Clinico-etiological Profiles and Immediate Outcome of Hand-Foot-and-Mouth Disease attending in a Tertiary Care Hospital.

Hand, foot and mouth disease (HFMD) is a common viral disease caused by a group of enteroviruses within the Picornaviridae family, specifically Coxsackie A16 (Cox A16) and Enterovirus 71 (EV71). Symptoms of HFMD include fever, mouth ulcers and skin rash. It is usually mild and self-limiting but some people may have a serious illness that requires hospitalization due to neurological complications and severe organ impairment, which can result in long-term morbidity and mortality. In rare cases, it can even lead to death. There is no specific treatment for severe cases of HFMD. Objective of the study was to evaluate the Clinico-etiological features and immediate outcome of HFMD. This cross-sectional observational study was conducted at the Outpatient department of Paediatrics and department of Dermatology and Venereology, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh. The sample included 87 children with clinically diagnosed HFMD aged between 1 month and 12 years. Written parental consent was obtained after primary selection and a detailed medical history and physical examination were performed on each participant. All information collected was recorded in a semi-structured questionnaire and the data was analyzed with SPSS version 22.0. The chi-square test was used as a statistical test and a p-value 0.05 was considered significant. The 87 HFMD patients had a Mean age 2.40±2.0 years, with 69.0% male and 31.0% female. The male to female ratio was 2.2:1. Most patients were from urban areas, followed by 2.3% from rural areas. 92.0% of the children were from middle-income families. According to the clinical information, 100% of patients had fever, rash and oral ulcers. High grade fever (≥101.30°F) had in 66.7% and low grade fever (<101.30°F) had in 33.3%. Rash was noted in 100.0% of patients on the hand, 90.8% on the feet, 82.8% on the knee and 79.3% on the buttocks. The rash was painful in 74.7% of cases and itchy in 73.6% of cases. Painful oral ulcers occurred in 80.5% of cases and painless oral ulcers in 19.5% of cases. This study found that Coxsackie virus A6 (Cox A 6) was the most important etiologic agent in 87 clinically diagnosed HFMD patients. Of the 87 patients, 78(89.7%) were RT-PCR positive, including Cox A 6 [75(86.2%)], Cox A 16 [1 (1.1%)], other enterovirus 2[2nd (3.0%)] and only 9(10.3%) patients RT-PCR negative. The immediate outcome was fever resolved within 5 days in most patients (58.6%) and within 5-7 days in 23.0%. The rash resolved within 7 days in 68.8% of cases (completely resolved in 24.1% of cases, 24.1% resolved but hyper-pigmented areas, 14.9% hypo-pigmented areas and 5.7% had mild lesions). Oral ulcerations resolved within 5 to 7 days in 51.8% of cases, followed by 24.1% within 5 days. No complications were found in the examined patients. The prognosis was usually good.