This is a common and usually mild viral infection that often causes local clusters of infections among groups of young children and is characterised by oral ulceration and a vesicular rash on the extremities. It is caused by a variety of strains of the coxsackie A16 virus and is highly infectious. Sporadic cases associated with Coxsackie A4-7, A9, A10, B1-B3, and B5 have also been reported. It frequently spreads through classrooms, schools and local communities in an epidemic manner. The incubation period is between 3 and 10 days. It presents clinically as small, scattered oral ulcers that often cause few symptoms. Although the initial lesions are vesicular, intact blisters are rarely seen. Unlike primary herpes infections, the gingivae are rarely affected. It is unusual for regional lymph nodes to be involved except in severe cases and constitutional symptoms tend to be mild or absent. The cutaneous exanthem consists of small vesicles or occasionally larger blisters that form mainly around the base of fingers or toes, but may extend to involve any part of the limb. In some outbreaks, either the mouth or the extremities alone may be affected. Although serological investigations can confirm the diagnosis, due to the relatively mild and transient nature of the disease, this investigation is rarely undertaken. Typically, the condition resolves spontaneously within a week to 10 days and does not recur. However, in some epidemics patients have developed severe complications, including interstitial pneumonitis, myocarditis and encephalitis, resulting in death .
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