Co-circulation of coxsackieviruses A6 and A10 in hand, foot and mouth disease outbreak in Finland

Blomqvist, Soile; Klemola, Päivi; Kaijalainen, Svetlana; Paananen, Anja; Simonen, Marja-Leena; Vuorinen, Tytti; Roivainen, Merja

doi:10.1016/j.jcv.2010.02.002

Cited by 261 publications

(264 citation statements)

References 22 publications

(10 reference statements)

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“…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%

“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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confidence: 99%

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

Oza²,

et al. 2013

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“…[13][14][15] CVA6, a common cause of herpangina, 4 has recently been associated with HFMD. 12,[16][17][18] It has been noted to have an atypical presentation with regard to seasonality, affected age group and clinical presentation. This virus is often associated with cases of HFMD in the winter season, in adults or older children, and is commonly associated with onychomadesis.…”

Section: Discussionmentioning

confidence: 99%

Hand-foot-and-mouth disease caused by coxsackievirus A6 in a patient infected with HIV

Mayaphi

Zyl

Sono

et al. 2015

Southern African Journal of Infectious Diseases

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Case studyIn August 2013, a 12-year-old boy infected with human immunodeficiency virus (HIV), who has been on antiretroviral therapy for more than two years, presented to the Tshwane District Hospital HIV clinic with fever and a rash. His symptoms had started two days ago. The rash was mainly on the palms and soles, and was sometimes itchy. His antiretroviral (ARV) drug regimen consisted of zidovudine, lamivudine and nevirapine. He was no longer receiving prophylaxis for pneumocystis pneumonia at the time of consultation.On examination, he was clinically stable and pyrexial (37.6 °C). The boy had a macular rash on his palms and soles (Figure 1), and a vesicular rash at the right corner of his mouth. There were dark streaks on his palate, and no other lesions. In addition to his ARV drugs, he was also prescribed mupirocin ointment and oral acyclovir. A blood sample for syphilis tests was taken on the day of consultation, and a stool sample was submitted a day later for enterovirus testing.Blood taken a month before this consultation revealed that the patient's HIV viral load was undetectable, and the CD4 count was 929 cells/µl (30.9%). The syphilis tests, rapid plasma reagin and the Treponema pallidum haemagglutination assay were all negative. Enterovirus realtime reverse transcription polymerase chain reaction (RT-PCR), carried out on a stool sample, tested positive. A leftover serum sample (after the syphilis testing) tested negative on enterovirus real-time RT-PCR.However, this sample was slightly haemolysed and was tested five days after collection. Nucleotide sequence analysis of the nested enterovirus RT-PCR products from the stool sample showed that the patient was infected with the coxsackievirus A6 (CVA6) strain. At the follow-up visit, the patient and his guardian reported that the rash had disappeared completely without any complications, roughly a week after the consultation. MethodEthical approval for this investigation was obtained from the University A 12-year-old boy on treatment for human immunodeficiency virus (HIV) presented to an HIV clinic with fever and a rash on the palms and soles. The syphilis test were negative. Enterovirus was identified from a stool sample by PCR and characterised as as coxsackievirus A6(CVA6). The patient completely recovered a week later. CVA6 has recently been associated with HFMD. This case highlights the significance of the laboratory confirmation of suspected HFMD cases aand phylogenetic analysis of the identified virus.Peer reviewed.

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“…In addition, outbreaks or sporadic cases may also be caused by other human enteroviruses, such as CV-A10. In recent years, CV-A10-related HFMD has been associated with increasingly common but sporadic cases of HFMD, and by global outbreak events (Blomqvist et al, 2010;Wu et al, 2010;Yu and Song, 2010;Davia et al, 2011;Lu et al, 2012;Mirand et al, 2012;He et al, 2013). All of these studies strongly demonstrated that CV-A10 infections are an important cause of HFMD.…”

Section: Introductionmentioning

confidence: 98%

Three-step method for the amplification of the coxsackievirus A10 genome

et al. 2016

Genet. Mol. Res.

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Co-circulation of coxsackieviruses A6 and A10 in hand, foot and mouth disease outbreak in Finland

Cited by 261 publications

References 22 publications

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

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

Hand-foot-and-mouth disease caused by coxsackievirus A6 in a patient infected with HIV

Three-step method for the amplification of the coxsackievirus A10 genome

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