Hand Foot Mouth Disease (HFMD) is a viral infection of children caused by Coxsackie virus A-16, a type of enterovirus. Individual cases and outbreaks of HFMD occur worldwide. There are reports of HFMD epidemics from India. Recurrence of HFMD is very rare. We report here, a sporadic case of recurrent HFMD.
Keywords: Hand foot mouth disease, recurrent, children
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Dias E, Dias M. Recurring hand foot mouth disease in a child. Ann Trop Med Public Health 2012;5:40-1
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Dias E, Dias M. Recurring hand foot mouth disease in a child. Ann Trop Med Public Health [serial online] 2012 [cited 2020 Aug 15];5:40-1. Available from: https://www.atmph.org/text.asp?2012/5/1/40/92879
Hand Foot Mouth Disease (HFMD) is a common viral disease of infants and children below 10 years of age. Older children and adults are occasionally affected, but tend to develop milder form of illness compared to younger children. Coxsackie virus A16 is the most common cause, although many other enteroviruses are also associated with HFMD including Coxsackie’s virus A4, A5, A6, A7, A9, A10, A24, B2 to B5 and echo virus 18. Another prominent cause of HFMD is enterovirus 71, which has caused large outbreaks in Australia, US.  Recurrence of HFMD is very rare. We report here a case of HFMD recurrence in 9-year-old child. It is reported here for its rarity.
A 9-year-old child presented with history of fever, cold and oral ulcers on the lips and buccal mucosa with papulo-vesicular lesions over the hand, feet both dorsal, palmer, planter surface, buttocks and trunk. Child also complained of difficulty in swallowing which improved in 3 days. The diagnosis of HFMD was made on clinical grounds because of the pathognomic clinical presentation. The child was treated symptomatically with antipyretics, antihistamines and calamine lotion. It was a mild illness. The lesions healed completely without any complications in 7-8 days. Patient gave a history of similar episode of high grade fever, ulcer, and vesicular rash over the mouth, hand, feet with difficulty in swallowing which lasted for 10 days. It was more severe compared to the present episode.
HFMD is a viral disease which should be differentiated from apthous ulcers, Varicella, Herpangina. Since 1997, outbreaks of HFMD caused by enterovirus 71 have been reported in Asia particularly from Malaysia,  Singapore  and Taiwan.  In India Sasidharan et al., reported HFMD epidemic caused by EV 71 from Calicut for the first time in 2003.  Later epidemics have been reported from Nagpur,  West Bengal  and Assam. 
Infection is spread by direct contact with the virus. Virus is shed in nose, throat secretions, saliva, blister fluid and stool of infected person. The virus can remain in the body for weeks even after the patient has recovered completely. Infection results in immunity to the specific virus that caused HFMD. But recurrence of HFMD is not known in normal immunocompetent children. There is one case report of HFMD recurring during common variable deficiency.  Our case would be the first case of a recurrent HFMD from India A second case of HFMD may occur following infection with a different member of the entero virus group. 
Increasing number of case warrants for awareness among pediatricians and dermatologists. Quick detection and treatment is required to prevent cardiopulmonary and neurological complications and prevention of virus transmission to others to avert epidemics. Closure of schools or staying away from schools may not of much help as virus is excreted in feces for several weeks but may help to bring down the harshness of epidemics.
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