Coxsackievirus A6 Polymorphic Exanthem in Israeli Children

Renert‐Yuval, Yael; Marva, Eytan; Weil, Merav; Shulman, Lester M.; Gencylmaz, Nilsu; Sheffer, Sivan; Wolf, Dana; Molho‐Pessach, Vered

doi:10.2340/00015555-2261

Cited by 11 publications

(10 citation statements)

References 20 publications

(23 reference statements)

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“…This virus had not been identified at baseline because our investigative protocol did not include the detection of enteroviruses. Indeed, enterovirus infections are rarer in adults (our population) than in children, and their clinical presentation is most often in the form of hand, foot and mouth disease syndrome or vesicular eruptions, and rarely as exanthema . However, we propose that the enterovirus found by metagenomics in our study could be the responsible pathogen in these cases, because it is not normally present in the cutaneous microbiome .…”

Section: Discussionmentioning

confidence: 64%

Acute exanthemas: a prospective study of 98 adult patients with an emphasis on cytokinic and metagenomic investigation

et al. 2019

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Summary Background Acute exanthemas (AEs) are frequently seen; they can be caused by drugs or viruses but often the cause is unknown. Objectives To describe the clinical, virological and histological aspects of AEs and explore their cytokinic and metagenomic profiles. Methods This prospective study examined 98 patients with AE, from February to July 2014. Clinical data were recorded in a standardized chart. Virological investigation and skin biopsies were performed. In addition, blood and skin samples were analysed for cytokines and then by a shotgun metagenomic approach. We identified five groups of patients: those with maculopapular exanthemas (MPEs) that were virally induced (group 1); those with drug‐induced MPEs (group 2), those with MPEs that were both viral and drug induced (group 3), those with idiopathic MPEs (group 4) and those with pityriasis rosea (group 5). Results A virus was identified in 29 cases (human herpesvirus 6, 72%). Cytokinic analysis of the skin (n = 23 MPEs) showed higher levels of interferon‐γ and interleukin‐1 receptor‐α in viral MPEs, higher interleukin‐33 levels in idiopathic MPEs, and higher macrophage inflammatory protein 1α levels in drug‐induced MPEs. By metagenomics analysis (n = 10 MPEs), viruses identified with routine practice methods were not found in group 1 (n = 4 MPEs). However, Enterovirus A was detected in two cases, especially in a group 1 patient for whom metagenomic analysis rectified the diagnosis of the culprit agent. Conclusions Human herpesvirus 6 was the virus most frequently identified, and histology did not discriminate MPEs. In addition, the level of interleukin‐33 seen in idiopathic MPEs suggests that an environmental factor may be the trigger for these. The results bring into question the utility of routine polymerase chain reaction analysis and viral serology for determining cause in AE. What's already known about this topic? Acute exanthemas, especially maculopapular exanthemas, are a frequent reason for patients consulting emergency and dermatology departments. It is difficult to evaluate the aetiology of acute exanthema based on the clinical aspects. Few data are available on the investigations needed in routine practice, and no prospective series have been published. What does this study add? Our study provides a global and prospective description of acute exanthemas. Cytokine analysis could help to investigate the pathophysiology of idiopathic eruptions. Metagenomic analysis provides new insights about the value of routine practice virological investigations. We show for the first time the feasibility of metagenomics analysis in the skin, which results question the interest of routine PCR and viral sérologies for the exploration of such acute exanthemas.

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Section: Discussionmentioning

confidence: 64%

Acute exanthemas: a prospective study of 98 adult patients with an emphasis on cytokinic and metagenomic investigation

et al. 2019

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“…For instance, the 2012 outbreak of HFMD in Thailand was because of CVA6, but from 2008-2011, CVA16 and EV71 were the major viral agents (16). It is confirmed by similar reports from China, Singapore (2008), Finland (2008), Japan (2010), Taiwan (2010), Thailand (2012), India (2012), and North America (2012) (3,14,(16)(17)(18)(19)(20)(21).…”

Section: Discussionmentioning

confidence: 74%

Co-Circulation of Echovirus 6 and 30 with Coxsackievirus A6 Among Children with Hand, Foot, and Mouth Disease in Ahvaz, Southwest Iran

Rasti

Rastegarvand

Makvandi

et al. 2019

Arch Clin Infect Dis

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Objectives: The aim of this study was to evaluate the etiologic agents of a hand, foot, and mouth disease (HFMD) outbreak in Ahvaz, Southwest Iran and their evolutionary analysis by phylogenetic construction and Simplot analysis. Methods: We collected 16 serum samples in an outbreak of HFMD in Ahvaz in October 2013. RNA was extracted from the samples and subjected to reverse transcription polymerase chain reaction for detection of Enterovirus group A and B. Positive cases were sequenced and subjected to phylogenetic and Simplot analysis for detecting the signs of recombination. Results: Of the 16 specimens, nine (56.25%) were PCR-positive with the universal primers for the Enterovirus 5'UTR region. Coxsackievirus A6 was detected as a predominant agent of HFMD with two cases of Echovirus 6 and Echovirus 30. In the case of Echovirus 6, the signs of recombination in the 5'UTR region were observed based on phylogenetic and Simplot analysis. Conclusions: Coxsackievirus A6 is the main agent of HFMD in Ahvaz. The evidence of recombination in this isolate of Echovirus 6 in this study emphasizes common hygiene practices and sanitation to prevent the circulation of this isolate in community and the advent of new strains.

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“…According to the National Enterovirus Surveillance System, Coxsackievirus A9 accounted for 1.5% of the 2758 cases of enterovirus and human parechovirus infections during 2014 to 2016 10 . Coxsackieviruses have been linked to a variety of dermatologic entities, such as hand‐foot‐mouth disease, eczema coxsackium, and polymorphic exanthems ranging from a petechial and purpuric eruption to a Gianotti‐Crosti‐like eruption 16‐18 . In addition, there are anecdotal reports of Wells syndrome and papular‐purpuric gloves and socks syndrome associated with Coxsackieviruses 19,20 .…”

Section: Discussionmentioning

confidence: 99%

Viral panniculitis in a patient with disseminated opportunistic Enterovirus infection

et al. 2020

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Infection‐induced panniculitis has been described in association with a broad range of microorganisms. Among those, viral panniculitis represents a minor category, with only a few anecdotal reports in the literature documenting viral infection in the subcutaneous fat. Herein, we report a woman in her 30s with seropositive rheumatoid arthritis on rituximab and prednisone, who presented with a 6‐month history of progressive multisystem manifestations, including unintentional weight loss, fever, fatigue, myopathy, pancreatitis, and sensorineural hearing loss. She had indurated plaques on her thighs characterized by predominantly lobular panniculitis with chronic lymphohistiocytic inflammation. Molecular studies performed at the Centers for Disease Control and Prevention identified evidence of Enterovirus group with the highest identity of Coxsackievirus A9. Enterovirus RNA was also detected in the cerebrospinal fluid and muscle. Based on the findings, a diagnosis of disseminated enteroviral infection in the setting of B‐cell depletion was rendered. To the best of our knowledge, this represents the first reported case of viral panniculitis with documentation of Coxsackievirus A9 in the skin. Since rituximab may be used for the treatment of autoimmune dermatological diseases, familiarity of the potential occurrence of severe enteroviral infections in the setting of immunosuppressive treatment is important for dermatopathologists.

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Coxsackievirus A6 Polymorphic Exanthem in Israeli Children

Cited by 11 publications

References 20 publications

Acute exanthemas: a prospective study of 98 adult patients with an emphasis on cytokinic and metagenomic investigation

Acute exanthemas: a prospective study of 98 adult patients with an emphasis on cytokinic and metagenomic investigation

Co-Circulation of Echovirus 6 and 30 with Coxsackievirus A6 Among Children with Hand, Foot, and Mouth Disease in Ahvaz, Southwest Iran

Viral panniculitis in a patient with disseminated opportunistic Enterovirus infection

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