A literature review and case report of hand, foot and mouth disease in an immunocompetent adult

Abstract

BackgroundTo report an uncommon case of hand, foot and mouth disease, (HFMD) in an immunocompetent adult; a highly infectious disease, characterized by the appearance of vesicles on the mouth, hands and feet, associated with coxsackieviruses and enteroviruses; including a literature review.Case reportA 23 year Caucasian male with no medical or surgical history, no allergies, was not taking any medication and smoked ten cigarettes a day, suffering from discomfort in the oral cavity; itching, burning and pain when swallowing associated with small erythematous lesions located on the hard palate, and small ulcers in tonsillar pillars and right buccal mucosa. Mild fever of 37.8 °C and general malaise. The patient reported he had had contact with a child diagnosed with HFMD. From his background and symptoms, the patient was diagnosed with HFMD. Following symptomatic treatment, the symptoms remitted in 7 days.MethodsA literature review in MEDLINE (PubMed). The inclusion criteria were for studies on humans over the last 5 years, using the keywords HFMD.ResultsWe found 925 articles, which were subsequently reduced to 52 documents after applying the inclusion criteria. Maculopapular lesions were found on hands and feet.ConclusionsDentists may have a key role diagnosing the disease. A surveillance system to predict future outbreaks, encourage early diagnosis, put appropriate public health measures in place and research vaccine development is vitally important in order to control the disease.

Hand, foot and mouth disease as an emerging public health problem: Case report of familial child-to-adult transmission

“…10,11 Cases of immunocompetent adults suffering from HFMD have also been described by other authors. [10][11][12][13][14][15][16] Familial transmission between the child and an adult, similar to the situation observed in our case, was presented in 3 case series by Kaminska et al 12 Viral transmission occurred faster between the infected pediatric patient and an adult than between 2 adults. Intra-familial transmission between a small child and immunocompetent adults was also the subject of case reports by Omaña-Cepeda et al and Tai et al 13,14 An unusual location of erythematous crusted macules on the scalp, which accompanied a typical spectrum of clinical symptoms in a generally healthy adult, was presented by Andreoni and Colton.…”

Erythema multiforme‐like hand, foot, and mouth disease in an immunocompetent adult: a case report

“…However, a considerable number of adult patients do not manifest mucosal lesions . Classical cutaneous lesions consist of asymptomatic 3–7 mm papulovesicles over the palms and soles, less commonly on the lateral and dorsal aspect of the fingers, the periungual and perioral areas, and occasionally on the distal extremities, knees, and buttocks . Our patient showed a generalized distribution with involvement of the trunk and proximal extremities.…”

“…Recently, there has been an increasing number of reported adult‐onset HFMD . It is estimated that around 11% of exposed adults get infected and less than 1% manifest the disease, possibly relating to childhood enterovirus exposure leading to cross‐immunity and immunologic memory …”

Hand, Foot and Mouth Disease Case Reports of Familial Child to Immunocompetent Adult Transmission

“…Viremia occurs after 72 hours, followed by secondary infection and viral seeding in areas such as the oral mucosa, hands and feet. 4 . Pain may be treated with standard doses of acetaminophen or ibuprofen.…”

“…Most of these patients have low levels of vitamin A, associated with reduced immunity and they are therefore more susceptible to a more severe manifestation of the disease. Delays in access to health services lead to an increased likelihood of a more severe form of the disease 4 .…”