Coxsackievirus infection

Alternative names
Hand - foot - mouth disease

Hand-foot-mouth disease is a viral infection that usually begins in the throat. It is caused by the Coxsackievirus.

Causes, incidence, and risk factors

Hand-foot-and-mouth disease is caused by the Coxsackie virus (a member of the Enterovirus family). The throat and tonsils develop small ulcers while the hands, feet, and diaper area are affected by a rash with characteristic vesicles (very small blisters). This is usually a mild illness with the rash healing in 5 to 7 days.

The actual incidence is unknown, but hand-foot-and-mouth disease is a relatively common infection. Another coxsackie virus infection with a high incidence and related features is herpangina. This is characterized by painful ulcers in the mouth and throat, but does not show a rash on the hands, feet or buttocks.

The most important risk factor is age. The infection affects young children, but can be seen in adolescents and occasionally adults. The outbreaks occur most often in the summer and fall.


  • Fever.  
  • Sore throat.  
  • Ulcers in the throat, mouth and tongue.  
  • Headache.  
  • A rash with vesicles (small blisters - 3-7 mm) on hands, feet, and diaper area. The vesicles are typically on the palm side of the hands, the sole side of the feet, and are very characteristic in appearance. The vesicles are also tender or painful if pressed.  
  • Loss of appetite.

Signs and tests

A physical examination demonstrating the characteristic vesicles on the hands and feet and the history of recent illness are usually sufficient to diagnose hand, foot, and mouth disease.


There is no specific treatment for the infection other than symptomatic relief of symptoms.

Treatment with antibiotics is not effective, and is not indicated. Acetaminophen or Ibuprofen can be used to treat fever. Aspirin should not be used in viral illnesses in children under age 12 years.

Salt water mouth rinses (1/2 teaspoon of salt to 1 glass of warm water) may be soothing if the child is able to rinse without swallowing. Ensure an adequate fluid intake because swallowing may be painful. Extra fluid is needed when a fever is present. The best fluids are cold milk products, especially ice cream. Many children refuse juices and sodas, for example, because their acidity causes burning pain in the ulcers.

Expectations (prognosis)

Generally, complete recovery occurs in 5 to 7 days.


  • Dehydration can occur because the mouth lesions can cause pain with swallowing.  
  • Possible convulsions with high fever (febrile seizures).

Calling your health care provider

Apply home treatment and call the health care provider if there are signs of complications, such as pain in neck or arms and legs. Other times to call include: when a high fever is not reduced by medication, signs of dehydration occur such as dry skin and mucus membranes, weight loss, irritability, lethargy, and decreased or dark urine.

Emergency symptoms include convulsions.


Avoid contact with people with known illness. Practice strict hand washing if in contact with infected children.

Johns Hopkins patient information

Last revised: December 4, 2012
by Janet G. Derge, M.D.

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