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An outbreak of coxsackievirus A6 hand, foot, and mouth disease associated with onychomadesis in Taiwan, 2010.
BMC Infect Dis. 2011 Dec 14; 11:346.BI

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.

Authors+Show Affiliations

Taiwan Centers for Disease Control, Taipei, Taiwan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22168544

Citation

Wei, Sung-Hsi, et al. "An Outbreak of Coxsackievirus A6 Hand, Foot, and Mouth Disease Associated With Onychomadesis in Taiwan, 2010." BMC Infectious Diseases, vol. 11, 2011, p. 346.
Wei SH, Huang YP, Liu MC, et al. An outbreak of coxsackievirus A6 hand, foot, and mouth disease associated with onychomadesis in Taiwan, 2010. BMC Infect Dis. 2011;11:346.
Wei, S. H., Huang, Y. P., Liu, M. C., Tsou, T. P., Lin, H. C., Lin, T. L., Tsai, C. Y., Chao, Y. N., Chang, L. Y., & Hsu, C. M. (2011). An outbreak of coxsackievirus A6 hand, foot, and mouth disease associated with onychomadesis in Taiwan, 2010. BMC Infectious Diseases, 11, 346. https://doi.org/10.1186/1471-2334-11-346
Wei SH, et al. An Outbreak of Coxsackievirus A6 Hand, Foot, and Mouth Disease Associated With Onychomadesis in Taiwan, 2010. BMC Infect Dis. 2011 Dec 14;11:346. PubMed PMID: 22168544.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An outbreak of coxsackievirus A6 hand, foot, and mouth disease associated with onychomadesis in Taiwan, 2010. AU - Wei,Sung-Hsi, AU - Huang,Yuan-Pin, AU - Liu,Ming-Chih, AU - Tsou,Tsung-Pei, AU - Lin,Hui-Chen, AU - Lin,Tsuey-Li, AU - Tsai,Chen-Yen, AU - Chao,Yen-Nan, AU - Chang,Luan-Yin, AU - Hsu,Chun-Ming, Y1 - 2011/12/14/ PY - 2011/08/14/received PY - 2011/12/14/accepted PY - 2011/12/16/entrez PY - 2011/12/16/pubmed PY - 2012/6/2/medline SP - 346 EP - 346 JF - BMC infectious diseases JO - BMC Infect. Dis. VL - 11 N2 - 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. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/22168544/An_outbreak_of_coxsackievirus_A6_hand_foot_and_mouth_disease_associated_with_onychomadesis_in_Taiwan_2010_ L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-11-346 DB - PRIME DP - Unbound Medicine ER -