Quick Case: Hand Foot Mouth Disease in a Remote Area in Northeast

By: Dr. J. Gnanaraj and Dr. Bipin Kumar

INTRODUCTION

The Assam Rifles have their colonies in remote areas and they are self contained units where 1000 to 2000 people live together. One such colony is near a place called Jalukie in Nagaland. Recently within a week 17 children presented with ulcers in the mouth, foot and hands that prevented them from eating and some had fever at presentation. All of them were from one housing unit. During the initial week they were treated conservatively with Paracectamol syrup and intravenous fluids if they were not able to eat.

Later they were give Zinc syrup and it helped them start eating from the next day. To check if it was the zinc syrup that made the difference it was not used in few patients and they did take a much longer time. A proper controlled trial is necessary to see if the Zinc syrup significantly reduced the morbidity due to the Hand Foot Mouth disease. Zinc is an immune-modulator that has shown to improve the symptoms of some of the viral diseases [2].

DISCUSSION

It is caused by enterovirus [16 & 17] called Coxsackie virus [1]. It is transmitted through contact with patients or things that they touch. It generally starts as a sore throat and then the ulcers develop. It is a self limiting disease that goes away after 10 days. The virus can stay for a long time especially in the spit and in the stools.
Zinc has an important role as an immune-modulator and has been used successfully for treatment of viral dermatological conditions [2]. Those who were started on zinc syrup were able to start eating without significant pain within 48 hours while those who did not receive it had problems with eating even after four to five days.

Dr. J. Gnanaraj MS, MCh [Urology], FICS, FARSI, FIAGES is a urologist and laparoscopic surgeon trained at CMC Vellore. He has been appointed as a Professor in the Electronics and Instrumentation Engineering Department of Karunya University and is the Director of Medical Services of the charitable organization SEESHA. He has a special interest in rural surgery and has trained many surgeons in remote rural areas while working in the mission hospitals in rural India. He has helped 21 rural hospitals start minimally invasive surgeries. He has more than 150 publications in national and international journals, most of which are related to modifications necessary for rural surgical practice. He received the Barker Memorial award from the Tropical Doctor for the work regarding surgical camps in rural areas. He is also the recipient of the Innovations award of Emmanuel Hospital Association for health insurance programs in remote areas and the Antia Finseth innovation award for Single incision Gas less laparoscopic surgeries. During the past year, he has been training surgeons in innovative gas less single incision laparoscopic surgeries.