{
  "schemaVersion": 2,
  "eyebrow": "Pediatric Infectious Disease",
  "title": "Hand, Foot, and Mouth Disease",
  "summary": "Hand, foot, and mouth disease is usually diagnosed clinically and managed with hydration-focused supportive care. The key physician task is to recognize dehydration, neurologic or cardiopulmonary complications, and mimics requiring lesion PCR, cerebrospinal fluid evaluation, or alternate treatment.",
  "seoDescription": "Clinical diagnosis, differential, testing, supportive management, complication recognition, and infection-control decisions for hand, foot, and mouth disease.",
  "clinicalQuestion": "How should clinicians diagnose, triage, manage, and prevent transmission of hand, foot, and mouth disease?",
  "specialty": "Pediatrics and Infectious Disease",
  "audience": "U.S. physicians and medical trainees",
  "tags": [
    "hand foot and mouth disease",
    "HFMD",
    "coxsackievirus A16",
    "coxsackievirus A6",
    "enterovirus A71",
    "oral ulcers",
    "vesicular exanthem",
    "enterovirus PCR"
  ],
  "keyTakeaways": [
    "Diagnose typical HFMD clinically when oral vesicles or ulcers occur with acral vesicles; lesion real-time PCR is reserved for atypical, severe, or epidemiologically consequential presentations. [13][14][16]",
    "Assess hydration at every encounter because painful oral lesions and odynophagia make dehydration the most common complication. [14]",
    "Escalate promptly for neurologic findings, hemodynamic compromise, or signs of hypoperfusion; suspected enteroviral CNS disease warrants CSF enterovirus PCR. [14][19]",
    "There is no established routine antiviral therapy; treatment is supportive, with IVIG described as a consideration for immunocompromised patients. [10][14]",
    "Reduce household and childcare transmission through soap-and-water hand hygiene after toileting or diaper changes, avoidance of close contact and shared food, and disinfection of high-touch surfaces and toys. [8]"
  ],
  "sections": [
    {
      "id": "triage-and-disposition",
      "eyebrow": "First Decision",
      "heading": "Identify patients who need urgent evaluation",
      "intro": "Most cases are self-limited, but triage should prioritize hydration and enteroviral complications.",
      "paragraphs": [
        "Examine oral intake, urine output, mucous membranes, perfusion, and vital signs at presentation. Oral ulcer pain, dysphagia, drooling, and poor intake can cause dehydration; in typical HFMD, dehydration is the most frequent complication. [14] Patients unable to maintain hydration, with clinical dehydration, or with inadequate outpatient observation should receive acute care assessment for fluid support.",
        "Treat altered mental status, lethargy, severe headache, neck stiffness, weakness, seizure, hypotension, or hypoperfusion as a complication pathway rather than uncomplicated HFMD. EV-A71 outbreaks have been associated with a high incidence of central nervous system complications. [19] When meningitis or encephalitis is suspected, obtain CSF enterovirus PCR as the key etiologic test while evaluating and managing the patient according to the broader CNS infection syndrome. [14]",
        "A febrile child with vesicles plus hypotension or hypoperfusion requires evaluation for bacterial meningitis or sepsis as well as enteroviral disease; do not attribute shock physiology to uncomplicated HFMD. [14]"
      ],
      "bullets": [
        "Outpatient management is reasonable when oral fluid intake is adequate, perfusion is normal, and caregivers can monitor intake and clinical trajectory. [14]",
        "Hospital-level assessment is indicated for dehydration or inability to drink because painful oral lesions can rapidly limit intake. [14]",
        "Neurologic symptoms or cardiorespiratory instability should trigger urgent escalation and CNS-directed diagnostic evaluation. [14][19]"
      ],
      "subsections": [],
      "table": {
        "caption": "Disposition framework for suspected HFMD. [14][19]",
        "columns": [
          "Clinical branch",
          "Key discriminator",
          "Next action"
        ],
        "rows": [
          [
            "Uncomplicated mucocutaneous illness",
            "Oral lesions with acral vesicles; adequate drinking and normal perfusion. [14][16]",
            "Supportive outpatient care and hydration surveillance. [14]"
          ],
          [
            "Dehydration risk",
            "Poor intake, drooling, dysphagia, or odynophagia from oral lesions. [14]",
            "Assess hydration and arrange acute care fluid support if oral hydration is not maintained. [14]"
          ],
          [
            "Suspected CNS complication",
            "Neurologic symptoms in the setting of enteroviral illness. [19]",
            "Urgent evaluation; obtain CSF enterovirus PCR when CNS infection is suspected. [14]"
          ],
          [
            "Shock or severe systemic illness",
            "Hypotension or hypoperfusion. [14]",
            "Evaluate immediately for bacterial meningitis or sepsis and other serious illness; do not manage as routine HFMD. [14]"
          ]
        ]
      }
    },
    {
      "id": "clinical-diagnosis-and-testing",
      "eyebrow": "Diagnostic Strategy",
      "heading": "Use clinical pattern recognition first, then test atypical or consequential cases",
      "intro": "Routine laboratory confirmation is not necessary for the characteristic oral and acral syndrome.",
      "paragraphs": [
        "Make a clinical diagnosis when the syndrome includes oral vesicles that ulcerate and a painful erythematous vesicular eruption on the hands and feet; lesions may also involve the groin or buttocks. [14][16] Oral lesions can precede the cutaneous eruption and commonly involve the buccal mucosa, palate, and tongue. [16] Disease typically lasts 7 to 10 days, although one reference describes acute illness lasting 10 to 14 days. [3][13][14]",
        "Obtain real-time PCR from a vesicle or lesion swab when morphology is atypical, diagnosis would change management, severe disease raises concern for enteroviral complication, or strain identification is important to a public-health investigation. Lesion PCR can detect coxsackievirus or enterovirus, and multiplex real-time PCR assays have been developed for prevalent HFMD-associated enteroviruses. [13][15] Serology is not sensitive for acute diagnosis; IgG may be used to monitor recovery, and some centers use serology to distinguish EV-A71 from coxsackievirus because of prognostic implications. [13]",
        "Interpret virologic detection in context. Enterovirus can be detected in stool for approximately 6 weeks after infection and oropharyngeal shedding is generally less than 4 weeks; therefore, stool positivity alone may not establish that a current atypical eruption is caused by HFMD. [13] Standard respiratory multiplex panels may report a combined enterovirus/rhinovirus target rather than differentiate the two because of genomic similarity. [14]"
      ],
      "bullets": [
        "Preferred confirmatory specimen: swab an active vesicle or lesion for real-time PCR. [13]",
        "Avoid relying on acute serology to establish HFMD. [13]",
        "For suspected CNS involvement, use CSF enterovirus PCR rather than a respiratory panel to establish an enteroviral CNS diagnosis. [14]"
      ],
      "subsections": [],
      "table": {
        "caption": "Clinical patterns that redirect the differential or testing strategy. [13][14][16]",
        "columns": [
          "Pattern",
          "Interpretation",
          "Decision"
        ],
        "rows": [
          [
            "Oral ulcers plus acral vesicles",
            "Typical HFMD pattern. [14][16]",
            "Clinical diagnosis is usually sufficient. [13]"
          ],
          [
            "Posterior pharyngeal lesions without a hand or foot eruption",
            "Consider herpangina: lesions occur on anterior faucial pillars, soft palate, uvula, tonsils, and tongue and ulcerate over 3 to 4 days. [14]",
            "Do not label as HFMD solely because of enteroviral oral lesions. [14]"
          ],
          [
            "Diffuse, hemorrhagic, bullous, adult, or otherwise atypical eruption",
            "Coxsackievirus A6 has been associated with an adult resurgence of atypical HFMD. [24]",
            "Obtain lesion PCR when confirmation will clarify diagnosis or guide outbreak response. [13][15]"
          ],
          [
            "Vesicular eruption in which HSV or varicella-zoster is plausible",
            "Microscopy of vesicle biopsy or scraping can differentiate HFMD from VZV and HSV. [13]",
            "Pursue targeted alternate diagnosis rather than assuming HFMD. [13]"
          ]
        ]
      }
    },
    {
      "id": "etiology-and-differential",
      "eyebrow": "Etiologic Branches",
      "heading": "Distinguish classic HFMD from enteroviral and nonenteroviral mimics",
      "intro": "Distribution of lesions and systemic severity determine whether the working diagnosis remains HFMD.",
      "paragraphs": [
        "HFMD is an enteroviral syndrome most often associated with coxsackievirus A16 and EV-A71; coxsackievirus A6 is also a common causative serotype and is linked to atypical presentations, including cases in adults. [3][13][17][24] Etiologic typing rarely changes routine outpatient treatment, but EV-A71 attribution has prognostic relevance in some settings because of its association with CNS complications during outbreaks. [13][19]",
        "Separate HFMD from isolated herpangina by skin involvement. Herpangina produces fever and painful posterior oral lesions, whereas HFMD produces oral vesicles or ulcers together with painful lesions on the hands and feet and may include groin or buttock involvement. [14] This distinction matters because neither syndrome requires routine antiviral treatment, but absent acral disease should prompt reassessment of the diagnosis rather than reflexive confirmation testing. [10][14]",
        "When vesicles, ulceration, or distribution are not characteristic, prioritize disorders for which treatment or infection-control implications differ. The differential includes varicella-zoster virus and herpes simplex virus; microscopy of a vesicle biopsy or scraping is described as a means of distinguishing these infections from HFMD. [13] Atypical HFMD can be clinically broad, particularly with coxsackievirus A6, so lesion PCR is most useful when it resolves that specific diagnostic fork. [13][24]"
      ],
      "bullets": [
        "Classic distribution: buccal mucosa, palate, or tongue lesions plus palmar and plantar vesicles. [16]",
        "Expanded HFMD distribution: groin and buttocks may be involved. [14]",
        "Atypical adult disease: consider coxsackievirus A6 and confirm with lesion PCR if the result will alter management or outbreak classification. [13][24]"
      ],
      "subsections": [],
      "table": null
    },
    {
      "id": "management-and-monitoring",
      "eyebrow": "Treatment",
      "heading": "Manage pain-limited intake and monitor for clinical deterioration",
      "intro": "Therapy is supportive because uncomplicated HFMD resolves without cause-directed antiviral treatment.",
      "paragraphs": [
        "Direct management toward maintaining hydration and reducing the functional impact of oral pain. HFMD treatment is supportive, and uncomplicated illness generally resolves within days to two weeks without residual sequelae. [10][13][14] Reassess rather than simply extend supportive care when intake declines, dehydration develops, fever or systemic illness is disproportionate to the mucocutaneous syndrome, or neurologic findings emerge.",
        "Do not use routine enterovirus-directed antiviral therapy for uncomplicated HFMD. In immunocompromised patients, IVIG has been described as a consideration to reduce illness duration and viral shedding; this is not presented as routine treatment for immunocompetent children with classic disease. [14] Consultation is appropriate when immunocompromise coexists with severe, persistent, or complicated enteroviral disease.",
        "Set a short-interval monitoring plan around oral intake and neurologic status rather than rash resolution. The rash and oral lesions usually last 7 to 10 days, but a patient whose ability to drink worsens during that interval needs reassessment for dehydration. [3][14] New neurologic symptoms require urgent reevaluation for enteroviral CNS involvement. [14][19]"
      ],
      "bullets": [
        "Primary outpatient target: preserved fluid intake despite painful oral lesions. [14]",
        "Primary complication to monitor: dehydration. [14]",
        "Exception to routine supportive care: consider IVIG only in the setting of immunocompromise, with specialist-directed assessment of severity and competing diagnoses. [14]"
      ],
      "subsections": [],
      "table": null
    },
    {
      "id": "transmission-control",
      "eyebrow": "Infection Control",
      "heading": "Interrupt household, childcare, and healthcare transmission",
      "intro": "Transmission prevention should focus on contact, respiratory secretions, stool exposure, and contaminated surfaces.",
      "paragraphs": [
        "Counsel families and caregivers to use soap-and-water handwashing after toileting, diaper changes, and potty training and before food preparation or eating. [8] HFMD spreads through oral-oral and fecal-oral routes and can also spread through respiratory secretions and contaminated objects. [3][8][16] Hand sanitizer can be carried when soap and water are unavailable, but soap-and-water hygiene is the specifically emphasized intervention after diaper and toilet exposures. [8]",
        "Advise avoidance of close contact, including kissing, hugging, and sharing food, during active illness; disinfect counters, doorknobs, toys, and other frequently touched surfaces. [8] Most people are no longer contagious after 7 to 10 days, although contagiousness can last longer, and stool shedding can persist for approximately 6 weeks. [8][13] This prolonged shedding supports continued meticulous hand hygiene after symptoms resolve, especially for diapered children and household food handlers."
      ],
      "bullets": [
        "Clean high-touch objects and shared toys because contaminated surfaces can mediate transmission. [8]",
        "Avoid shared food and close face-to-face contact during active illness. [8]",
        "Continue post-illness hand hygiene after toileting and diaper changes because stool shedding may persist for weeks. [13]"
      ],
      "subsections": [],
      "table": null
    }
  ],
  "faq": [
    {
      "question": "When should lesion PCR be obtained for suspected HFMD?",
      "answer": "Use a vesicle or lesion swab for real-time PCR when the eruption is atypical, severe disease raises etiologic concern, HSV or VZV remains plausible, or confirmation will affect outbreak investigation or clinical decisions. Typical oral-plus-acral HFMD is usually diagnosed clinically. [13][15]"
    },
    {
      "question": "Does a positive stool enterovirus test confirm active HFMD?",
      "answer": "Not necessarily. Enterovirus may be detectable in stool for about 6 weeks after infection, so correlate stool positivity with the active lesion pattern and clinical syndrome; a lesion swab is the more direct confirmatory specimen for suspected HFMD. [13]"
    }
  ],
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  "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.",
  "citations": [
    {
      "number": 1,
      "title": "Epidemiology of hand, foot, and mouth disease outbreaks ...",
      "detail": "www.thelancet.com",
      "url": "https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065(25)00140-3/fulltext",
      "authors": "www.thelancet.com",
      "host": "www.thelancet.com",
      "snippet": "by F Liu · 2025 · Cited by 33 — Hand, foot, and mouth disease is a common contagious illness of childhood. There are three enterovirus A71 (EV-A71) vaccines licensed -vaccine",
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      "url": "https://www.nature.com/articles/srep36375",
      "authors": "www.nature.com",
      "host": "www.nature.com",
      "snippet": "Hand-foot-mouth disease (HFMD) is one kind of common infectious diseases, which is caused by various enteroviruses from Picornaviridae family. Coxsackie A virus and enterovirus 71 (EV71) are the major agents according to the reports data1.\"),2.\") while several studies also showed that there are many",
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    {
      "number": 3,
      "title": "Hand Foot and Mouth Disease - an overview",
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      "host": "www.sciencedirect.com",
      "snippet": "Hand, Foot and Mouth Disease (HFMD) is a common disease in children. It is caused by an enterovirus, usually coxsackievirus type A 16 (coxA 16) and enterovirus 71 (EV 71) . The diagnosis of HFMD is usually based on the clinical features. The illness typically initially begins with fever, sore throat",
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    {
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      "title": "Hand, foot, and mouth disease: A systematic review of ...",
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      "host": "www.sciencedirect.com",
      "snippet": "Hand, foot, and mouth disease (HFMD) is an acute viral illness primarily caused by enteroviruses, most notably Enterovirus A71 (EV-A71) and Coxsackievirus A16 (",
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      "host": "www.sciencedirect.com",
      "snippet": "by V Reddy · 2020 · Cited by 11 — Hand, foot, and mouth disease HFMD is a highly contagious viral infection typically caused by coxsackievirus A16 and enterovirus 71. commonly affects children",
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      "authors": "www.sciencedirect.com",
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      "snippet": "Hand–foot–and–mouth disease (HFMD) is typically a pediatric illness, recent comprehensive review described HFMD as an infection",
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      "snippet": "by X Lei · 2015 · Cited by 66 — Hand, foot, and mouth disease (HFMD), caused by enteroviruses, is a syndrome characterized by fever with vesicular eruptions mainly on the skin of the hands,",
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      "number": 8,
      "title": "Hand-foot-and-mouth disease: Tips for preventing",
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      "authors": "pmc.ncbi.nlm.nih.gov",
      "host": "pmc.ncbi.nlm.nih.gov",
      "snippet": "by YZ Chen · 2021 · Cited by 4 — Diagnosis of hand, foot, and mouth disease caused by EV71 and other enteroviruses by a one‐step, single tube, duplex RT‐PCR. J Med Virol. 2012;84(11):1803",
      "score": 0.53750324
    },
    {
      "number": 10,
      "title": "C1 PAGE.indd",
      "detail": "publications.aap.org",
      "url": "https://publications.aap.org/pediatricsinreview/issue-pdf/827686",
      "authors": "publications.aap.org",
      "host": "publications.aap.org",
      "snippet": "PCR (RT-PCR) and serologic testing; treatment is support- ive, and ... Hand, foot, and mouth disease (HFMD) is caused by coxsackieviruses and is ...Read more",
      "score": 0.49685127
    },
    {
      "number": 11,
      "title": "Diagnosis of foot-and mouth disease by real time reverse ...",
      "detail": "pmc.ncbi.nlm.nih.gov",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC2631516",
      "authors": "pmc.ncbi.nlm.nih.gov",
      "host": "pmc.ncbi.nlm.nih.gov",
      "snippet": "by TA Paixão · 2008 · Cited by 69 — Diagnosis of foot-and-mouth disease by RT-PCR: use of phylogenetic data to evaluate primers for the typing of viral RNA in clinical samples.",
      "score": 0.48572227
    },
    {
      "number": 12,
      "title": "Validation and utilization of an internally controlled multiplex ...",
      "detail": "pmc.ncbi.nlm.nih.gov",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC4464700",
      "authors": "pmc.ncbi.nlm.nih.gov",
      "host": "pmc.ncbi.nlm.nih.gov",
      "snippet": "by TT Thanh · 2015 · Cited by 31 — Hand foot and mouth disease (HFMD) is a commonly benign and self-limiting viral infection of infants and acids, in particular real-time PCR,",
      "score": 0.46380913
    },
    {
      "number": 13,
      "title": "Hand, Foot, and Mouth Disease - StatPearls - NCBI Bookshelf",
      "detail": "www.ncbi.nlm.nih.gov",
      "url": "https://www.ncbi.nlm.nih.gov/books/NBK431082",
      "authors": "www.ncbi.nlm.nih.gov",
      "host": "www.ncbi.nlm.nih.gov",
      "snippet": "## Evaluation\n\nThe diagnosis of HFMD is usually made clinically. The virus can be detected in the stool about 6 weeks after infection; however, shedding from the oropharynx is generally less than 4 weeks. Light microscopy of biopsies or scrapings of vesicles differentiates HFMD from varicella-zoster",
      "score": 0.462061
    },
    {
      "number": 14,
      "title": "Infectious Diseases",
      "detail": "pmc.ncbi.nlm.nih.gov",
      "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC7123921",
      "authors": "pmc.ncbi.nlm.nih.gov",
      "host": "pmc.ncbi.nlm.nih.gov",
      "snippet": "(hypotension, hypoperfusion) as in bacterial meningitisBest diagnostic test:CSF enterovirus PCRHerpanginaCaused by many enteroviruses, including coxsackievirus type ASudden onset ofhigh fever in children 3–10 years of age, and can be associated with vomiting, malaise, myalgia, and backachePoor intak",
      "score": 0.45900398
    },
    {
      "number": 15,
      "title": "Rapid detection of hand, foot and mouth disease ...",
      "detail": "pubmed.ncbi.nlm.nih.gov",
      "url": "https://pubmed.ncbi.nlm.nih.gov/29758237",
      "authors": "pubmed.ncbi.nlm.nih.gov",
      "host": "pubmed.ncbi.nlm.nih.gov",
      "snippet": "by M Wang · 2018 · Cited by 27 — The multiplex real-time PCR methodology established in this study can be employed for the rapid detection of the four most prevalent HFMD-associated EVs, for",
      "score": 0.42978892
    },
    {
      "number": 16,
      "title": "Viral Infections of the Oral Mucosa - StatPearls - NCBI Bookshelf",
      "detail": "www.ncbi.nlm.nih.gov",
      "url": "https://www.ncbi.nlm.nih.gov/books/NBK585132",
      "authors": "www.ncbi.nlm.nih.gov",
      "host": "www.ncbi.nlm.nih.gov",
      "snippet": "Hand, Foot, and Mouth Disease\n\nHand, foot, and mouth disease is caused by the coxsackie virus A16 or enterovirus 71 and is most often found in children younger than 10.(#article-131967.r18)(#article-131967.r19) The infection is characterized by a seasonal pattern, with outbreaks in the summer months",
      "score": 0.33685493
    },
    {
      "number": 17,
      "title": "Basic Reproduction Number of Enterovirus 71 and ...",
      "detail": "pubmed.ncbi.nlm.nih.gov",
      "url": "https://pubmed.ncbi.nlm.nih.gov/33320199",
      "authors": "pubmed.ncbi.nlm.nih.gov",
      "host": "pubmed.ncbi.nlm.nih.gov",
      "snippet": "by Z Zhang · 2021 · Cited by 34 — Enterovirus 71 (EV-A71), coxsackievirus A16 (CV-A16), and coxsackievirus A6 (CV-A6) are common serotypes causing hand, foot, and mouth disease",
      "score": 0.65359193
    },
    {
      "number": 18,
      "title": "a new emerging pathogen causing hand, foot and mouth ...",
      "detail": "pubmed.ncbi.nlm.nih.gov",
      "url": "https://pubmed.ncbi.nlm.nih.gov/26112307",
      "authors": "pubmed.ncbi.nlm.nih.gov",
      "host": "pubmed.ncbi.nlm.nih.gov",
      "snippet": "Enterovirus 71 (EV71) and coxsackievirus A16 (CA16) are the predominant pathogens causing outbreaks of hand, foot and mouth disease (HFMD) worldwide.",
      "score": 0.6152965
    },
    {
      "number": 19,
      "title": "A Guide to Clinical Management and Public Health Response ...",
      "detail": "iris.who.int",
      "url": "https://iris.who.int/bitstreams/83910cae-0a19-4a57-bd38-bd119ed92179/download",
      "authors": "iris.who.int",
      "host": "iris.who.int",
      "snippet": "by World Health Organization · 2011 · Cited by 247 — Outbreaks of hand, foot, and mouth disease by enterovirus 71. High incidence of complication disorders of central nervous system.",
      "score": 0.58777803
    },
    {
      "number": 20,
      "title": "Recent Development of Enterovirus A Vaccine Candidates ...",
      "detail": "pubmed.ncbi.nlm.nih.gov",
      "url": "https://pubmed.ncbi.nlm.nih.gov/30095317",
      "authors": "pubmed.ncbi.nlm.nih.gov",
      "host": "pubmed.ncbi.nlm.nih.gov",
      "snippet": "by CY Fang · 2018 · Cited by 71 — Hand, foot, and mouth disease (HFMD) is a childhood illness commonly caused by enterovirus A. Enterovirus A71 (EV-A71) are the most commonly identified viruses",
      "score": 0.572078
    },
    {
      "number": 21,
      "title": "Enterovirus D - an overview",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/topics/medicine-and-dentistry/enterovirus-d",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "In the genus Enterovirus, enterovirus 71 (EV71) and coxsackievirus A16 (CVA16) cause hand, foot, and mouth disease (HFMD) in infants and young children.",
      "score": 0.59061456
    },
    {
      "number": 22,
      "title": "Modification effects of long-term air pollution levels on the ...",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/pii/S0147651324001350",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "by C Zhang · 2024 · Cited by 17 — Hand, foot, and mouth disease (HFMD) is a contagious viral disease commonly caused by enterovirus 71 (EV-71) and coxsackie virus A16 that mainly affects infants",
      "score": 0.54942364
    },
    {
      "number": 23,
      "title": "Epidemiology and genetic characteristics of coxsackievirus ...",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/pii/S2590053623000514",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "by Z Sun · 2023 · Cited by 12 — Pediatric hand-foot-and-mouth disease (HFMD) is a common infectious illness caused by enterovirus (EV), first diagnosed in the late 1950s. It usually",
      "score": 0.5462305
    },
    {
      "number": 24,
      "title": "Clinicopathologic analysis of atypical hand, foot, and ...",
      "detail": "www.sciencedirect.com",
      "url": "https://www.sciencedirect.com/science/article/abs/pii/S0190962216309963",
      "authors": "www.sciencedirect.com",
      "host": "www.sciencedirect.com",
      "snippet": "by J Second · 2017 · Cited by 70 — Hand, foot, and mouth disease is a contagious viral infection usually affecting children. A resurgence of cases in adults, mainly caused by coxsackievirus A6",
      "score": 0.54274267
    }
  ],
  "publishedAt": "2026-08-24T18:17:17.295913+00:00",
  "updatedAt": "2026-08-24T18:17:17.295913+00:00",
  "readingMinutes": 6,
  "slug": "hand-foot-and-mouth-disease"
}