Coxsackievirus: Practical Recognition of Hand, Foot, and Mouth Disease Syndrome in Children
Abstract:
The hand-foot-and-mouth syndrome represents a significant clinical and epidemiological challenge in pediatric prac tice due to its high contagiousness, rapid spread in organized children's groups, and the absence of specific antiviral treatment. This study provides a comprehensive analysis of the clinical characteristics, diagnosis, and management of hand-foot-and-mouth syndrome in outpatient settings. The primary etiological agents of this disease are enterovi ruses, primarily Coxsackievirus A16 and Enterovirus 71, which demonstrate a strong affinity for epithelial tissues of the skin and mucous membranes. The article details the pathogenesis, where viral replication initially occurs in the mucosa of the oropharynx and gastrointestinal tract, followed by systemic dissemination through viremia. Clinically, the syndrome manifests with a triad of fever, painful enanthema in the oral cavity, and a characteristic vesicular or maculopapular rash on the palms, soles, and occasionally on the buttocks or genital area. The study encompassed two hundred fifty pediatric patients aged from six months to eighteen years, with eighty-four diagnosed cases of hand foot-and-mouth syndrome, constituting thirty-three point six percent of the total sample. The analysis highlights that the highest incidence was observed in children under five years old, particularly those attending childcare institutions. Diagnosis was primarily clinical, based on typical presentation, as laboratory confirmation was not always accessible or required. The study thoroughly describes differential diagnostic approaches, distinguishing hand-foot-and-mouth syndrome from other pediatric conditions such as herpetic stomatitis, varicella, scarlet fever, measles, and allergic der matitis. A clear set of clinical criteria for diagnosis is proposed, emphasizing the relevance of a syndromic approach in the absence of virological confirmation. The article reviews therapeutic tactics, including the use of antipyretics, oral antiseptics, local analgesics, and hydration therapy. In the overwhelming majority of cases, symptomatic treatment was effective, and the disease had a benign and self-limited course, with resolution typically occurring within seven days. No severe complications or hospitalizations were recorded. The study also addresses epidemiological aspects, describing several outbreaks in preschool institutions and underlining the role of early recognition and isolation of cases to prevent widespread transmission. Practical recommendations are provided for pediatricians and family doc tors, aimed at improving outpatient care and enhancing clinical vigilance. Furthermore, the article identifies gaps in current diagnostic and treatment protocols and calls for the development of standardized clinical guidelines tailored to resource-limited settings. The findings underscore the importance of medical education, parental awareness, and timely intervention as critical components of effective disease control. In conclusion, the research contributes to the optimization of diagnostic strategies, supports evidence-based symptomatic management, and reinforces the need for coordinated public health measures in the context of pediatric infectious diseases.
