An outbreak of coxsackievirus A6 hand, foot, and mouth disease associated with onychomadesis in Taiwan, 2010

BMC Infectious Diseases

Chun-Ming Hsu⁵  Luan-Yin Chang¹  Yen-Nan Chao⁴  Chen-Yen Tsai³  Tsuey-Li Lin⁴  Hui-Chen Lin⁴  Tsung-Pei Tsou⁴  Ming-Chih Liu⁴  Yuan-Pin Huang⁴  Sung-Hsi Wei² 

[1] Division of Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei 100, Taiwan;Institute of Public Health, National Yang-Ming University, Taipei, Taiwan;Department of Pediatrics, China Medical University Beigang Hospital, Yunlin, Taiwan;Taiwan Centers for Disease Control, Taipei, Taiwan;Department of Pediatrics, Kuang Tien General Hospital, Taichung, Taiwan

关键词: Onychomadesis;    and mouth disease;    foot;    Hand;    Coxsackievirus A6;   

Others  :  1175503
DOI  :  10.1186/1471-2334-11-346

 received in 2011-08-14, accepted in 2011-12-14,  发布年份 2011

【 摘 要 】

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.

【 授权许可】

   
2011 Wei et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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