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Hand, foot, and mouth disease and herpangina

José R Romero, MD, FAAP
Section Editors
Morven S Edwards, MD
Jan E Drutz, MD
Deputy Editor
Mary M Torchia, MD


Hand, foot, and mouth disease (HFMD) is a clinical syndrome characterized by an oral enanthem and a macular, maculopapular, or vesicular rash of the hands and feet (and possibly other locations) [1]. HFMD is one of the most recognizable viral exanthems in children and adults [2]. HFMD was first described in a summer outbreak that occurred in Toronto, Canada in 1957 and was caused by coxsackievirus A16 [3]. Since then, at least 15 other enterovirus serotypes have been shown to cause HFMD, most commonly Coxsackievirus A serotypes.

Herpangina is a benign clinical syndrome characterized by fever and a painful papulo-vesiculo-ulcerative oral enanthem [4]. It can be clinically differentiated from HFMD and primary herpetic gingivostomatitis [5]. Herpangina was first described in the 1920s but the viral etiology was not established until 1951 [4,6,7]. Herpangina is caused by 22 enterovirus serotypes, most commonly Coxsackievirus A serotypes.

An overview of HFMD and herpangina will be presented here. Other enterovirus infections are discussed separately. (See "Enterovirus and parechovirus infections: Epidemiology and pathogenesis" and "Enterovirus and parechovirus infections: Clinical features, laboratory diagnosis, treatment, and prevention".)


Multiple enterovirus serotypes cause HFMD and herpangina (table 1). The majority of these serotypes belong to the Enterovirus A species of the genus Enterovirus. (See "Enterovirus and parechovirus infections: Epidemiology and pathogenesis", section on 'Classification'.)

Coxsackievirus A16 and enterovirus A71 are the serotypes most frequently associated with HFMD and are responsible for the majority of large outbreaks. Enterovirus A71 has been associated with outbreaks involving thousands of persons in the Asia-Pacific region [8,9]. Beginning in 2008, coxsackievirus A6 has been increasingly reported as a cause of outbreaks of HFMD around the world [10-17]. (See 'Enterovirus A71 HFMD' below and 'Coxsackievirus A6 HFMD' below.)

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Literature review current through: Nov 2017. | This topic last updated: Jul 06, 2017.
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