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Severe atypical hand-foot-and-mouth disease in adults due to coxsackievirus A6: Clinical presentation and phylogenesis of CV-A6 strains.
J Clin Virol. 2019 01; 110:1-6.JC

Abstract

BACKGROUND

Typically, hand-foot-and-mouth disease (HFMD) is a mild childhood illness associated with coxsackievirus (CV)-A16, CV-A6, enterovirus (EV)-A71.

OBJECTIVES

To identify the viral agents associated with severe cases of atypical HFMD in Italy.

STUDY DESIGN

Epidemiologically unrelated cases of severe atypical HFMD admitted to the Emergency Room (ER) of IRCCS San Martino IST (Genoa, Italy) in 2014-2016 were investigated. Serologic screening for viral positivity was performed against exanthem-inducing agents. Ten cases with serology indicative of recent EV infection were selected. Molecular assays were used to detect viral genomes in blood [EVs, Parvovirus B19 (PVB19), herpesviruses (CMV; EBV, HHV-6, -7, -8)].

RESULTS

CV-A6 was detected in 10 cases of severe atypical HFMD. Two cases were also infected with PVB19. Herpesviruses were not detected. Phylogenetic analysis mapped the CV-A6 strains into a single cluster related to two recent isolates from a German and an Asian child. Fever, systemic symptoms, severe vasculitis-like rash, and enanthem were predominant at presentation. Spontaneous recovery occurred in 1-3 weeks.

CONCLUSIONS

CV-A6 is emerging as a frequent cause of severe atypical HFMD in Italian adults. This viral agent is disseminating worldwide. Dermatologists must identify the manifold alterations caused by EVs and understand the diagnostic power of current virology methods.

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Authors+Show Affiliations

Broccolo F
Department of Medicine and Surgery, School of Medicine, University of Milano-Bicocca, Monza, Italy. Electronic address: francesco.broccolo@unimib.it.
Drago F
DISSAL Department of Dermatology, IRCCS San Martino-IST, Genoa, Italy.
Ciccarese G
DISSAL Department of Dermatology, IRCCS San Martino-IST, Genoa, Italy.
Genoni A
Clinical Microbiology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
Puggioni A
Clinical Microbiology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
Rosa GM
Department of Internal Medicine, Cardiology, Ospedale Policlinico San Martino, Genoa, Italy.
Parodi A
DISSAL Department of Dermatology, IRCCS San Martino-IST, Genoa, Italy.
Manukyan H
Office for Vaccines Research and Review, FDA Center for Biologics Evaluation and Research, Silver Spring, MD, USA.
Laassri M
Office for Vaccines Research and Review, FDA Center for Biologics Evaluation and Research, Silver Spring, MD, USA.
Chumakov K
Office for Vaccines Research and Review, FDA Center for Biologics Evaluation and Research, Silver Spring, MD, USA.
Toniolo A
Clinical Microbiology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.

MeSH

AdolescentAdultAntibodies, ViralCommunicable Diseases, EmergingDisease OutbreaksEnterovirus A, HumanExanthemaFemaleGenome, ViralHand, Foot and Mouth DiseaseHospitalizationHumansItalyMaleMiddle AgedPhylogeny

Pub Type(s)

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

Language

eng

PubMed ID

30472520

Citation

Broccolo, F, et al. "Severe Atypical Hand-foot-and-mouth Disease in Adults Due to Coxsackievirus A6: Clinical Presentation and Phylogenesis of CV-A6 Strains." Journal of Clinical Virology : the Official Publication of the Pan American Society for Clinical Virology, vol. 110, 2019, pp. 1-6.
Broccolo F, Drago F, Ciccarese G, et al. Severe atypical hand-foot-and-mouth disease in adults due to coxsackievirus A6: Clinical presentation and phylogenesis of CV-A6 strains. J Clin Virol. 2019;110:1-6.
Broccolo, F., Drago, F., Ciccarese, G., Genoni, A., Puggioni, A., Rosa, G. M., Parodi, A., Manukyan, H., Laassri, M., Chumakov, K., & Toniolo, A. (2019). Severe atypical hand-foot-and-mouth disease in adults due to coxsackievirus A6: Clinical presentation and phylogenesis of CV-A6 strains. Journal of Clinical Virology : the Official Publication of the Pan American Society for Clinical Virology, 110, 1-6. https://doi.org/10.1016/j.jcv.2018.11.003
Broccolo F, et al. Severe Atypical Hand-foot-and-mouth Disease in Adults Due to Coxsackievirus A6: Clinical Presentation and Phylogenesis of CV-A6 Strains. J Clin Virol. 2019;110:1-6. PubMed PMID: 30472520.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Severe atypical hand-foot-and-mouth disease in adults due to coxsackievirus A6: Clinical presentation and phylogenesis of CV-A6 strains. AU - Broccolo,F, AU - Drago,F, AU - Ciccarese,G, AU - Genoni,A, AU - Puggioni,A, AU - Rosa,G M, AU - Parodi,A, AU - Manukyan,H, AU - Laassri,M, AU - Chumakov,K, AU - Toniolo,A, Y1 - 2018/11/17/ PY - 2018/07/26/received PY - 2018/11/10/revised PY - 2018/11/16/accepted PY - 2018/11/26/pubmed PY - 2020/2/26/medline PY - 2018/11/26/entrez KW - Atypical KW - CV-A6 KW - Coxsackievirus KW - Enterovirus KW - Exanthem KW - Hand foot and mouth disease SP - 1 EP - 6 JF - Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology JO - J. Clin. Virol. VL - 110 N2 - BACKGROUND: Typically, hand-foot-and-mouth disease (HFMD) is a mild childhood illness associated with coxsackievirus (CV)-A16, CV-A6, enterovirus (EV)-A71. OBJECTIVES: To identify the viral agents associated with severe cases of atypical HFMD in Italy. STUDY DESIGN: Epidemiologically unrelated cases of severe atypical HFMD admitted to the Emergency Room (ER) of IRCCS San Martino IST (Genoa, Italy) in 2014-2016 were investigated. Serologic screening for viral positivity was performed against exanthem-inducing agents. Ten cases with serology indicative of recent EV infection were selected. Molecular assays were used to detect viral genomes in blood [EVs, Parvovirus B19 (PVB19), herpesviruses (CMV; EBV, HHV-6, -7, -8)]. RESULTS: CV-A6 was detected in 10 cases of severe atypical HFMD. Two cases were also infected with PVB19. Herpesviruses were not detected. Phylogenetic analysis mapped the CV-A6 strains into a single cluster related to two recent isolates from a German and an Asian child. Fever, systemic symptoms, severe vasculitis-like rash, and enanthem were predominant at presentation. Spontaneous recovery occurred in 1-3 weeks. CONCLUSIONS: CV-A6 is emerging as a frequent cause of severe atypical HFMD in Italian adults. This viral agent is disseminating worldwide. Dermatologists must identify the manifold alterations caused by EVs and understand the diagnostic power of current virology methods. SN - 1873-5967 UR - https://www.unboundmedicine.com/medline/citation/30472520/Severe_atypical_hand_foot_and_mouth_disease_in_adults_due_to_coxsackievirus_A6:_Clinical_presentation_and_phylogenesis_of_CV_A6_strains_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1386-6532(18)30280-4 DB - PRIME DP - Unbound Medicine ER -