An outbreak of coxsackievirus A6 hand, foot, and mouth disease associated with onychomadesis in Taiwan, 2010
Open Access
- 14 December 2011
- journal article
- Published by Springer Science and Business Media LLC in BMC Infectious Diseases
- Vol. 11 (1), 346
- https://doi.org/10.1186/1471-2334-11-346
Abstract
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. 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. 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. 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.Keywords
This publication has 15 references indexed in Scilit:
- Onychomadesis Outbreak in Valencia, Spain Associated with Hand, Foot, and Mouth Disease Caused by EnterovirusesPediatric Dermatology, 2011
- Onychomadesis after a hand, foot, and mouth disease outbreak in Spain, 2009Epidemiology and Infection, 2010
- Co-circulation of coxsackieviruses A6 and A10 in hand, foot and mouth disease outbreak in FinlandJournal of Clinical Virology, 2010
- Coxsackievirus A6 and Hand, Foot, and Mouth Disease, FinlandEmerging Infectious Diseases, 2009
- Rapid and Highly Sensitive Coxsackievirus A Indirect Immunofluorescence Assay Typing Kit for Enterovirus SerotypingJournal of Clinical Microbiology, 2008
- Epidemiological survey of enterovirus infections occurring in Taiwan between 2000 and 2005: Analysis of sentinel physician surveillance dataJournal of Medical Virology, 2007
- MEGA4: Molecular Evolutionary Genetics Analysis (MEGA) Software Version 4.0Molecular Biology and Evolution, 2007
- Nail Matrix Arrest Following Hand‐Foot‐Mouth Disease: A Report of Five ChildrenPediatric Dermatology, 2000
- Basic local alignment search toolJournal of Molecular Biology, 1990
- Nail changes secondary to systemic drugs or ingestantsJournal of the American Academy of Dermatology, 1984