Recurring hand foot mouth disease in a child


Hand Foot Mouth Disease (HFMD) is a viral infection of children caused by Coxsackie virus A-16, a type of enterovirus. Individual cases and outbreaks of HFMD occur worldwide. There are reports of HFMD epidemics from India. Recurrence of HFMD is very rare. We report here, a sporadic case of recurrent HFMD.

Keywords: Hand foot mouth disease, recurrent, children

How to cite this article:
Dias E, Dias M. Recurring hand foot mouth disease in a child. Ann Trop Med Public Health 2012;5:40-1
How to cite this URL:
Dias E, Dias M. Recurring hand foot mouth disease in a child. Ann Trop Med Public Health [serial online] 2012 [cited 2020 Aug 15];5:40-1. Available from:

Hand Foot Mouth Disease (HFMD) is a common viral disease of infants and children below 10 years of age. Older children and adults are occasionally affected, but tend to develop milder form of illness compared to younger children. Coxsackie virus A16 is the most common cause, although many other enteroviruses are also associated with HFMD including Coxsackie’s virus A4, A5, A6, A7, A9, A10, A24, B2 to B5 and echo virus 18. Another prominent cause of HFMD is enterovirus 71, which has caused large outbreaks in Australia, US. [1] Recurrence of HFMD is very rare. We report here a case of HFMD recurrence in 9-year-old child. It is reported here for its rarity.

Case Report

A 9-year-old child presented with history of fever, cold and oral ulcers on the lips and buccal mucosa with papulo-vesicular lesions over the hand, feet both dorsal, palmer, planter surface, buttocks and trunk. Child also complained of difficulty in swallowing which improved in 3 days. The diagnosis of HFMD was made on clinical grounds because of the pathognomic clinical presentation. The child was treated symptomatically with antipyretics, antihistamines and calamine lotion. It was a mild illness. The lesions healed completely without any complications in 7-8 days. Patient gave a history of similar episode of high grade fever, ulcer, and vesicular rash over the mouth, hand, feet with difficulty in swallowing which lasted for 10 days. It was more severe compared to the present episode.


HFMD is a viral disease which should be differentiated from apthous ulcers, Varicella, Herpangina. Since 1997, outbreaks of HFMD caused by enterovirus 71 have been reported in Asia particularly from Malaysia, [2] Singapore [3] and Taiwan. [4] In India Sasidharan et al., reported HFMD epidemic caused by EV 71 from Calicut for the first time in 2003. [5] Later epidemics have been reported from Nagpur, [6] West Bengal [7] and Assam. [8]

Infection is spread by direct contact with the virus. Virus is shed in nose, throat secretions, saliva, blister fluid and stool of infected person. The virus can remain in the body for weeks even after the patient has recovered completely. Infection results in immunity to the specific virus that caused HFMD. But recurrence of HFMD is not known in normal immunocompetent children. There is one case report of HFMD recurring during common variable deficiency. [9] Our case would be the first case of a recurrent HFMD from India A second case of HFMD may occur following infection with a different member of the entero virus group. [10]

Increasing number of case warrants for awareness among pediatricians and dermatologists. Quick detection and treatment is required to prevent cardiopulmonary and neurological complications and prevention of virus transmission to others to avert epidemics. Closure of schools or staying away from schools may not of much help as virus is excreted in feces for several weeks but may help to bring down the harshness of epidemics.

1. Modlin JF. Coxsackieviruses, Echoviruses and newer enteroviruses. In: Mandell GL, Bennett JE, Dolin R, editors. Principles and Practice of Infectious diseases. 6 th ed, vol. 2. Philadelphia: Elsevier; 2005. p. 2148-61.
2. Chan YF, Abu Bakar S. Recombinant human enterovirus 71 in hand foot and mouth disease patients. Emerg Infect Dis 2004;10:1468-70.
3. Chang LY, King CC, Hsu KH, Ning HC, Tsao KC, Li CC, et al. Risk factors of enterovirus 71 infection and associated hand foot and mouth disease/ herpangina in children during epidemic in Taiwan. Pediatrics 2002;109:e88.
4. Shah VA, Chong CY, Chan KP, Ng W, Ling AF. Clinical characterstic of an outbreak of hand foot and mouth disease in Singapore. Ann Acad Med Singapore 2003;32:381-7.
5. Sasidharan CK, Sugathan P, Agarwal R, Khare S, Lal S, Jayaram Paniker CK. Hand-foot-and-mouth disease in Calicut. Indian J Pediatr 2005;72:17-21.
6. Saoji VA. Hand, foot and mouth disease in Nagpur. Indian J Dermatol Venereol Leprol 2008;74:133-5.
7. Sarma N, Sarkar A, Mukherjee A, Ghosh A, Dhar S, Malakar R. Epidemic of hand, foot and mouth disease in West Bengal, India in August, 2007: A multicentric study. Indian J Dermatol 2009;54:26-30.
8. Arora S, Arora G, Tewari V. Hand foot and mouth disease: Emerging epidemics. Indian J Dermatol Venereol Leprol 2008;74:503-5.
9. Le Cleach L, Benchikhi H, Liedman D, Boumsel L, Wolkenstein P, Revuz J. Hand-foot-mouth syndrome recurring during common variable deficiency. Ann Dermatol Venereol 1999;126:251-3.
10. CDC Hand foot mouth disease. Available from: [Last accesed on 2010 Oct 14].

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.92879

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