# Hand, Foot and Mouth Disease and Enteroviruses

> Hand, foot and mouth disease and enteroviruses for NEET-PG Medicine, covering Coxsackievirus A16, enterovirus 71, herpangina and neurological complications.

- Canonical URL: https://prepelephant.com/topics/neet-pg/medicine/hand-foot-mouth-disease-and-enteroviruses
- Exam / course: NEET-PG · Subject: Medicine
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-14
- Last updated: 2026-10-14
- Reference basis: Nelson Textbook of Pediatrics; Harrison's Principles of Internal Medicine; Ananthanarayan and Paniker's Textbook of Microbiology
- How to cite: "Hand, Foot and Mouth Disease and Enteroviruses", PrepElephant, https://prepelephant.com/topics/neet-pg/medicine/hand-foot-mouth-disease-and-enteroviruses

## Direct answer

Hand, foot and mouth disease is a mild, self-limiting enteroviral infection of young children, most often caused by Coxsackievirus A16 and marked by vesicles on the palms, soles and in the mouth. Enterovirus 71 can cause the same picture but may progress to brainstem encephalitis, acute flaccid paralysis and cardiopulmonary failure. Diagnosis is usually clinical, and management is supportive because no specific antiviral is licensed.

## What you must remember

- **Causative agents:** enteroviruses, mainly Coxsackievirus A16 and enterovirus 71, spread by the faecal-oral and respiratory routes.
- **Typical lesions:** painful oral ulcers with vesicles on the palms, soles and buttocks, usually without itching.
- **Herpangina:** a Coxsackie A group infection with vesicles confined to the posterior oral cavity, sore throat and fever.
- **Enterovirus 71:** the most severe form, causing brainstem encephalitis, acute flaccid paralysis and neurogenic pulmonary oedema.
- **Aseptic meningitis:** a further complication, usually milder, with a lymphocytic cerebrospinal fluid pleocytosis.
- **Onychomadesis:** nail shedding several weeks after the illness, from temporary disruption of the nail matrix.
- **Diagnosis:** clinical in most cases; RT-PCR on vesicle fluid, throat swab or stool identifies the enterovirus type.
- **Management:** hydration and analgesia, with admission for children who show neurological or cardiopulmonary signs.

## Comparing the two main causative viruses

A 3-year-old child presents with fever, painful mouth ulcers and vesicles on the palms and soles during an outbreak in a playgroup. The main question is whether the child has the mild Coxsackievirus A16 pattern or the severe enterovirus 71 pattern, and the table sets out the difference.

| Feature | Coxsackievirus A16 | Enterovirus 71 |
|---|---|---|
| Usual severity | Mild, self-limiting | Can be severe and fatal |
| Neurological complications | Uncommon; mainly aseptic meningitis | Brainstem encephalitis, acute flaccid paralysis |
| Cardiopulmonary complications | Rare | Neurogenic pulmonary oedema, cardiopulmonary failure |

Fever that persists, myoclonus, limb weakness or breathlessness in a child with typical rash should prompt urgent review, because these signs signal the severe pattern.

Clinicians also watch for bulbar signs such as swallowing difficulty and voice change, which can precede respiratory failure. Outbreak control depends on hand hygiene, school exclusion while blisters are active and early recognition of warning signs, and infection control advice is much the same for all enteroviruses.

## Where the exam tries to catch you

Questions in this area usually test the distribution of lesions and the complications that distinguish enterovirus 71 from milder disease.

- **Trap:** hand, foot and mouth disease is always benign. — **Correct:** enterovirus 71 causes severe neurological and cardiopulmonary disease, which can be fatal.
- **Trap:** hand, foot and mouth disease is the same as foot-and-mouth disease of cattle. — **Correct:** the cattle disease is an aphthovirus infection of cloven-hoofed animals, unrelated to the human enteroviral illness.
- **Trap:** herpangina lesions appear on the palms and soles. — **Correct:** herpangina is confined to the posterior oral cavity, and palmar and plantar lesions point to hand, foot and mouth disease.
- **Trap:** nail shedding is an acute sign of infection. — **Correct:** onychomadesis appears weeks after the illness, once the nail matrix recovers.

## Frequently asked questions

### What is the difference between herpangina and hand, foot and mouth disease?

Herpangina is an enteroviral infection with vesicles and ulcers confined to the posterior oral cavity and palate, and it usually lacks skin lesions. Hand, foot and mouth disease also has vesicles on the palms, soles and buttocks, along with oral ulcers. Both are caused by enteroviruses, mainly Coxsackie A group viruses.

### Why is enterovirus 71 more dangerous than Coxsackievirus A16?

Enterovirus 71 causes more severe disease than Coxsackievirus A16, including brainstem encephalitis, acute flaccid paralysis and neurogenic pulmonary oedema. Coxsackievirus A16 usually produces a mild illness with few complications. Early recognition of neurological warning signs is therefore important in outbreaks.

### Why is acute flaccid paralysis surveillance relevant to enterovirus infection?

Acute flaccid paralysis surveillance is relevant because enterovirus 71 can cause a poliomyelitis-like paralysis. Surveillance under the polio eradication programme in India must distinguish enteroviral causes from poliovirus. Stool specimens are collected for virological testing to make this distinction.

### What causes nail shedding after hand, foot and mouth disease?

Nail shedding after hand, foot and mouth disease, called onychomadesis, results from temporary disruption of the nail matrix during the illness. It appears several weeks after recovery as the nail separates from the nail bed. The nails regrow normally, and no specific treatment is needed.

### Is there a specific antiviral treatment for hand, foot and mouth disease?

No specific antiviral is licensed for hand, foot and mouth disease, so treatment is supportive. Analgesia, hydration and antipyretics manage symptoms in most children. Children with neurological or cardiopulmonary signs need hospital care for close monitoring.