An outbreak of coxsackievirus A6 hand, foot, and mouth disease associated with onychomadesis in Taiwan, 2010
Journal
BMC Infectious Diseases
Journal Volume
11
Pages
346
Date Issued
2011
Author(s)
Wei S.-H.
Huang Y.-P.
Liu M.-C.
Tsou T.-P.
Lin H.-C.
Lin T.-L.
Tsai C.-Y.
Chao Y.-N.
Hsu C.-M.
Abstract
Background: In 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.Methods: Patients 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.Results: Of 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.Conclusions: HFMD patients with CA6 infection experienced symptoms targeting a broader spectrum of skin sites and more profound tissue destruction, i.e., desquamation and nail abnormalities. ? 2011 Wei et al; licensee BioMed Central Ltd.
Subjects
And mouth disease; Coxsackievirus A6; Foot; Hand; Onychomadesis
SDGs
Other Subjects
virus protein; capsid protein; virus RNA; adolescent; adult; article; caregiver; child; controlled study; Coxsackie virus A; Coxsackie virus infection; disease association; Enterovirus; epidemic; female; Finland; gene sequence; hand foot and mouth disease; human; immunofluorescence; infant; major clinical study; male; nail disease; nucleotide sequence; preschool child; rash; school child; serotype; skin exfoliation; symptomatology; Taiwan; virus isolation; virus strain; classification; Enterovirus; epidemic; genetics; hand foot and mouth disease; isolation and purification; nail disease; phylogeny; reverse transcription polymerase chain reaction; sequence analysis; Taiwan; viral skin disease; virology; Adolescent; Adult; Capsid Proteins; Child; Child, Preschool; Disease Outbreaks; Enterovirus; Female; Hand, Foot and Mouth Disease; Humans; Infant; Male; Nail Diseases; Phylogeny; Reverse Transcriptase Polymerase Chain Reaction; RNA, Viral; Sequence Analysis, RNA; Skin Diseases, Viral; Taiwan; Young Adult
Type
journal article