CAMAGÜEY.- We are in a season of the year in which in a natural way, as described in the medical literature, at the end of summer and beginning of autumn increases viral infections, due to the environmental humidity and other weather factors of countries such as ours. Thus began our dialog with Dr. Yamina Rivero Fernández, holder of a Master's Degree in Infectious Diseases, specialist of 2nd. Grade in Pediatrics in the Hospital Eduardo Agramonte Piña, of this city, in addition, Assistant Professor at the University of Medical Sciences Carlos J. Finlay.

I moved closer to her interested in the subject of today, precisely because of the time of year and knowing about this condition that describes us as: "It is an acute respiratory disease (term which includes several infectious diseases of the upper respiratory tract), this one is not so complicated, of viral etiology, produced by Coxsackievirus group A and within this the most important serotypes are 4 and 5, 9, 10 and 16, major causes of the syndrome called hand, foot and mouth, to which we are referring to and between the enterovirus we have the 71.

"How is it transmitted?

-Through the aerosols, that is that even adults can contaminate the children through the droplets of saliva that go from one person to another, but also, and very important, is that it can be contracted through the hands because there is a viral type that is an enterovirus and is eliminated in the stool, and if the individual goes to the bathroom and does not wash his hands becomes an asymptomatic carrier of the disease. It can appear in outbreaks, for example in the nurseries or where there is a cluster of people, precisely for that contact.

- Does it tend to get complicated?

- No, it is generally not.

- So, does any respiratory condition cannot be converted in this syndrome?

- In fact, only in the cases that I mentioned before.

- What is its clinical expression?

-The child begins with fever, which sometimes is not so high, respiratory symptoms in few occasions, rhinorrhea (plenty of fluid through the nose), sporadic cough, and in the course of three to five days an exanthema, that is what we see in skin and the name will locate us on what we find. In the first place, although are not visible, the vesicle lesions inside the mouth, especially in the cheeks, and others that are seen around the mouth of the baby, in the palms of the hands and the soles of the feet, hence its name.

- Why are these vesicles distributed that way?

-It is not described the cause of this peculiar way of "choice" these parts of the body, but if I can assure you that it is a condition described since a long time ago and is named by the location of the lesions. Although, we are currently seeing typical cases and others not so typical, because some babies have presented this skin condition in other parts of their bodies.

- What should parents do to a child with this disease?

-Always, to take him to the doctor. In the clinics of the family physician and nurse, that is, in the primary health care, are prepared to diagnose this condition and treat it with success.

"As it is natural parents are alarmed because the baby does not want to eat, something very logical due to the lesions in the mouth, they cause him pain. He must stay with the discomfort around five to seven days, with a very benign evolution, without complications and if any are very exceptional circumstances, and if it is caused by enterovirus, especially the 71 quoted may cause myocarditis (inflammation of the myocardium) which heals".

- Does it always require hospital isolation?

- No, not even drugs. The important thing is to isolate the child in his home, with extreme cleanliness, because if it is transmitted by secretions from the nose and throat, and if you clean him with a soft cloth or handkerchief, one has to pass through bleach before using it again, or in its defect, use disposable tissues or paper, so that these contaminant secretions die there and much washing of hands, that is essential.

"And if the cause is an enterovirus that person can be eliminating the virus in the feces of asymptomatic way several days, and the risk of spreading the disease increases if you don't wash your hands properly.

"It is good to reiterate that our physicians, pediatricians or not, are prepared to diagnose and treat the disease, and to follow it, because these children have to be visited by them in their homes."

- If the baby is taken to the hospital?

- He is attended, valued, is never without getting the medical service.

- With the condition at home, what is the most important thing to keep in mind?

- A comprehensive hygiene and medical follow-up. The virus usually do not require medicines or antibiotics and this makes them more difficult to be controlled.

- Does it have a preference of age?

-Between six months and two years of age; however, there may be other older kids suffering it and even adults, but in general, in the latter case behaves as the asymptomatic carrier

- What type of food is the most recommended?

- There is no doubt that the exclusive breastfeeding until the six months of age and combined for up to two years.

- If in addition to this syndrome, the child suffers from diseases of the heart, kidneys…

-If he has a chronic illness, care is another, this occurs before any health problem by simple it may seem.

- Other general tips?

- To maintain a strict hygiene, not to take the children where there is an excess of people, to be attentive to the symptoms, to visit the health care provider if the baby already has them, suspend the baby to attend the children's nursery, to have him at home and that he should be examine by his doctor to detect any slip and if he face it, the baby must be valued again and then everybody would take the necessary measures and procedures.

"If there is not complications, which is the most frequent, to wait its course until the medical discharge, and I insist that the solution is not to admit the baby in the hospital because before a condition like this one, he has his immune system to fight the virus and if you hospitalize him, there is the risk of becoming infected with bacteria and this should be avoided."





Translated by Linet Acuña Quilez