Three Cases of Intra-familial Transmission of Hand, Foot and Mouth Disease Treated with Acyclovir

Abstract

Background: Hand, foot and mouth disease (HFMD) is a viral illness that presents mainly in children but also in adults with constitutional symptoms such as low-grade fever, malaise, and myalgia in addition to macular, maculopapular, or papulovesicular skin lesions on hands, feet, and mouth. No specific antiviral therapy is available for HFMD as most cases have a benign clinical course with complete resolution of symptoms and signs within 7 to 10 day. To our knowledge, three previous studies have demonstrated prompt symptomatic relief and shortened disease course after initiating treatment with acyclovir. Case Presentation: Three cases of intra-familial transmission HFMD including two young siblings (2-year-old boy and 4-year-old boy) and their 37-year-old immunocompetent mother. The diagnosis was made clinically and therapy with oral acyclovir was initiated within 24 hours of first lesion appearance for all three cases. The young siblings received oral acyclovir 200 mg four times daily, while their immunocompetent mother received acyclovir 800 mg four times daily. In the two young siblings, new lesions stopped appearing and most existing lesions showed noticeable involution after a single day of treatment. Significant reduction in pruritus and defervescence were also noted at this time. Complete resolution was achieved with three days of acyclovir therapy. The single vesicle observed on their mother showed complete resolution after a single day of treatment. Conclusion: We present three studies of HFMD successfully treated with acyclovir to demonstrate the therapeutic benefit of acyclovir for symptomatic HFMD in young children and adults. Early initiation of oral acyclovir may influence the disease course by shortening the duration and intensity of symptoms. In the case of outbreaks, in particular, acyclovir should be considered as it may offer benefit to the population at large. We recommend a randomized, controlled trial to further investigate the therapeutic role of acyclovir in HFMD.