Echovirus 4 associated to hand, foot and mouth disease

Abstract

SUMMARYHand, foot and mouth disease (HFMD) is a contagious enteroviral infection occurring primarily in children and characterized by vesicular palmoplantar eruptions and erosive stomatitis. Echovirus 4 (EV-4) has been commonly associated with aseptic meningitis. The association of HFMD with EV-4 has not been reported previously. Two samples of a 14-month child who presented mild fever, sores in the mouth, rash with blisters on the palm of hands and soles of feet were sent to Enteric Viruses Laboratory of Adolfo Lutz Institute. Clinical samples were inoculated in three different cell lines, and those which presented cytopathic effect (CPE), were submitted to Indirect Immunofluorescence Assay (IFA) and "one step" RT-PCR. Agarose gel electrophoresis from RT-PCR product, showed a product with 437 bp, which is characteristic of Enterovirus group. Echovirus 4 was identified by IFA. Although HFMD is a viral infection associated mainly with Enterovirus 71 (HEV-71) and Coxsackievirus A16 (CV-A16), our results demonstrate a diversity of serotype related to HFMD and stress the importance of epidemiological surveillance to this disease and its complications.

Distribution of enteroviruses in hospitalized children with hand, foot and mouth disease and relationship between pathogens and nervous system complications

“…Other major enteroviruses in our studies include ECHO14, CVB and CVA10. In recent years, these viruses have shown an increasing trend as causes of HFMD; in particular, CVA6 and CVA 10 have recently emerged as pathogens of HFMD outbreaks in other countries, including Singapore and Finland [40,41] With the exception of ECHO14, the echovirus serotypes identified and the CVB group viruses, including CVB3, CVB4 and CVB5, have been previously associated with cases of HFMD [18,42]. …”

Simultaneous Detection and Identification of Enteric Viruses by PCR-Mass Assay

“…During our clinical study, we identified 32 specimens co-infected with two or three viruses (Figure 3). Although HFMD is frequently caused by EV71 and coxA16, there are increasing numbers of reports of other viruses associated with HFMD outbreak or sporadic cases [20], [21]. Infection with a single virus rarely results in severe cases, but co-infection was associated with severe clinical syndrome with rapid progressive neurological and cardiopulmonary complications [22]–[24].…”

Molecular Diagnosis of Enteroviruses Associated with Hand, Foot and Mouth Disease (HFMD)

“…Human enterovirus 71 (HEV-71) and Coxsackievirus A16 (CV-A16) are common etiological agents causing HFMD epidemics. HFMD usually spreads from person-to-person through contact with nose or throat discharges, feces or vesicular fluid [1].…”