Hand foot and mouth disease

hand, foot, and mouth disease A common viral disease of toddlers that produces blistering of palms, soles, and the inside or the mouth. The condition often sweeps through day-care centers in the summer. There is no connection to the cattle disease known as hoof-and-mouth disease.

The child is infectious wherever the rash or sores appear; the virus will be present in stool and digestive tract for several weeks. Infected children do not need to be isolated, however, because most adults are immune and the illness is not severe. Many children are infected but do not exhibit symptoms; they develop immunity without illness.

Cause

The disease is caused by the coxsackievirus and is spread by contact with nose and mouth secretions. While infection bestows immunity for life, it is possible to get this disease a second time from a different type of coxsackievirus.

Symptoms

Symptoms usually appear within four to six days after infection. The mild illness usually lasts only a few days and includes ulcers inside the cheeks, on gums, or tongue, together with a fever, achiness, sore throat, headache, and poor appetite. Two days later, a rash on palms, fingers, soles, and diaper area appear; this is the signal that the virus is abating.

Diagnosis

Tests are unnecessary to diagnose this condition, but if the child is very ill, samples can be taken for culture from the lesions or stool.

Treatment

There is no treatment other than painkillers to relieve blister discomfort, although Benadryl solution may help. Acetaminophen is given for fevers above 101°F or for headaches. Small sips of soothing foods and fluids will ease mouth sores, with the use of frozen or diluted juice, lukewarm broth, soft noodles, or gelatin desserts.

Complications

Complications are extremely rare.

Prevention

Hand-washing is the only way to prevent this disease. This is especially important in a day care or nursery school. Family members can be protected by washing the towels, washcloths, and bedding used by a sick child.

hantavirus pulmonary syndrome A respiratory illness caused by a new strain of hantavirus (a group of viruses carried by rodents) that causes its victims to gasp for air as their lungs fill with fluid. It kills about half the people it infects, usually within a week. Hantaviruses can be found throughout the world, where more than 170 names have been given to the hantavirus infections, including the often-fatal hemorrhagic fever. The syndrome was first diagnosed in the United States in 1993 at a Navajo reservation in the Four Corners area of New Mexico, Colorado, Utah, and Arizona.

Until 1993, hantaviruses around the world had been linked to the development of hemorrhagic fever, but the strain that was discovered in Four Corners provoked a new disease, with debilitating flu-like symptoms and respiratory failure. Today the number of infections with the hantavirus in the United States is rising, reaching 131; almost half have been fatal, according to the Centers for Disease Control and Prevention. More than 50 of the 131 cases occurred before the Navajo reservation outbreak. Since the Navajo outbreak, more than 100 cases of hantavirus pulmonary syndrome have been reported in 21 states (including New York). In addition, seven cases have been diagnosed in Canada and four in Brazil.

Cause

The hantaviruses are a group of viruses carried by rodents responsible for a variety of diseases including hantavirus pulmonary syndrome and hemor-rhagic fever. They are not passed directly from human to human. The severity of the illness it causes depends on the strain.

Each hantavirus infects primarily one type of rodent. The Hantaan, Seoul, Puumala, Prospect Hill, and Porogia strains are five viruses within the Han-tavirus genus, the newly added fifth genus within the Bunyaviridae family. The Hantaan virus was isolated in a Korean lab in 1976 from the lungs of a striped field mouse. The Seoul virus infects domestic rats, and the Puumala virus affects the bank vole. Deer mice carry the U.S. strains.

Hantavirus pulmonary syndrome (HPS) is caused by a hantavirus named Muerto Canyon (Valley of Death) virus for the spot in New Mexico where it was isolated. The disease can be spread by several common rodent species (deer mice, white-footed mice, and cotton rats) and has been found in 24 states; it is most common in New Mexico, which has had 28 cases; in Arizona, with 21 cases, and in California, with 13 cases. Hantaviruses are not passed directly from human to human.

Scientists believe the outbreak was triggered by climate irregularities associated with the most recent El Niño (the occasional warming of waters in the tropical Pacific). While it is believed that the mice who carry the virus probably were infected for years, the climate-induced explosion in the deer mouse population may have fueled the spread of the disease in humans.

People can become infected with the virus after being bitten by rodents, and many people who have developed the disease live in mice-infested homes. Researchers do not know why some people are susceptible to the infection while others are not. The hantavirus does not appear to be highly infectious, and it almost always occurs in isolated cases. There were only four instances in which more than one case occurred at the same time and place.

Symptoms

Hantavirus pulmonary syndrome begins as a flulike illness with fever and chills, muscle aches, and cough; it can be easily misdiagnosed as hepatitis or an inflamed pancreas. The virus goes on to damage the kidneys and lungs, causing an accumulation of fluid that can overwhelm the lungs. The disease is fatal in 40 percent of cases.

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