Hand, Foot
and Mouth
Disease
(HFMD)
- A Case
Presentation
and Discussion
February 25, 2023
1400H - 1500H
Via Zoom
Empowerment
objective - for
laypeople to have a
basic understanding
of Hand, Foot and
Mouth Disease - its
diagnosis,
treatment and
prevention.

Hand, Foot
and Mouth
Disease
(HFMD)
- A Case
Presentation
and Discussion
ROJoson PEP Talk
I have a Patient
Empowerment
Program in which I
like to empower the
lay people or
patients to take
control in the
management of
their health.
Empowerment
objective - for
laypeople to have a
basic understanding
of Hand, Foot and
Mouth Disease - its
diagnosis,
treatment and
prevention.

I started the PEP Talk
on May 15, 2021.
There are 3 courses
in the PEP Talk.
I completed the Core
Course on October 9,
2021.

From October 23,
2021 onwards, I have
been tackling Health
Disorder and Health
Issue Courses. This
may take 3 years or
longer depending on
our enthusiasm and
perseverance.

Hand, Foot
and Mouth
Disease
(HFMD)
- A Case
Presentation
and Discussion
My PEP TALK today is
entitled:
Hand, Foot and
Mouth Disease.
This topic was
thought of because
of the reported
increasing incidence
of HFMD in the
Philippines since
October 2022.
Empowerment
objective - for
laypeople to have a
basic understanding
of Hand, Foot and
Mouth Disease - its
diagnosis,
treatment and
prevention.

Backgrounder of incidence of HFMD
HFMD infections started in October 2022 in San
Pascual, Batangas where there were 105 cases
detected mostly among children aged one to 16.
November 2022, around 540 HFMD cases were
detected in Albay, affecting kids one to 10 years
old. In the same month, 145 cases were also
recorded in the Ilocos Region, mostly among kids
aged four to nine.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Backgrounder of incidence of HFMD
The National Capital Region (NCR) also logged 155
HFMD cases recorded from October to December
6, and most of them are children aged 11 and
below.
𝗔 𝘁𝗼𝘁𝗮𝗹 𝗼𝗳 𝟵𝟯 𝘀𝘂𝘀𝗽𝗲𝗰𝘁 𝗰𝗮𝘀𝗲𝘀 𝗼𝗳 𝗛𝗮𝗻𝗱, 𝗙𝗼𝗼𝘁, 𝗮𝗻𝗱
𝗠𝗼𝘂𝘁𝗵 𝗗𝗶𝘀𝗲𝗮𝘀𝗲𝘀 (𝗛𝗙𝗠𝗗) 𝘄𝗲𝗿𝗲 𝗿𝗲𝗽𝗼𝗿𝘁𝗲𝗱 𝗶𝗻 𝘁𝗵𝗲 𝗖
𝗼𝗿𝗱𝗶𝗹𝗹𝗲𝗿𝗮 𝗿𝗲𝗴𝗶𝗼𝗻 𝗳𝗿𝗼𝗺 𝗝𝗮𝗻𝘂𝗮𝗿𝘆 𝟭 𝘁𝗼 𝗝𝗮𝗻𝘂𝗮𝗿𝘆 𝟮𝟰,
𝟮𝟬𝟮𝟯. 𝗧𝗵𝗶𝘀 𝗶𝘀 𝟭𝟰𝟱𝟬% 𝗵𝗶𝗴𝗵𝗲𝗿 𝗰𝗼𝗺𝗽𝗮𝗿𝗲𝗱 𝘁𝗼 𝘁𝗵𝗲 𝘀
𝗮𝗺𝗲 𝗽𝗲𝗿𝗶𝗼𝗱 𝗶𝗻 𝟮𝟬𝟮𝟮 𝘄𝗵𝗲𝗿𝗲𝗶𝗻 𝗼𝗻𝗹𝘆 𝘀𝗶𝘅 (𝟲) 𝗰𝗮𝘀𝗲𝘀
𝘄𝗲𝗿𝗲 𝗿𝗲𝗽𝗼𝗿𝘁𝗲𝗱.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Backgrounder of incidence of HFMD
HFMD: 232 suspected cases among Davao
students (February 8, 2023)
Latest: ???????
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion
With this frequent occurrence of HFMD in the
Philippines, we should all be aware and beware of
it – its diagnosis, treatment and prevention, if
possible.
PATIENT EMPOWERMENT PROGRAM

Clarification of Terms:
Hand, foot and mouth disease vs foot and
mouth disease
DO NOT INTERCHANGE!
Hand, foot and mouth disease (HFMD) is a human
disease caused by a coxsackie virus.
Foot and mouth disease (FMD) is an animal
disease, also called hoof and mouth disease
caused by picornavirus.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Contents of PEP Talk:
Case Presentation and Discussion of Hand,
Foot, and Mouth Disease
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Case Presentation
February 10, 2023
I had a telemedical consultation on a possible
Hand, Foot, and Mouth Disease (HFMD).
42-year-old female breast cancer patient
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Case Presentation
42-year-old female breast cancer patient
“Hi doc, may I ask po if you can do teleconsult?
Nagfever po kase ako ngayon. Kanina pagkagising
ko medyo masakit ulo ko and parang may phlegm.
But not sure. kung dahil sa sipon or nahawa ako
sa kids ko who have HFMD right now. Hoping na
hindi naman at sipon lang. Naglalaro fever ko sa
37.8 C -38.1C.”
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Case Presentation
42-year-old female breast cancer patient
Data:
Upon waking up this morning, felt a slight
headache but which disappeared after a few
minutes. Then, mild chills set in. Temperature
taken: 38.1C.
Up and about. Temperature fluctuating 37.5C -
37.6C. (at time of consult)
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Case Presentation
42-year-old female breast cancer patient
No frank colds.
No frank cough.
With mild pain and discomfort on the throat.
With whitish spots and “butlig” (blister).
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Case Presentation
42-year-old female breast cancer
patient
With whitish spots and “butlig”
(blister).
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Case Presentation
42-year-old female breast cancer
patient
With whitish spots and “butlig”
(blister).
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Case Presentation
42-year-old female breast cancer patient
A daughter (10 years old) has been diagnosed to
have HFMD on January 28, 2023.
A son (7 years old) also, on February 3, 2023.
Symptoms: Fever, mouth sores and skin rashes.
Both have recovered from the disease.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

A daughter (10 years old)
has been diagnosed to
have HFMD on January 28,
2023.
A son (7 years old) also, on
February 3, 2023.
Symptoms: Fever, mouth
sores and skin rashes.
Both have recovered from
the disease.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

A daughter (10 years old)
has been diagnosed to
have HFMD on January 28,
2023.
A son (7 years old) also, on
February 3, 2023.
Symptoms: Fever, mouth
sores and skin rashes.
Both have recovered from
the disease.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

A daughter (10 years old)
has been diagnosed to
have HFMD on January 28,
2023.
A son (7 years old) also, on
February 3, 2023.
Symptoms: Fever, mouth
sores and skin rashes.
Both have recovered from
the disease.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Case Presentation
42-year-old female breast cancer patient
Based on pattern recognition (fever, mouth sores
and skin rashes) and with exposure to HFMD and
high prevalence now in the community
Primary diagnosis for the mother: Hand, Foot and
Mouth Disease (evolving – no rashes yes – will
wait for a few more days).
Diagnoses for children: Hand, Foot and Mouth
Diseases (resolving)
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Case Presentation
42-year-old female breast cancer patient
Update: February 13, 2023 (3rd day after onset of
symptoms)
"Yes doc ang dami sa hands ko. Sa scalp initially. 2nd day
lumabas yung sa right hand then afternoon sa.left hand po.
That night sobrang painful mg paa and kamay ko. I can't
evem walk to the toilet. Parang arthritis ganon.level ng
sakit. Now on my 4th day nagblister na din yung sa feet ko
and sa hands not sure kung drying up na b. Masakit pa din
feet and hands ko but not as much as the 2nd Nd 3rd day"
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Case Presentation
42-year-old female
breast cancer patient
Update:
Skin rashes started
coming out on the 2nd
day – hands and feet
(and scalp).
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion
Case Presentation
42-year-old female
breast cancer patient
Update:
Skin rashes started
coming out on the 2nd
day – hands and feet
(and scalp).

Case Presentation
42-year-old female breast cancer patient
TREATMENT:
Non-medication medical management with
monitoring.
• Rest and anxiety control
• High fluid intake
• Eat foods that do not aggravate sore throat
• Take paracetamol only if with temperature of
39C and if with intolerable pain.
• Follow-up – after one week.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Discussion on
Hand, Foot and
Mouth Disease
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

HFMD was first reported in New Zealand in 1957.
Coxsackievirus A16 was first identified next year
in 1958 in Canada.
HFMD has been considered to be a benign disease
of self-limiting nature.
HFMD is contagious or infectious.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

The term HFMD derives its name from typical
maculopapular or vesicular lesions involving the
skin of the hands, feet and oral mucosa.
Hand, foot and mouth disease gets its name from
the blister-like rash that forms on the hands, feet
and mouth. The rash can actually appear
anywhere on the body, including the trunk,
extremities, genitals and buttocks.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Recognition of HFMD (diagnosis):
• Fever or flu-like symptoms
• Mouth sores
• Skin rashes
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion
Pattern Recognition

DOH Diagnostic Classification
Suspected case
Probable case
Confirmed case
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

DOH Diagnostic Classification
Suspected case – any individual regardless of age,
who developed acute febrile illness with
papulovesicular or maculopapular rashes on
palms and soles, with or without vesicular
lesions/ulcers in the mouth.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

DOH Diagnostic Classification
Probable case – a suspected case that has not yet
been confirmed by a laboratory test, but is
geographically and temporally related to a
laboratory confirmed case.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

DOH Diagnostic Classification
Confirmed case – a suspected case with positive
laboratory result for human enteroviruses that
cause HFMD.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Diagnosing hand, foot, and mouth disease
One can usually tell if someone has hand, foot,
and mouth disease by examining the patient and
the rash appearance while considering the
patient’s age and other symptoms.
Sometimes, healthcare providers might collect
samples from the patient’s throat or feces (poop)
and send them to a laboratory to test for the
virus.
However, these tests are RARELY done. (if only for
documentation and if diagnosis is uncertain)
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion
During an outbreak

Differential diagnosis of hand, foot, and mouth
disease
The differential diagnosis for HFMD should include conditions that
present with maculopapular or vesicular rashes with or
without oral lesions. These conditions include:
• Erythema multiforme
• Herpangina
• Herpes simplex
• Herpes zoster
• Kawasaki disease
• Toxic epidermal necrolysis(TEN)
• Viral pharyngitis
• Rocky Mountain spotted fever
• Varicella zoster infection (chickenpox)
• Steven-Johnson syndrome
• Monkeypox
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion
If an outbreak is not
present yet,
may be difficult to
diagnose (may have
to do tests).

Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion
Usually no or
infrequent skin rashes
small, white, blister-like
sores
small, red, blister-like
sores

Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Usual Age of Affectation
Hand, foot, and mouth disease is common in
infants and children.
Adults can also be infected.
Adults usually have milder symptoms than
children.
Most children have mild symptoms for 7 to 10
days.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Treatment
There is no specific medical treatment for hand,
foot, and mouth disease.
Treat symptoms and prevent dehydration.
• Take over-the-counter medications to relieve
fever and pain caused by mouth sores. Never
give aspirin to children.
• Drink enough liquids. Mouth sores can make it
painful to swallow, so your child may not want
to drink much. Make sure they drink enough to
stay hydrated.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Treatment
No antibiotics.
No need for antiviral drugs.
NO vaccine developed yet.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Prognosis
Most people with hand, foot, and mouth
disease get better on their own in 7 to 10 days.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Can you get hand-foot-and-mouth disease twice?
It is possible to contract the virus more than
once, but the symptoms will be less severe.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Is HFMD airborne?
HFMD is moderately infectious to others. It is
spread by direct contact with nose and throat
discharges, fluid from the blisters, and feces
(stool) of infected individuals.
Airborne droplets in the infected person’s sneeze
or cough can also spread the virus.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Should parents quarantine if child has HFMD?
Why do you need to quarantine for hand, foot,
and mouth disease?
HFMD is very contagious. To help prevent the
spread of HFMD, it’s important to stay home from
school or work while you or your child have
symptoms.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

What is the contagious period for hand foot
mouth?
People with hand, foot, and mouth disease are
usually most contagious during the first week that
they are sick.
People can sometimes spread the virus to others
for days or weeks after symptoms go away or if
they have no symptoms at all.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

What is the last stage of hand foot and mouth?
The final stage of the illness is manifested
by small, tender red spots that progress to blisters
in the mouth, palms of the hands, soles of the
feet, and less frequently on the arms and legs, as
well as the buttock and genital areas.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

You can help prevent catching or spreading hand,
foot, and mouth disease by following simple
steps:
- Wash your hands
Wash your hands often with soap and water for at
least 20 seconds.
Help children wash their hands. Teach them how
to wash their hands and make sure they wash
them often.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

You can help prevent catching or spreading hand,
foot, and mouth disease by following simple
steps.
-Clean and disinfect
Clean and disinfect frequently touched surfaces
and shared items, including toys and doorknobs.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

You can help prevent catching or spreading hand,
foot, and mouth disease by following simple
steps.
- Avoid touching your eyes, nose, and mouth.
You can get infected with hand, foot, and mouth
disease if you have the virus on your hands
and then touch your eyes, nose, or mouth. To
lessen your chance of getting sick, don’t touch
your eyes, nose, and mouth with unwashed
hands.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

You can help prevent catching or spreading hand,
foot, and mouth disease by following simple
steps.
- Avoid close contact with sick people
Avoid touching someone who has hand, foot, and
mouth disease, such as hugging or kissing them.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

You can help prevent catching or spreading hand,
foot, and mouth disease by following simple
steps.
If your child is sick:
Because HFMD is normally mild, children can
continue to go to child care and schools as long
as: they have no fever, they have no uncontrolled
drooling with mouth sores, and they feel well
enough to participate in classroom activities.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Clarification of Terms:
Hand, foot and mouth disease vs foot and
mouth disease
DO NOT INTERCHANGE!
Hand, foot and mouth disease (HFMD) is a human
disease caused by a coxsackie virus.
Foot and mouth disease (FMD) is an animal
disease, also called hoof and mouth disease
caused by picornavirus.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion
Summary
Take Away

Recognition of HFMD (diagnosis):
• Fever or flu-like symptoms
• Mouth sores
• Skin rashes
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion
Pattern Recognition
Summary
Take Away

Usual Age of Affectation
Hand, foot, and mouth disease is common in
infants and children.
Adults can also be infected.
Adults usually have milder symptoms than
children.
Most children have mild symptoms for 7 to 10
days.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Treatment
There is no specific medical treatment for hand,
foot, and mouth disease.
Non-medication medical management with
monitoring.
• Rest and anxiety control
• High fluid intake
• Eat foods that do not aggravate sore throat
• Take paracetamol only if with temperature of
39C and if with intolerable pain.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Treatment
No antibiotics.
No need for antiviral drugs.
NO vaccine yet.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Prognosis
Most people with hand, foot, and mouth
disease get better on their own in 7 to 10 days.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Take Away in
relation to
Patient
Empowerment
Be always in touch with reliable medical
information on HAND, FOOT and MOUTH
DISEASE (HFMD).
Knowledge is power; it gives power.
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to gain greater control over decisions in
preventing, recognition and treatment of
Hand, Foot and Mouth Disease.
Hand, Foot and
Mouth Disease
(HFMD)
- A Case
Presentation and
Discussion

Hand, Foot
and Mouth
Disease
(HFMD)
- A Case
Presentation
and Discussion
Empowerment
objective - for
laypeople to have a
basic understanding
of Hand, Foot and
Mouth Disease - its
diagnosis,
treatment and
prevention.