BackgroundIn 2010, an outbreak of coxsackievirus A6 (CA6) hand, foot and mouth disease (HFMD) occurred in Taiwan and some patients presented with onychomadesis and desquamation following HFMD. Therefore, we performed an epidemiological and molecular investigation to elucidate the characteristics of this outbreak.MethodsPatients who had HFMD with positive enterovirus isolation results were enrolled. We performed a telephone interview with enrolled patients or their caregivers to collect information concerning symptoms, treatments, the presence of desquamation, and the presence of nail abnormalities. The serotypes of the enterovirus isolates were determined using indirect immunofluorescence assays. The VP1 gene was sequenced and the phylogenetic tree for the current CA6 strains in 2010, 52 previous CA6 strains isolated in Taiwan from 1998 through 2009, along with 8 reference sequences from other countries was constructed using the neighbor-joining command in MEGA software.ResultsOf the 130 patients with laboratory-confirmed CA6 infection, some patients with CA6 infection also had eruptions around the perioral area (28, 22%), the trunk and/or the neck (39, 30%) and generalized skin eruptions (6, 5%) in addition to the typical presentation of skin eruptions on the hands, feet, and mouths. Sixty-six (51%) CA6 patients experienced desquamation of palms and soles after the infection episode and 48 (37%) CA6 patients developed onychomadesis, which only occurred in 7 (5%) of 145 cases with non-CA6 enterovirus infection (p < 0.001). The sequences of viral protein 1 of CA6 in 2010 differ from those found in Taiwan before 2010, but are similar to those found in patients in Finland in 2008.ConclusionsHFMD patients with CA6 infection experienced symptoms targeting a broader spectrum of skin sites and more profound tissue destruction, i.e., desquamation and nail abnormalities.

Taiwan Centres for Disease Control.

Adenovirus type 7 caused a high proportion of severe infections.

The ingestion of foreign bodies such as coins, fish bones, plastic toy parts, batteries, and needles is common in children. Although the majority of ingested foreign bodies pass through the gastrointestinal tract unaided, some children require either nonsurgical or surgical intervention. The medical records of children who presented to the pediatric emergency department of a single tertiary referral center between December 2001 and May 2006 were reviewed. A total of 87 patients underwent an endoscopic procedure because of suspected foreign body ingestion and foreign bodies were identified by endoscopy in 74 patients (85.1%). The mean age of these 74 patients was 3.4 years (range, 6 months to 13 years). The most common site of foreign body lodgement was the esophagus (n = 38, 51.4%); other sites included the stomach (n = 33, 44.6%) and duodenum (n = 3, 4.0%). The types of foreign bodies included coins (n = 42, 56.8%), button batteries (n = 16, 21.6%), sharp objects (n = 9, 12.2%), chicken bones (n = 2, 2.7%) and others (n = 5, 6.7%). Only two foreign bodies (button batteries) in the duodenum could not be removed successfully by endoscopy. Instead, they were moved into the intestine and then eliminated spontaneously the following day. There were no major complications caused by foreign body ingestion or endoscopic procedures. The outcome of all patients was uneventful without morbidity or mortality. In our experience, endoscopic removal of foreign bodies under general anesthesia is an effective and safe method in children; the method also prevents erosion and perforation of the gastrointestinal tract.