Disease Description (Causes and Symptoms)

Cause: Primarily infection with Coxsackie A group viruses (especially A16) and enterovirus 71 (EV‑A71), which belong to the enterovirus family, is responsible.
Pathophysiology: The virus is transmitted through respiratory secretions, blister fluid, feces, and other routes. It invades the oral and skin mucosa and superficial tissues, forming ulcers and blisters. Some EV‑A71 infections can cause central nervous system complications (meningitis, encephalitis) or acute neurological and respiratory complications.
Main symptoms: Fever, malaise, loss of appetite, painful ulcers in the mouth (soft palate, tongue, oral mucosa), and an erythematous vesicular rash on the hands and feet (and sometimes the buttocks). In children, pain can make feeding and eating difficult, increasing the risk of dehydration. The incubation period is usually about 4–6 days.

Treatment

General principle: Mostly symptomatic treatment (supportive care). No specific antiviral medication is recommended as standard treatment.
Medication:
- Antipyretics and analgesics: Acetaminophen (Tylenol); ibuprofen if necessary (as directed by a doctor). Aspirin is not recommended in children (risk of Reye syndrome).
- Antibiotics: Used only when a secondary bacterial infection is suspected.
Topical treatment and daily care:
- To relieve oral pain, cold and soft foods (such as ice cream and jelly) are recommended. If chewing or swallowing is difficult, provide small amounts frequently.
- Consult a doctor about whether oral topical analgesics can be used according to the child’s age.
- Provide sufficient fluids (to prevent dehydration). Oral rehydration solution (ORS) is recommended for mild dehydration.
Hospitalization criteria/emergency treatment:
- Immediate emergency-room evaluation or hospitalization is necessary in cases of dehydration due to inability to eat or drink (decreased urine output, persistent vomiting, lethargy, etc.), altered consciousness, seizures, difficulty breathing, severe high fever, or neurological symptoms (severe headache, vomiting, seizures, coma, etc.).
Preventive treatment:
- In some countries (e.g., China), vaccines against EV‑A71 have been commercialized, but they are not in universal use worldwide (check local and age-specific recommendations).

Precautions:
- To prevent dehydration, provide water and electrolyte drinks frequently in small amounts. If the person is unable to take in enough fluids, visit a medical institution.
- Seek medical attention immediately if abnormal symptoms such as high fever or seizures occur.
- Because the infection may be contagious, strictly follow infection-prevention measures such as handwashing, disinfection of frequently touched surfaces, and separate use of personal items.
Main complications:
- Although rare, EV‑A71 infection can cause meningitis, encephalitis, acute cerebellar syndrome, and acute cardiopulmonary failure (neurogenic pulmonary edema).
Self-care tips:
- Control fever and pain, ensure sufficient fluid intake, provide soft and cool foods, and monitor urine output and intake throughout the day.

Items to bring:
- A list of currently used medications (prescription, nonprescription, and nutritional supplements)
- A record of when symptoms began and how they progressed (when fever began, changes in food intake, urine output, whether vomiting occurred, etc.)
- Photos of the rash/oral lesions (helpful for a more accurate evaluation)
- Information about recent contacts (family members, daycare contacts, etc. showing the same symptoms)
- Vaccination records (if available)
Items to check before the visit:
- Urine output over 24 hours (compared with the usual baseline pattern)
- Food and fluid intake over the past 24 hours
- Highest temperature and whether there was a response to antipyretics
- Presence or absence of abnormal neurological or respiratory symptoms such as seizures, decreased consciousness, or difficulty breathing

What virus causes this disease? Are additional tests needed?
Does the child’s condition require hospitalization or additional testing?
What are the side effects of the prescribed medication? How should antipyretics be used?
How should we manage the condition at home when there is a risk of dehydration?
How long can it be transmitted to other children? And so on.

My child is not eating or drinking. Until when is oral intake considered sufficient, and when should hospitalization be considered? (For example, ask about specific criteria such as daily urine output and the duration of vomiting.)
If headache, dizziness, or altered consciousness appears in addition to fever and vomiting, what tests will be performed immediately? (Ask about testing and treatment if meningitis or encephalitis is suspected.)