hand, foot and mouth disease
Introduction
Introduction to Hand, Foot and Mouth Disease Hand, foot and mouth disease is mainly caused by enterovirus, which is easily obtained under 4 years old. There is an onset at the turn of the summer and autumn, and the peak is in September. The typical onset process is moderate heat fever (body temperature below 39 °C), and then sore throat. Children show drooling, refusal to eat, and some small blisters in the scorpion. Children with no complications can heal in a week or so. A small number of children have neurological symptoms, as well as aseptic meningitis and secondary skin infections, with few sequelae. basic knowledge Sickness ratio: 0.1% Susceptible people: children Mode of infection: respiratory tract spread digestive tract spread contact spread Complications: meningitis headache myocarditis
Cause
Causes of hand, foot and mouth disease
Virus (25%):
There are several kinds of viruses that can cause hand, foot and mouth disease. The most common type is coxsackievirus A16. In addition, other strains of coxsackievirus A or enterovirus 71 can also cause hand, foot and mouth disease. Coxsackie virus is enterovirus. In one type, enteroviruses include poliovirus, coxsackie virus and echovirus, which are infected throughout the digestive tract including the oral cavity, and enter the body through contaminated food, beverages, fruits, etc. Proliferate in the intestines.
Immunity (20%):
Hand, foot and mouth disease mainly occurs in children under 4 years old, but adults may also get sick. Therefore, it can be said that everyone is susceptible. After infection, only the immunity of this type of virus is obtained, and there is no crossover for other types of viruses. Immunization, that is, after suffering from hand, foot and mouth disease, may also suffer from hand, foot and mouth disease due to infection with other types of viruses.
Foot and mouth disease virus (25%):
It belongs to the family of picornaviruses, now known as aphoviruses, which are spherical particles with a diameter of 22-30 nm and 7 different serotypes: A, O, C, SATI, SATZ, SAT3 and Asia-1. Type, there are at least 63 subtypes, the type distribution of each epidemic area is different, there is no cross-immunization between the various types, almost all of them are isolated from human O type, occasionally C type, the source of infection is suffering from foot-and-mouth disease. Animals, blood of diseased animals, skin mucosal secretions, saliva, urine dung, and milk all carry viruses, mostly by direct contact with diseased animals or milking, the virus enters the human body through tiny skin wounds, even through Consumption of infected milk, cheese, butter or other dairy products is infected, and even the meat and bones of sick cows can be infected, and it is difficult for people to infect each other.
Prevention
Hand, foot and mouth disease prevention
Hand, foot and mouth disease prevention measures:
1. Do a good job in reporting the epidemic, discover the patient in time, and take preventive measures to prevent the spread of the disease.
2, do a morning check, find suspected patients, and timely isolation treatment.
3, the contaminated daily necessities, utensils, etc. should be disinfected, children's feces and other excretions can be soaked with 3% bleaching powder clarification solution, clothing, bedding, toys, towels, etc. should be exposed to the sun, keep indoor ventilation gas.
4. When infectious diseases are prevalent, environmental sanitation, food hygiene and personal hygiene should be done well. Wash hands before and after meals to prevent illness from entering the mouth.
5, parents should take fewer children to crowded public places, reduce the chance of being infected, but also pay attention to the nutrition and rest of young children, avoid sun exposure, prevent excessive fatigue and reduce the body's resistance.
6, Chinese medicine has a cooling and detoxification effect, such as: Banlangen, Daqingye, honeysuckle, Guanzhong, etc. have a certain effect, can be used in water decoction. Honeysuckle, Yinchen, raw coix seed, Daqingye (ie, the leaves of Radix isatidis), licorice, etc. can be put into the water, poured out 20 minutes after boiling, when the tea is consumed, it can be used for three or five days, but it is physically weak and easy to diarrhea. Children don't drink. For children with herpes zoster in the mouth, who have ulcers and bad breath, in addition to the above-mentioned prescriptions, they can also be used for scented flowers, musk, raw gypsum, windproof, and light bamboo leaves to drink, which can clear the heart fire, and can also be used for children with loss of appetite. Add malt to the scented flower to appetize. If the child has herpes in the hands and feet, the external washing method can be used, boiled with wild chrysanthemum, comfrey, Kochia scoparia, Sophora flavescens, etc., and the hands and feet are soaked when cooled to a moderate temperature to play the role of heat, dampness and cooling blood.
1. Personal precautions
(1) During the epidemic period, children should not be taken to public places where people gather and have poor air circulation. Pay attention to keeping the family environment clean, and the room should be ventilated frequently and diligently dressed;
(2) Children should see a doctor in time for relevant symptoms. Children who are treated at home should not be exposed to other children. Parents should promptly dry or disinfect the children's clothing, and disinfect the stools in time. Children with mild illness do not need to be hospitalized. They should be treated at home and rest to reduce cross infection. ;
(3) Wash hands before changing children's diapers and handling feces before touching children, and properly dispose of the dirt;
(4) Bottles and nipples used by infants and young children should be thoroughly cleaned before and after use;
(5) Wash hands before and after meals with soap or hand soap, and do not let children drink raw water, eat cold food, and avoid contact with sick children.
2. Preventive measures for institutions such as kindergartens and primary schools
(1) In the popular season, places such as classrooms and dormitories should be well ventilated;
(2) Cleaning and disinfecting toys, personal hygiene appliances, tableware and other items daily;
(3) Workers should wear gloves when cleaning or disinfecting (especially cleaning the toilet). Wash hands immediately after cleaning;
(4) Essentials for disinfection: iodine, sterile cotton balls, etc.
3. Chinese medicine prevention prescription
(1) Honeysuckle 6g, Daqingye 6g, Mianyin Chen 15g, raw coix seed 10g, raw licorice 3g. Shuijianbi, taken twice a day for 5-7 days. The prescription has the functions of clearing away heat and detoxifying, strengthening spleen and dampness, and is suitable for prevention of susceptible populations. The above is 3 to 6 years old dose, infants and young children within 3 years old can be reduced, and those who are over 6 years old can take more. But children who are physically weak and easy to diarrhea should not drink.
(2) For children with herpes zoster, ulcers, and bad breath in the mouth, in addition to the above formula, you can also use hydrangea, musk, raw gypsum, windproof, and light bamboo leaves to drink, which can clear your heart. For children with loss of appetite, you can also add malt to the scent of the heart to appetize.
(3) If the child has herpes in the hands and feet, use the external washing method, boil with wild chrysanthemum, comfrey, Kochia scoparia, Sophora flavescens, etc., soak the hands and feet when cooling to moderate temperature to play the heat, dampness and cool blood. The role.
Complication
Hand, foot and mouth disease complications Complications meningitis headache myocarditis
Usually not serious, almost all patients can recover without treatment, hand, foot and mouth disease usually healed within 7-10 days, complications are not common, very few patients can be complicated by aseptic or viral meningitis, the symptoms are fever, headache Straight or back pain, other common complications are: myocarditis, encephalitis or meningitis, pneumonia, pulmonary edema, polio-like limb paralysis, allergic purpura, etc., occur more than 2 to 5 days after onset, such as Failure to treat in time may be fatal and the mortality rate is extremely low, only one in 100,000 or tens of thousands.
Symptom
Hand, Foot and Mouth Disease Symptoms Common symptoms Porphyra rash Abdominal pain Mouth redness Erosion blister Blisters Flowing low heat sore throat Anorexia
The incubation period is 3 to 5 days. There are hypothermia, general malaise, abdominal pain and other prodromal symptoms. In 1 to 2 days, the oral cavity, pharynx, soft palate, buccal mucosa, tongue, and gums appear painful miliary to mung bean-sized blisters, surrounded by redness and rupture. Small ulcers, due to pain, often drooling and refusal to eat, and rashes in the hands and feet, in the back side of the hands and feet and the back side of the fingers (toes), around the nails, the palmar stalks, an indefinite number of blisters, in addition to the hands and feet, but also Found in the buttocks and anus, can be seen in the trunk and limbs, dried up after a few days, subsided, rash no itching, no pain, individual children may have generalized papules, blisters, accompanied by aseptic meningitis, encephalitis, myocarditis Etc., generally good, the whole course of disease is about 5 to 10 days, most of them can heal themselves, and the prognosis is good.
When hand, foot and mouth disease occurs, the sick child often starts with fever, and the heat is not the same. There are also those who do not get hot, but most of them are about half of the people with low fever, and often accompanied by salivation, salivation, mouth pain, sore throat and anorexia. Symptoms, clinically characterized by oral cavity, hand and foot herpes, oral herpes found in the tongue, buccal mucosa, hard palate, lips, pharynx and tonsils, about 3mm in size, and quickly ulcerated to form ulcers, rashes are more common in the distal ends of the hands and feet, between the fingers, The heel edge and nail week, palm and ankle are also common, the lower limbs and buttocks can be densely distributed papule-like rash, starting from a maculopapular rash, then converted into herpes, round or oval, about 3 ~ 7mm such as rice Size, smaller than chickenpox rash, hard texture, surrounded by redness, only a few of the number of herpes, dozens of more, the general course of disease is lighter and shorter, more than 1 week to heal, no scar after the rash subsided Or hyperpigmentation, if there is a secondary infection, the skin damage is often aggravated.
Hand, foot and mouth disease can be seen all year round, more in summer and autumn, early onset of fever, cough, runny nose and drooling like upper respiratory tract infection, some children may have nausea, vomiting and other symptoms, after the hand, There are oval or fusiform blisters on the back of the foot and the back of the toe. The blister is surrounded by red blush. The liquid of the blister is clear. The long axis of the blisters is consistent with the dermatoglyphic, and then the center of the blister is sunken, yellowed, dried, and taken off. (desquamation), in addition, there are scattered hard red papules or herpes on the toes, and there are scattered blisters in the mouth, such as lips, tongue, oral mucosa, and gums, but the blister in the mouth is very fast. Broken to form a grayish white dot or a grayish white film with a blush around it. Under the gray-white film, a spotted or flaky erosion surface can be seen. The hand, foot and mouth disease is caused by a viral infection. The source of infection is Herpes liquid, throat secretions, fecal contamination of hands, toys, utensils, etc., its incubation period is 3-8 days.
Examine
Hand, foot and mouth disease check
Check for rashes and ulcers to identify hand, foot and mouth disease and other causes of oral ulcers. Throat swabs or stool specimens can be sent to the laboratory for virus detection, but virus detection takes 2-4 weeks to produce results.
1. Blood picture The total number of white blood cells and neutrophils are mostly normal.
2. Virus isolation Take the patient's blister fluid, saliva, etc. aseptically and inoculate them separately:
1 guinea pig foot skin, 4 to 5 days after the occurrence of blisters between the toes;
2 death in the mouse brain and its suckling mice;
3 pig kidney, calf kidney cell culture in the presence of cytopathic lesions, it can be considered that the foot-and-mouth disease virus is isolated, can be further identified with specific sera.
3. Serological test The combination of complement test is the most sensitive, and positive results can be obtained 10 to 20 days after onset.
Diagnosis
Diagnosis and differential diagnosis of hand, foot and mouth disease
diagnosis
According to epidemiological characteristics, the herpes, throat, swab, blood and blister are isolated and cultured to produce COX A19 virus.
Differential diagnosis
Hand, foot and mouth disease should be differentiated from foot and mouth disease .
First, the pathogen is different, the pathogen of foot-and-mouth disease is foot-and-mouth disease virus, which belongs to the zoonotic pathogen. Hand, foot and mouth disease is caused by several enterovirus infections.
Second, the source of infection is different. Foot-and-mouth disease virus only causes hoofed hoofs (two halves of hooves). Animals such as cattle, sheep, pigs, deer, camels, etc. have become the source of infection of foot-and-mouth disease. Only when animal disease first occurs, it is possible to cause illness. Disease, the source of infection of hand, foot and mouth disease is the person carrying the virus in the patient and the intestine, belonging to human diseases.
Third, the transmission route is different, foot-and-mouth disease is infected by the oral cavity of the sick animal, the ulcer plaque of the hoof crown, infected by the skin and mucous membranes; occasionally, it is infected with the milk infected by the virus and not heated (pasteurized), so People suffering from foot-and-mouth disease are extremely scattered. Hand, foot and mouth disease is caused by contact with patients. It is infected by daily necessities, utensils and toys. It can also be transmitted through the respiratory tract. Therefore, there may be epidemics of different scales.
Fourth, the incidence of different populations, people suffering from foot-and-mouth disease is determined by contact with sick animals, the age of the affected population is wide, but because of the low susceptibility, the incidence of the disease is very small, children and the elderly once the disease is more serious, hand, foot and mouth disease mainly It is a child infectious disease. The majority of children under the age of 3 are unclear. They rarely exceed 5 years old. In 1983, hand-foot-mouth disease was popular in Tianjin. The incidence rate of children under 3 years old was 32.85, and that of 3~6 years old was 14.23. Hey, it is 1.27 for 7~14 years old, 0.05 for 15 years old and above, and it is often popular in kindergartens.
V. Symptoms are different in body parts, foot-and-mouth disease, hand-foot-mouth disease. Although the diseased parts are in the mouth, between the fingers and the toes, there are similarities, but the symptoms and signs are different.
After the onset of foot-and-mouth disease, it is mainly characterized by systemic poisoning symptoms and local herpes damage. It has fever, headache, and general malaise. After 1~2 days, blistering occurs in the oral mucosa, tongue, fingers, and toe, and then 1~2 Tianshui bubble rupture, forming a plaque, secondary infection into pustules, then scarring, shedding, generally no scar, the course of disease 1 ~ `2 weeks, most of the prognosis is good, severe cases can be complicated by myocarditis, hand, foot and mouth disease mostly without fever Or low fever, but with symptoms of respiratory infection, first appeared in the oral mucus, herpes, distribution and buccal mucosa, gums, tongue, and ulceration, and then pimples on the fingers, feet, buttocks, knees, the next day Only a small part of the papules form herpes, such as mung bean, red bean, large single body does not fuse, contains transparent liquid, and does not break, 3 to 5 days self-absorption and contraction, systemic symptoms are light, the course of disease is about one week, the prognosis is good.
6. According to different diagnosis methods, foot-and-mouth disease needs to have the occurrence or prevalence of foot-and-mouth disease of local livestock, and it has the opportunity to contact with sick animals, or the infection of unheated milk contaminated by sick animals. The incubation period is 2~18, a friend is 3~8 days common. The disease has two major characteristics: systemic poisoning symptoms and local herpes and ulcer damage.
Need to be differentiated from herpes angina, herpes simplex.
