San José, Costa Rica, since 1956

Virus Produces Sores on Hands, Feet, Mouth

FOR parents of a feverish, sore-coveredchild, a diagnosis of “hand, foot andmouth disease” may sound grave. Butdon’t panic, experts say.Although it sounds like the live stock bornefoot-and-mouth disease – also knowas hoof-and-mouth – hand, foot and mouthdisease (HFMD) is a separate beast.Though both are caused by viruses thatproduce sores on hands and feet or – in thecase of animals, hooves – the respectiveviruses are human- or animal-specific.“It’s a completely different thing,” saidDr. Leana Castro, a pediatrician in Escazú,west of San José. “Many infections cangive the same symptoms.”HFMD’S trademark, however, is theappearance of rash-like sores on hands,feet, and around and inside the mouth.Unlike foot-and-mouth, HFMD occursonly in humans.Symptoms are similar to the commoncold: fever, sleeplessness, lack of appetite,sore throat. Patients – who tend to beyoung children – develop sores on theirfeet, mouth, and hands, which in somecases can spread all over the body.These lesions can be painful, accordingto Dr. Henry Wasserman, an epidemiologistwith the Health Ministry.HFMD is viral and is spread throughcontact with body fluids, said Castro. Severalviruses can cause HFMD, but themost common is called coxsackie virus,according to the U.S. Center for DiseaseControl.Because the virus can be passed onthrough contact with the open sores, theirlocation on the hands allows HFMD to bepassed easily among children who sharetoys. Therefore it’s a good idea for parentsto limit their children’s contact withothers while infected, according toWasserman.A different virus causes hoof-and mouthdisease, which is serious for livestockbut is not known to affect humans,though they can carry the disease andinfect animals, according to the U.S. government’sAnimal and Plant HealthInspection Service (APHIS). Though hoof and-mouth disease does not usually killanimals, it can result in large financiallosses for farmers faced with sick, skinnylivestock. Its highly contagious nature –almost all exposed animals become infected,according to APHIS – led to massiveslaughters of British cattle in 2001.THERE are no recorded cases of hoof and-mouth in Costa Rica, according toAgriculture Ministry spokeswoman PilarJiménez.HFMD, however, is quite common,reported Castro.“I see it (HFMD) pretty frequently inthe rainy season,” Castro said. “It’s verycommon all over the world.”THE Ministry of Health does not keepdata on HFMD, according to Wasserman,who added that he doesn’t think it’s awidespread problem.Though Castro doesn’t define HFMD asparticularly dangerous, afflicted childrenand adults should see a doctor, she said.“Obviously, it could be a problem,”Castro said, especially for children. “It’slike a cold, it’s annoying, they don’t eat,but it’s not serious or dangerous. Sick childrenmight have fever convulsions, but thisdoesn’t happen often. Most kids get betterwith no problems.”BUT in the meantime, parents and kidslive in misery. Judi Voorhees of SantaAna, southwest of San José, just nursed herdaughter Laiken, 1 1/2, and son Landen, 3,through HFMD.“In the second week of June, my daughterhadn’t been sleeping for three nights, shewas absolutely miserable,” Voorhees said.“She had a fever; she wouldn’t eat. On thethird day after the fever she got spots on theinside of her mouth, on her hands and feet.It was just awful. We stayed at home anddidn’t go out.”Voorhees, who was a teacher in theUnited States before moving to Costa Ricaless than a year ago, was familiar withHFMD, but she says that for someone whohas never seen it before, the symptoms canbe scary.“Your child acts so strange. They’re upcrying, and their skin peels off after therash disappears,” Voorhees said.THERE is no vaccine or cure forHFMD; in fact, there is very little to treat itat all.“It is treated symptomatically,” Castrosaid. “We give Tylenol for fever, andthere are some medications to treat symptoms,but these only help in some cases.”It is rare for adults to get HFMD, accordingto Castro, though it does happen.“They don’t get it so badly. They don’tusually get sores all over their body. Theyhave a more developed immune system,and so don’t transfer it as much.”

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