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Coxsackievirus A6-related hand foot and mouth disease: skin manifestations in a cluster of adult patients.
J Clin Virol. 2014 Mar; 59(3):201-3.JC

Abstract

BACKGROUND

Hand foot and mouth disease (HFMD) is a common childhood manifestation of enterovirus (EV) infection. It predominantly affects young children, and has been mainly associated with coxsackievirus (CV) A16 and EV 71.

OBJECTIVES

We report an unusual cluster of adult patients with HFMD.

STUDY DESIGN

Throat swabs and vesicular fluid samples obtained from patients admitted to the emergency room (ER) with HFMD were tested for EV by reverse transcription (RT)-real time PCR, and further subjected to sequencing and phylogenetic analysis.

RESULTS

CVA6 was identified as the causative agent of HFMD in five epidemiologically-unrelated adult patients (28-37 years old) admitted to the ER between December 2012 and February 2013. Phylogenetic analysis mapped the CVA6 strains into one cluster. All patients manifested with fever and a severe vasculitis-like rash, followed by spontaneous recovery.

CONCLUSIONS

This cluster identifies CVA6 as an emerging cause of HFMD of unusual age distribution, seasonality, and clinical severity, underscoring the need for continued alertness and clinical-genotypic surveillance of EV HFMD.

Authors+Show Affiliations

Shaare Zedek Medical Center Affiliated with the Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Electronic address: elibc1@yahoo.com.Shaare Zedek Medical Center Affiliated with the Hadassah-Hebrew University Medical Center, Jerusalem, Israel.Public Health Services, Israel Ministry of Health, Sheba Medical Center, Tel Hashomer 52621, Israel.Hadassah-Hebrew University Medical Center, Jerusalem, Israel.Hadassah-Hebrew University Medical Center, Jerusalem, Israel.Public Health Services, Israel Ministry of Health, Sheba Medical Center, Tel Hashomer 52621, Israel.Shaare Zedek Medical Center Affiliated with the Hadassah-Hebrew University Medical Center, Jerusalem, Israel.Hadassah-Hebrew University Medical Center, Jerusalem, Israel.Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24457116

Citation

Ben-Chetrit, Eli, et al. "Coxsackievirus A6-related Hand Foot and Mouth Disease: Skin Manifestations in a Cluster of Adult Patients." Journal of Clinical Virology : the Official Publication of the Pan American Society for Clinical Virology, vol. 59, no. 3, 2014, pp. 201-3.
Ben-Chetrit E, Wiener-Well Y, Shulman LM, et al. Coxsackievirus A6-related hand foot and mouth disease: skin manifestations in a cluster of adult patients. J Clin Virol. 2014;59(3):201-3.
Ben-Chetrit, E., Wiener-Well, Y., Shulman, L. M., Cohen, M. J., Elinav, H., Sofer, D., Feldman, I., Marva, E., & Wolf, D. G. (2014). Coxsackievirus A6-related hand foot and mouth disease: skin manifestations in a cluster of adult patients. Journal of Clinical Virology : the Official Publication of the Pan American Society for Clinical Virology, 59(3), 201-3. https://doi.org/10.1016/j.jcv.2013.12.012
Ben-Chetrit E, et al. Coxsackievirus A6-related Hand Foot and Mouth Disease: Skin Manifestations in a Cluster of Adult Patients. J Clin Virol. 2014;59(3):201-3. PubMed PMID: 24457116.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Coxsackievirus A6-related hand foot and mouth disease: skin manifestations in a cluster of adult patients. AU - Ben-Chetrit,Eli, AU - Wiener-Well,Yonit, AU - Shulman,Lester M, AU - Cohen,Matan J, AU - Elinav,Hila, AU - Sofer,Danit, AU - Feldman,Itamar, AU - Marva,Eytan, AU - Wolf,Dana G, Y1 - 2014/01/07/ PY - 2013/09/27/received PY - 2013/12/25/revised PY - 2013/12/27/accepted PY - 2014/1/25/entrez PY - 2014/1/25/pubmed PY - 2014/11/5/medline KW - Adult KW - Coxsackievirus A6 KW - Enterovirus KW - Hand foot and mouth disease SP - 201 EP - 3 JF - Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology JO - J. Clin. Virol. VL - 59 IS - 3 N2 - BACKGROUND: Hand foot and mouth disease (HFMD) is a common childhood manifestation of enterovirus (EV) infection. It predominantly affects young children, and has been mainly associated with coxsackievirus (CV) A16 and EV 71. OBJECTIVES: We report an unusual cluster of adult patients with HFMD. STUDY DESIGN: Throat swabs and vesicular fluid samples obtained from patients admitted to the emergency room (ER) with HFMD were tested for EV by reverse transcription (RT)-real time PCR, and further subjected to sequencing and phylogenetic analysis. RESULTS: CVA6 was identified as the causative agent of HFMD in five epidemiologically-unrelated adult patients (28-37 years old) admitted to the ER between December 2012 and February 2013. Phylogenetic analysis mapped the CVA6 strains into one cluster. All patients manifested with fever and a severe vasculitis-like rash, followed by spontaneous recovery. CONCLUSIONS: This cluster identifies CVA6 as an emerging cause of HFMD of unusual age distribution, seasonality, and clinical severity, underscoring the need for continued alertness and clinical-genotypic surveillance of EV HFMD. SN - 1873-5967 UR - https://www.unboundmedicine.com/medline/citation/24457116/Coxsackievirus_A6_related_hand_foot_and_mouth_disease:_skin_manifestations_in_a_cluster_of_adult_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1386-6532(13)00543-X DB - PRIME DP - Unbound Medicine ER -