Hand, Foot, and Mouth Disease (HFMD) is a common viral illness predominantly recognized in young children. While often associated with pediatric cases, adults can also contract HFMD. The experience in adults may differ from children, sometimes presenting with more pronounced symptoms. Understanding its progression in adults is important for accurate identification and management.
How the Virus Spreads
HFMD is primarily caused by enteroviruses, commonly Coxsackievirus A16, though strains like Coxsackievirus A6 and Enterovirus 71 (EV-A71) also cause illness. EV-A71 is linked to more severe disease and outbreaks in East and Southeast Asia. These highly contagious viruses spread through direct contact with an infected person’s respiratory secretions (saliva, nasal mucus, or droplets from coughing and sneezing), fluid from blisters, or feces. Adults often acquire HFMD from close contact with infected children in households or childcare settings. The virus can also survive on contaminated objects and surfaces, like doorknobs or toys, contributing to its spread.
First Signs in Adults
Initial HFMD symptoms in adults often mimic common viral infections, appearing three to six days after exposure. These can include mild to moderate fever, sore throat, general malaise, reduced appetite, headaches, muscle aches, or a runny nose.
Following these initial flu-like symptoms, characteristic HFMD lesions emerge. Painful sores, starting as small red spots and blistering, typically develop in the mouth on the tongue, gums, and inside the cheeks. A usually non-itchy rash then appears on the palms of the hands and soles of the feet. This rash consists of flat or slightly raised red spots, sometimes evolving into blisters, and can occasionally extend to the buttocks or genital area.
Why Adults Get It and Its Distinct Manifestations
Why Adults Contract HFMD
Adults can contract HFMD even if they had it as children because different viral strains exist; prior infection with one strain does not provide immunity against others. For instance, Coxsackievirus A6 is associated with more severe symptoms and is more likely to cause HFMD in adults. Additionally, as individuals age, their immune system changes, influencing their reaction to these viruses.
Distinct Manifestations in Adults
HFMD can manifest differently and often more severely in adults compared to children. Adults may experience more pronounced symptoms, including higher fever, significant discomfort, and a wider distribution of the rash, sometimes affecting the face, arms, legs, or trunk. Rare complications include nail shedding (onychomadesis), where nails separate from the nail bed several weeks after illness. Uncommon but severe neurological involvement, such as viral meningitis (inflammation of the tissue surrounding the brain), can also occur.
Minimizing Risk and Seeking Care
Preventing HFMD spread primarily involves good hygiene. Frequent handwashing with soap and water for at least 20 seconds is important, especially after changing diapers, using the toilet, and before eating. Avoiding close contact with infected individuals, such as hugging or sharing utensils, and regularly cleaning and disinfecting frequently touched surfaces and shared items can reduce the virus’s presence.
Adults should seek medical attention if their HFMD symptoms are severe, do not improve within 7 to 10 days, or if they experience signs of dehydration. Specific concerns include very high fever, stiff neck, severe headache, or any indication of neurological complications. Pregnant individuals who suspect HFMD should also contact their healthcare provider.