A 6 y.o. girl presents with fever and a sore throat.
On examining her throat you note lesions on the palate
She also complains that her foot is painful. It is pictured below.
What illness does she have?
Our patient has hand, foot and mouth disease (HFMD). It is a contagious illness usually in children under five years of age but can present at any age. It is primarily caused by enteroviruses, most commonly cocksackievirus A16.
Coxsackievirus A 16 was first identified by Gilbert Dalldorf in 1948 while he was searching for a cause for polio outbreaks. It was first found in stool from patients in Coxsackie, New York which gives the name to the virus. It is an RNA virus and part of the enterovirus family which also includes polio.
Cocksackie A causes herpangina, acute hemorrhagic conjunctivitis and hand,foot and mouth disease. Group B coxsackieviruses infect the heart , pancreas, pleura and liver leading to hepatitis and pericardial effusion.
THE COMMON CHILDHOOD RASHES
In the news lately is measles virus
1. Measles- due to lack of MMR vaccinations measles has occurred in all but nine states with only Alabama, Connecticut, Delaware, Maine, Massachusetts, Mississippi, Nevada, New Hampshire, and West Virginia not reporting cases as of July 29, 2025. Measles was first described by the Persian physician Muhammad ibn Zakariqa al-Razi in the 10th century. It is known for causing serious illness including encephalitis, seizures and deafness. Cough, conjunctivitis and coryza may accompany measles.
2. Scarlet fever- is a bacterial illness caused by Streptococcus.
3. Rubella- is more dangerous for pregnant women because it can cause congenital rubella syndrome.
4. Chickenpox- is caused by the varicella zoster virus. It can be serious in infants. The classic presentation is that of a “dew drop on a rose petal.”
5 Erythema infectiosum (fifth disease)- caused by parvo virus which is also called slapped cheek syndrome.
6. Roseola (sixth disease)-is a mild disease where the rash appears after the fever ends. As in measles the rash appears in 3-5 days but the fever does not subside in measles.
While there are many other diseases of childhood with an estimated 6-8 colds per year, no further diseases have joined the basic six.
Our patient had a fever for two days and then all her symptoms resolved
Ni Z, Xiang F, Huang H, et al. Isolation and genetic characterization of enterovirus in patients with febrile rash illness. Biomed Rep 2015 Mar 5;3(3).
Lawn J, Cousens S, Zupan J 4 million neonatal deaths: when? where? Why? Lancet 365:891-900.
Bhutta Z, Saseed M childhood infectious diseases: overview Internationa Encyclopedia of Public Health. 2008 aug 26:620-640.
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