouth disease.


[DDET Tell me more…]


  • Coxsackievirus (usu. A16)
    • ~ Enterovirus family…


  • Typically in children < 5  years.
    • Most commonly toddlers & infants.
  • Seasonal distribution (spring & summer months).
  • Spread via respiratory droplets & contact with blister-contents.
    • Viral shedding in faeces continues for several weeks post infection.

Clinical Presentation.

  • Prodrome of mild fever, sore throat & malaise.
    • May have mild URTI symptoms & reduced appetite.
    • Lasts 1-2 days, followed by emergence of rash.
  • Small 1-3mm macules progressing to 3-5mm gray vesicles w/ red border.
    • Sometimes ulcerate –> very painful.
    • Palmar lesions.
    • Tongue, palate, uvula & tonsillar pillars (even buttocks) may have lesions.
  • Poor oral intake is typical [mild dehydration only].
  • Healing occurs in 7-10 days.
  • Rarely complicated by viral meningitis.


[DDET How do we treat this ??]


  • No specific treatment/cure.
  • Parental reassurance.
  • Supportive care.
    • Analgesia.
    • Hydration.
    • Do not pierce blisters.

Enterovirus Update


[DDET What about the pregnant Auntie ??]

“Do we need to keep the kids away from her ?” Mum asks…

Risk to Pregnant Females.

  • No known risk to foetus or pregnant women.
  • A few document cases of newborn infection (from late 3rd trimester maternal infection)
    • Presents as early as 48 hours.
    • May be symptomatic.
    • Hepatitis, encephalitis & myocarditis in the newborn.


[DDET References.]

  1. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 7th Edition.
  2. www.rch.org.au


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