Welcome to theJanuaryIssue of the MUSC School-Based Telehealth Nurse's Newsletter!
This issue will feature program updates as well as a Clinical Focus on Hand Foot and Mouth Disease
Be sure to check out all of this important and exciting information!
Happy New Year!
The MUSC team would like to wish everyone a Happy New Year! We hope that everyone has a successful and healthy 2019!
Clinical Focus: Hand Foot and Mouth Disease
aka Coxsackie Virus
What is Hand Foot and Mouth caused by?
It is caused by an enterovirus called a Coxsackie Virus A.
What is the incubation period? It can take 3-6 days from the time of exposure to see symptoms develop.
Is it very contagious? Yes! It is highly contagious and spreads via aerosolized droplets, nasal or oral secretions and the fecal to oral route.
Who can get it? It typically affects children under the age of 5 years old but it can be seen in all ages. The new strain seems to be affecting older children and adults more readily.
How does it present?
Fever
Sore throat
Headache
Malaise
Development of small erythematous macules on oropharynx while later develop into 1-3mm vesicles which ulcerate.
Lesions on extremities begin as erythematous macules and then develop a central oval vesicle on an erythematous base. Most prevalent on the palms and soles but can be on buttocks.
How is it diagnosed? It is diagnosed clinically based on the history and physical exam.
What is the treatment? This virus will generally resolve on its own within approximately 7 to 10 days. Treatment is focused on supportive care and includes the following:
Encourage fluids (especially cold)
Offer ice pops or ice chips
Acetaminophen or Ibuprofen for pain/fever
Avoid salty/citrus foods
When should a patient be referred to a provider?
To confirm diagnosis if unclear
Signs or symptoms of dehydration
Fever lasting more than 3 days (to confirm diagnosis and ensure that nothing else is going on)
Lethargy that does not improve as fever comes down
Child appears toxic or severely ill
How can it be prevented?
Good hygiene/hand washing/disinfect common areas
Children should remain out of school or daycare until fever and oral lesions are resolved
What's new with Coxsackie? Over the past few years a new strain of Coxsackie virus has been noted in the US. It seems to be affecting more adults and lasting longer than a typical case. The new strain, Coxsackie A6, previously found only in Africa and Asia, is now cropping up all over the United States. It often causes a more widespread rash than the typical virus and the rash can be seen on the arms, legs, face and buttocks in addition to the hands and feet. The treatment is the same but the course may appear a bit more severe or last a bit longer.
Remember, the School-Based Telehealth team can assist with the assessment and diagnosis of all kinds of rashes including Hand Foot and Mouth!
Upcoming Conferences & Trainings
38th Annual School Nurse Conference
February 1-2, 2019
Columbia, South Carolina
More information to follow!
