Clinical and epidemiologic features of Coxsackievirus A6 infection in children in northern Taiwan between 2004 and 2009

Lo, Shih Hsuan; Huang, Yhu Chering; Huang, Chung Guei; Tsao, Kuo Chien; Li, Wen Chen; Hsieh, Yao‐Ching; Chiu, Cheng Hsun; Lin, Tzou Yien

doi:10.1016/j.jmii.2011.01.031

Cited by 94 publications

(81 citation statements)

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“…The low rate of gastrointestinal and respiratory symptoms is also consistent with past reports of CVA6 HFMD. 3,6 Overall, the extracutaneous features of the 2011-2012 HFMD outbreak appear similar to those of the most common cause of HFMD, CVA16, rather than more virulent strains such as enterovirus 71. 37 Only 10 patients in our sample were hospitalized, primarily because of the unusual nature of the skin disease.…”

Section: Figurementioning

confidence: 85%

“…3,6 Fever and oropharyngeal pain were the 2 most commonly reported symptoms. The low rate of gastrointestinal and respiratory symptoms is also consistent with past reports of CVA6 HFMD.…”

Section: Figurementioning

confidence: 99%

“…1 Over the past 5 years, CVA6 has also been implicated in HFMD outbreaks in Finland, France, Spain, India, Taiwan, Japan, Singapore, China, and Boston, Massachusetts. [2][3][4][5][6][7][8][9][10][11] The atypical cutaneous features characterizing the 2011-2012 North American CVA6-associated HFMD outbreak have not been clearly defined.…”

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confidence: 99%

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“Eczema Coxsackium” and Unusual Cutaneous Findings in an Enterovirus Outbreak

Oza²,

et al. 2013

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OBJECTIVE: To characterize the atypical cutaneous presentations in the coxsackievirus A6 (CVA6)–associated North American enterovirus outbreak of 2011–2012. METHODS: We performed a retrospective case series of pediatric patients who presented with atypical cases of hand, foot, and mouth disease (HFMD) from July 2011 to June 2012 at 7 academic pediatric dermatology centers. Patients were included if they tested positive for CVA6 or if they met clinical criteria for atypical HFMD (an enanthem or exanthem characteristic of HFMD with unusual morphology or extent of cutaneous findings). We collected demographic, epidemiologic, and clinical data including history of skin conditions, morphology and extent of exanthem, systemic symptoms, and diagnostic test results. RESULTS: Eighty patients were included in this study (median age 1.5 years, range 4 months–16 years). Seventeen patients were CVA6-positive, and 63 met clinical inclusion criteria. Ninety-nine percent of patients exhibited a vesiculobullous and erosive eruption; 61% of patients had rash involving >10% body surface area. The exanthem had a perioral, extremity, and truncal distribution in addition to involving classic HFMD areas such as palms, soles, and buttocks. In 55% of patients, the eruption was accentuated in areas of eczematous dermatitis, termed “eczema coxsackium.” Other morphologies included Gianotti-Crosti–like (37%), petechial/purpuric (17%) eruptions, and delayed onychomadesis and palm and sole desquamation. There were no patients with serious systemic complications. CONCLUSIONS: The CVA6-associated enterovirus outbreak was responsible for an exanthem potentially more widespread, severe, and varied than classic HFMD that could be confused with bullous impetigo, eczema herpeticum, vasculitis, and primary immunobullous disease.

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Section: Figurementioning

confidence: 85%

“…3,6 Fever and oropharyngeal pain were the 2 most commonly reported symptoms. The low rate of gastrointestinal and respiratory symptoms is also consistent with past reports of CVA6 HFMD.…”

Section: Figurementioning

confidence: 99%

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“Eczema Coxsackium” and Unusual Cutaneous Findings in an Enterovirus Outbreak

Oza²,

et al. 2013

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“…Recently, CV-A6 and CV-A10 of the HEV-A serotype have been increasingly associated with infectious disease, such as HFMD, herpangina, and onychomadesis (10)(11)(12)(13)(14)(15)(16). The prevalences of other HEV-A infections were underestimated for many years because more attention has been paid to HEV71 and CV-A16 in China.…”

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confidence: 99%

Emergence, Circulation, and Spatiotemporal Phylogenetic Analysis of Coxsackievirus A6- and Coxsackievirus A10-Associated Hand, Foot, and Mouth Disease Infections from 2008 to 2012 in Shenzhen, China

et al. 2013

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“…CVA7 and CVA14 infrequently cause sporadic cases of HFMD (1,2,41). Other HEVAs, such as CVA2, CVA4, CVA5, CVA6, and CVA10, which belong to another group ("the CVA2 group"), are mainly associated with herpangina in infants, which is also caused by coxsackie B viruses or echoviruses (9,23,28,32,50). It has been reported that CVA6 and CVA10 occasionally cause epidemic outbreaks of HFMD (6,39).…”

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confidence: 99%

Human SCARB2-Dependent Infection by Coxsackievirus A7, A14, and A16 and Enterovirus 71

Yamayoshi

Iizuka

Yamashita

et al. 2012

J Virol

130

112

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Human enterovirus species A (HEV-A) consists of at least 16 members of different serotypes that are known to be the causative agents of hand, foot, and mouth disease (HFMD), herpangina, and other diseases, such as respiratory disease and polio-like flaccid paralysis. Enterovirus 71 (EV71) and coxsackievirus A16 (CVA16) are the major causative agents of HFMD. CVA5, CVA6, CVA10, and CVA12 mainly cause herpangina or are occasionally involved with sporadic cases of HFMD. We have previously shown that human scavenger receptor class B, member 2 (SCARB2) is a cellular receptor for EV71 and CVA16. Using a large number of clinical isolates of HEV-A, we explored whether all clinical isolates of EV71 and other serotypes of HEV-A infected cells via SCARB2. We tested this possibility by infecting L-SCARB2 cells, which are L929 cells expressing human SCARB2, by infecting human RD cells that had been treated with small interfering RNAs for SCARB2 and by directly binding the viruses to a soluble SCARB2 protein. We showed that all 162 clinical isolates of EV71 propagated in L-SCARB2 cells, suggesting that SCARB2 is the critical receptor common to all EV71 strains. In addition, CVA7, CVA14, and CVA16, which are most closely related to each other, also utilized SCARB2 for infection. EV71, CVA14, and CVA16 are highly associated with HFMD, and EV71 and CVA7 are occasionally associated with neurological diseases, suggesting that SCARB2 plays important roles in the development of these diseases. In contrast, another group of viruses, such as CVA2, CVA3, CVA4, CVA5, CVA6, CVA8, CVA10, and CVA12, which are relatively distant from the EV71 group, is associated mainly with herpangina. None of these clinical isolates infected via the SCARB2-dependent pathway. HEV-A viruses can be divided into at least two groups depending on the use of SCARB2, and the receptor usage plays an important role in developing the specific diseases for each group.

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Clinical and epidemiologic features of Coxsackievirus A6 infection in children in northern Taiwan between 2004 and 2009

Abstract: Cox A6 is among the major serotypes of enteroviruses in Taiwan and most cases presented as herpangina and hand-foot-mouth disease. Nearly half of the cases may have leukocytosis and elevated CRP levels. Outcomes are usually good.

Cited by 94 publications

References 10 publications

“Eczema Coxsackium” and Unusual Cutaneous Findings in an Enterovirus Outbreak

“Eczema Coxsackium” and Unusual Cutaneous Findings in an Enterovirus Outbreak

Emergence, Circulation, and Spatiotemporal Phylogenetic Analysis of Coxsackievirus A6- and Coxsackievirus A10-Associated Hand, Foot, and Mouth Disease Infections from 2008 to 2012 in Shenzhen, China

Human SCARB2-Dependent Infection by Coxsackievirus A7, A14, and A16 and Enterovirus 71

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