Oh Wow! It’s hand, foot and mouth disease (HFMD)

HFMD blisters

I went to see a doctor at NUS University Health Centre last Friday because of two problems: sore around oropharynx and growing number of blisters on palms of both hands. The blisters hurts a lot when I do experiments, for examples, when I’m turning the screw cap of a container or when I use my right thumb (see the photo on the right) to push a syringe (with a syringe filter for eliminating crushed polyacrylamide gel from a aqueous mixture) forcefully. The doctor checked the blisters first and asked if they were itchy. I said no and they were painful when pressed. Then, he told me the blisters were actually ulcers and what I had is likely to be hand, foot and mouth disease (HFMD), and he expected that there were a lot of ulcers around my pharynx too, which was confirmed by looking at it with a flashlight. He then asked if I had a fever. I did have a fever about two weeks ago. He said HFMD is very common, the symptoms would disappear slowly after the fever, and no medicine was specific for HFMD.

The diagnosis was completely out of my expectation. I was like “Wow! This is cool and new. It does explain the puzzles I have.” I thought I was having a cold and a fungal infection in my hands. I never thought the two symptoms were related. Before seeing the doctor, I applied miconazole (an antifungal drug) to treat the blisters on palms, but it did not seem to work, and the blisters grew more day by day. Now I know they are ulcers, and that is why they are painful when pressed.

I learned only the name of HFMD during an outbreak in Singapore among small children in recent years. According to a guide on HFMD prepared by WHO[ 1 ], there were 15 252 and 20 003 reported cases in Singapore in 2006 and 2007, respectively. “The age-specific annual incidence rate was highest in those aged 0–4 years, ranging from 1640.5 to 5975.5 per 100 000 population and accounting for 62.2% to 74.5% of reported cases.” It is so sad that so many children got HFMD and will get it in the future. I can’t imagine how hard and painful it is for them. I understand HFMD is moderately contagious, so I’m staying away from children and their parents. It would be ideal if vaccines could be developed for HFMD. Why have vaccines not been made for HFMD? I have no clue right now. I’ll pick up a virology course and dig in. Virology really interests me.

The Wikipedia article on HFMD is very clear and helpful. With the Signs and symptoms list (see below; indicates the symptoms I experienced), I am able to connect all the odd feelings in the past four weeks. The first sign I remember was a blister on the sole of my right foot. It hurt every step I walked. I don’t know if I had a fever before it because I did not take my temperature. The blister disappeared after about five days, and everything seemed normal again. But severals days later, I suddenly felt fatigue and a headache after watching Iron Man 3 in VivoCity on the evening of 1 May. I also had diarrhea that lasted for two days. This time I took my temperature and it reached as high as 38.5 °C. The fever lasted for three days. In addition, from 2 May, I started to have sore throat and referred ear pain (right ear), which went away after about 6 and 3 days, respectively. Then, the ulcers started to appear on palm of my hands around 7 May. A week later, I start to have sore throat (or pharynx) again, and finally I went to see the doctor on 17 May.

It is really fascinating to see a virus reproduce so many symptoms on different hosts (people). Another interesting questions is how do they cause the ulcers? I can’t find any article on this right now. If this is understood, a treatment may be developed for the ulcers even if the HFMD virus itself can’t be treated. That would be very nice because, in my opinion, the ulcers are the most troublesome symptom of HFMD.

  • Fever
  • Headache
  • Fatigue
  • Malaise
  • Referred ear pain
  • Sore throat
  • Painful oral, nasal, or facial lesions, ulcers or blisters
  • Loss of appetite
  • Diarrhea
  • Body rash, followed by sores with blisters on palms of hand, soles of feet, and sometimes on the lips. The rash is rarely itchy for children, but can be extremely itchy for adults
  • Sores or blisters may be present on the buttocks of small children and infants
  • Irritability in infants and toddlers

UPDATE: As of 12 June 2013, I had fully recovered from HFMD, which lasted for more than seven weeks, and the ulcers in my hands were the last to disappear. From Week 6 on, the hand ulcers were not painful any more, and became less and less.

References

  1. World Health Organization (2011) A guide to clinical management and public health response for hand, foot and mouth disease (HFMD). Geneva: WHO. Back to Paragraph

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