Case Study on Coxsackie Virus: Facts about Transmission of Infection

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Red rash around the mouth, bilateral palms of hands, and bilateral soles of the feet

History of Present Illness (HPI)

An 18-month-old child presented with a one-day history of red rash on hands, feet, and mouth. The patient's mother states that there is no itching, pain, or fever associated with it. The mother indicates that there is no relieving agent, but the rash was exacerbated by Benedryl. The last dose of Benedryl was last night around 7 pm before the patient went to bed. The child has no loss of appetite, and she goes to daycare

Last Menstrual Period (LMP- if applicable)

Not applicable


No known food or drug allergies

Past Medical History

The patient had a hand, foot, and mouth disease a year ago

Family History

The Mother and father are in good health with no history of rashes in the last six months. The Patients sister goes to daycare and has had a hand, foot, and mouth disease a year ago

Surgery History

The patient had Myringotomy with Tubes Bilateral in 2015

Social History (alcohol, drug, or tobacco use)

Not applicable

Current medications

The patient was on Benedryl OTC. The mother states to have given the patient one tsp. last night before bed


The skin was well hydrated but had a red rash on bilateral palms of hands, bilateral soles of feet, and around the patient's mouth. There were no lesions. The Oropharynx was red and swollen but with no exudate

Objective Data

Vital Signs/ Height/Weight

90/50, 85, 98.6,20, 23lb

Temperature is 98.6, blood pressure is 90/50, weight is 23lb. in general, and the patient appears well developed and well-nourished. The skin is well hydrated. There is a red rash with papules on the bilateral palms of hands, bilateral soles of the feet, and around the mouth


The head is normocephalic and atraumatic


The tympanic membranes were pink bilaterally, nasal mucosa was pink and moist. The oropharynx reveals redness and swelling


The abdomen was soft with no organomegaly, tenderness, distention, or a palpable mass


The rate and rhythm were regular with no murmurs or rub


The lungs were clear bilaterally to auscultation with normal breath sounds


Coxsackie Virus Differential Diagnosis

  1. Scabies causes burrows between fingers, on the wrist, feet, knees, and groin.

  2. Molluscum Contagiosum presents with Papules that have umbilicated centers and can spread on scratching to the rest of the body.

  3. Coxsackie viral infection has an incubation period of 3 to 7 days and presents with small blisters that ulcerate on the palm of hands, soles of the feet, and the diaper area. The patient can also have a sore throat with ulcerations on the mouth, tongue, and throat. (Kids Health, 2016).

Coxsackie Virus Medical Diagnosis

Coxsackie viral infection (hand, foot, and mouth) - Coxsackievirus causes hand, foot, and mouth disease which presents with painful blisters on the bilateral palms of hands and soles of the feet and around the mouth. The oropharynx was red and swollen.

Coxsackievirus Treatment

The patient will be given children's Tylenol suspension OTC. He will take 1tsp po q4-6 hours to relieve pain. The mother will stop administering Benadryl to the baby. Hand foot and mouth disease is a viral disease that affects children younger than five years of age. Hand foot and mouth disease presents with fever, skin rash, and mouth sores. Not all children will have the symptoms, but can still pass the Coxsackie virus. The mother should monitor the child for dehydration because some children can stop feeding due to sores in the back of their mouth. ("Hand Foot and Mouth Disease | Home | HFMD | CDC", 2016).

The disease can spread via close skin contact, fecal contamination, the air, or contact with contaminated objects and surfaces. Washing hands with soap and water often, disinfecting dirty surfaces and soiled items, and avoiding close skin contact like hugging, kissing, or sharing eating utensils or cups with an infected person can help prevent the spread of the disease. "The majority of HFMD infections are self-limited, hence require no treatment." (Coxsackie Virus: Facts about Transmission of Infection", 2016).

The infection often resolves after sometimes hence follow-up plan is not necessary.

No follow-up is needed unless the Coxsackie virus becomes worse. "Majority of HFMD infections is self-limited, so no treatment is required" ("Coxsackievirus: Facts about Transmission of Infection", 2016). Follow-up can be done when the child visits


Coxsackievirus: Facts about Transmission of Infection. (2016). Medicine Net.

Hand Foot and Mouth Disease | Home | HFMD | CDC. (2016). (2016). Coxsackievirus infection

Polisky, M. & Nichols, B. (2010). SOAP for pediatrics, Lippincott Williams and Wilkins, New York

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