1. How is the virus transmitted?

Fecal-oral contamination. The virus is highly contagious and can reach epidemic levels, particularly in the summer and fall. Virus may be shed in the feces for three months.

2. What caused the pharyngeal ulcerations and papulovesicular lesions?

The incubation period is approximately one week. After initial replication in the gut, the virus is spread to the target organ by viremia. Most patients present with papulovesicular lesions and mild fever. The lesions may last three to four days. The maculopapular eruptions may also be evident on the buttocks, extremities, and face, more often in young children.

3. Why did the physician make a clinical diagnosis instead of ordering laboratory tests to identify the infectious agent?

The classic presentation and non-threatening nature of this viral infection generally allows for a clinical diagnosis. The virus can be cultured from the cutaneous vesicles or oral lesions and causes lytic cytopathic effect (CPE) in cultured cells. Immunofluorescence can then be used to "type" the virus. These studies are generally carried out for research or epidemiologic purposes, not diagnosis.

4. Are other family members likely to become infected?

Yes, if they don't have pre-existing immunity. Disease is no more severe in adults than in children.

5. Will the child have recurrent infections?

Type specific immunity is generated, providing protection from re-infection with that specific serotype of enterovirus. However, there are 64 serotypes of enterovirus, and little if any cross-protection.