Hand-foot-and-mouth disease differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]; Yamuna Kondapally, M.B.B.S[3]

Overview

Hand-foot-and-mouth disease should be differentiated from other conditions that cause maculopapular or vesicular rash which includes herpes simplex virus infections, herpangina, chicken pox and measles.

Differentiating Hand-foot-and-mouth disease from other Diseases

Hand-foot-and-mouth disease should be differentiated from other conditions that cause maculopapular or vesicular rash include:

Infection Presentation
Herpes simplex virus stomatitis Associated with high grade fever, acute gingivitis and oral ulcerations
The vesicles are small, grouped together and on an erythematous base.
Absence of rash on palms and soles.
A Tzanck test shows multinucleated giant cells and direct fluorescent antigens test can also help to differentiate hand-foot-and-mouth disease from herpes simplex virus infection.
Herpangina Raised white cell count but <15,000 cells/mL and serum creatine <1.5 times baseline
Bacteremia and sepsis Leucocytosis >15,000 cells/mL OR serum creatinene level >1.5 times baseline or abdominal tenderness and serum albumin < 3 g/dL
Chickenpox Hypotension or shock, ileus, megacolon, leucocytosis >20,000 cells/mL OR leucopenia <2,000, lactate >2.2 mmol/L, delirium, fever ≥ 38.5 °C, organ failure
Measles Raised white cell count but <15,000 cells/mL and serum creatine <1.5 times baseline
Pharyngitis Raised white cell count but <15,000 cells/mL and serum creatine <1.5 times baseline
Stevens-Johnson syndrome
Erythema multiforme
Raised white cell count but <15,000 cells/mL and serum creatine <1.5 times baseline
Henoch-Schönlein purpura Raised white cell count but <15,000 cells/mL and serum creatine <1.5 times baseline
Kawasaki disease Raised white cell count but <15,000 cells/mL and serum creatine <1.5 times baseline
Behcet's disease Raised white cell count but <15,000 cells/mL and serum creatine <1.5 times baseline
Pemphigus vulgaris Raised white cell count but <15,000 cells/mL and serum creatine <1.5 times baseline

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