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    手足口病

    手足口病 

    1. 定義: 輕微傳染病, 發生紅斑及小水泡於手腳及口腔黏膜為特徵, 約一週痊癒.
    2. 發生率: 發生於6-10月之間多, 多於小兒, 年齡多小於10歲. (幼兒或幼稚園小兒)
    3. 病因: 病毒感染 (病原: coxsackievirus A16/ enterovirus 71), 潛伏期5-10天
    4. 症狀: 輕度發熱 (約38度)a 喉嚨口腔疼痛 2-3天退燒. 小紅斑出現後快速演變為小水泡 (1-3mm), 出現於軟顎, 頰粘膜, 齒齦及舌頭, 易破成淺潰瘍
    5. 鑑別診斷:
    a. Herpangina 泡疹咽峽炎
    b. Herpes simplex 單純泡疹
    c. Coxsackie A-9 or Echovirus 11 infection
    d. small pox 天花
    1. 治療及預後: 自限性疾病, 多可於一週左右自行痊癒. 嚴重者須住院接受支持療法

    HAND-FOOT-AND-MOUTH DISEASE
    Introduction
    a. pathogen: enterovirus (picornavirus groug)
    b. Clinical: characteristic vesicular lesions in the mouth and on the extremities.
    Epidemiology
    a. epidemic outbreaks: every 3 years.
    b. Association: coxsackievirus A16/ enterovirus 71
    c. Spread: person to person (oral-oral, fecal-oral)
    d. Age of onset: <10y/o.
    Etiology and pathogenesis
    a. viral implantation in the buccal mucosa, ileum--> 24h later --> regional LN
    b. incubation period: 3-6 days --> viremia a
    c. seeding of viruses to target organ: oral mucosa, skin of the hands/ feet.
    d. 7th day: antibody appear --> virus disappear.
    Clinical appearances
    a. prodrome: (<1day) fever, malaise, abdominal pain.
    b. Ulcerative oral lesions: most common.
    ‧ Presenting sign: 80%. Number: 5-10.
    ‧ Site: hard palate, tongue, buccal mucosa, lips
    ‧ Reddish macule/ papule --> vesicles --> shallow erosion with erythematous halo.
    ‧ Painful, interfere with eating.
    ‧ Disease severity: correlated with oral ulcer.
    a. skin
    ‧ appear: with/ after the oral lesion
    ‧ site: dorsal surfaces/ sides of fingers, hands, toes, feet. Palm, sole: may.
    ‧ Erythematous macule/ papule, 2-10mm, with gray, round vesicles. Red halo.
    ‧ Arrangement: in o r parallel to the skin lines.
    Patho: (7-10 days: resolution)
    a. intraepidermal vesicle:
    ‧ PMN, monocytes, eosinophilic material
    ‧ Ballooning degeneration, reticular degeneration: may (+)
    a. dermis: edematous, with PMN, L infiltrate.
    b. Intracytoplasmic particles in crystalline array: coxsackievirus : EM
    Lab:
    a. Clinical: ulcerative oral lesions, exanthem on the hands/ feet, mild fever.
    b. WBC: 4000 - 16000/mm3
    c. Virus-specific IgM: ELISA
    d. Cell culture (+) . PCR.
    Treatment: symptomatic relief of painful lesions.

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