Source: Manual of Ambulatory Pediatrics 2010
SOAP Note – Hand-Foot-and-Mouth Disease
HAND-FOOTAND-MOUTH DISEASE
A contagious viral disease characterized by fever and vesicular lesions of the mouth, palms of the hands, and soles of the feet.
I. Etiology: Coxsackievirus A, Enterovirus 17
II. Incidence
A. A highly infectious disease generally occurring among children in epidemic form. Occurs infrequently in adults.
B. Seen mainly in summer
C. Enteroviral infections with other manifestations may be prevalent in the community concurrently (herpangina, gastroenteritis).
D. Virus may be excreted for weeks after cessation of symptoms.
III. Incubation period: 3 to 6 days
IV. Communicability
A. Highly communicable
B. Spread by fecal–oral route and possibly by respiratory route
C. Virus can maintain activity for days at room temperature.
V. Subjective data
A. Abrupt onset of fever, around 101F
B. Sore throat; dysphagia
C. Anorexia
D. Occasionally headache and abdominal pain
E. A rash on the palms of the hands and the soles of the feet may or may not be noted by parents.
F. Convulsions may occur with onset of fever.
VI. Objective data
A. Elevated temperature
B. Hyperemia of anterior tonsillar pillars
C. Vesicles on an erythematous base on anterior tonsillar pillars, also on soft palate, tonsils, and uvula. Vesicles rapidly ulcerate, leaving shallow ulcers with red areolae.
D. Maculopapular rash and vesicles on palms of hands and soles of feet, as well as interdigital surfaces
VII. Assessment
A. Diagnosis: Classic case easily diagnosed by clinical picture
B. Differential diagnosis
1. Herpangina: Clinical picture similar, but no lesions on hands and feet
2. Gingivostomatitis (herpes simplex): Gingival and buccal mucosa involved; no lesions on hands and feet
VIII. Plan
A. Treatment is symptomatic.
B. Warm saline mouth rinses
C. Acetaminophen, 10 to 15 mg/kg every 4 hours or
D. Pedia Profen for elevated temperature and discomfort 5–10 mg/kg every 6–8 hours
E. Tepid baths for elevated temperature
F. Force fluids
1. Cold, bland liquids
2. Try Popsicles, Jell-O, sherbet
IX. Education
A. Call back if child will not take fluids or is vomiting.
B. Fever will last 1 to 4 days.
C. Do not overdress; keep child cool.
D. Be alert for dehydration (see Appendix H, p. 534)
E. Transmitted by direct contact with nose and throat secretions, stools, and blood of infected child
F. Keep child isolated until temperature is normal for 24 hours.
G. Highly contagious, at least during acute phase.
H. There is no prophylaxis.
I. Carbonated drinks; citrus juices; hot, spicy foods and the like should be avoided, because they may increase discomfort.
J. Do not be concerned about dietary intake during acute stage, but do force fluids.
K. Prognosis is excellent; disease is self-limited.
L. Immunity to infecting strain is generally conferred after one attack. However, it does not confer immunity to a different strain of coxsackie or enterovirus.
M. Lesions may persist for 1 week or more.
X. Follow-up
A. Maintain daily telephone contact with patient if temperature is markedly elevated.
B. Generally no follow-up visit is necessary.
XI. Consultation/referral
A. Signs of dehydration
B. Hand-foot-and-mouth disease in an infant
C. Prolonged course: No improvement within 5 to 6 days
D. Febrile convulsions