TY - JOUR
T1 - Coxsackievirus A6 associated hand, foot and mouth disease in adults
T2 - Clinical presentation and review of the literature
AU - Downing, Christopher
AU - Ramirez-Fort, Marigdalia K.
AU - Doan, Hung Q.
AU - Benoist, Frances
AU - Oberste, M. Steven
AU - Khan, Farhan
AU - Tyring, Stephen K.
N1 - Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2014/8
Y1 - 2014/8
N2 - Background: Hand, foot, and mouth disease (HFMD) is generally considered a rare illness in adults. Classically, HFMD has been strongly associated with coxsackievirus strain A16 and enterovirus 71. The coxsackievirus A6 (CVA6) strain has been linked to severe worldwide outbreaks since 2008. CVA6 is associated with a more severe and profound course of disease, affecting both children and adults. Objectives: To present a series of five adult patients diagnosed with HFMD due to CVA6. We investigate method of diagnosis and compare clinical presentation of adult cases to those in children. Study design: Each patient underwent a full-body skin exam as well as inspection of the oral cavity. Rapid plasma reagin (RPR) and serologic assays by complement fixation against coxsackievirus B (1-6) and A (2,4,7,9,10,16) were performed as indicated. As standard serological testing does not detect CVA6, real-time reverse transcription-polymerase chain reaction (qRT-PCR) of serum, buccal swabs, and skin scrapings were performed by the Centers for Disease Control and Prevention (CDC). Results: Each patient had clinical findings consistent with various stages of HFMD. One patient presented with delayed onychomadesis and desquamation of the palms and soles. RPR and serologic assays by complement fixation against CVB (1-6) and CVA (2,4,7,9,10,16) were mostly negative, although elevated in two patients due to cross-reactivity. qRT-PCR identified CVA6 genetic material in samples from all patients. Conclusion: This series demonstrates that there is a wide array of disease presentation of CVA6 associated HFMD in adults.
AB - Background: Hand, foot, and mouth disease (HFMD) is generally considered a rare illness in adults. Classically, HFMD has been strongly associated with coxsackievirus strain A16 and enterovirus 71. The coxsackievirus A6 (CVA6) strain has been linked to severe worldwide outbreaks since 2008. CVA6 is associated with a more severe and profound course of disease, affecting both children and adults. Objectives: To present a series of five adult patients diagnosed with HFMD due to CVA6. We investigate method of diagnosis and compare clinical presentation of adult cases to those in children. Study design: Each patient underwent a full-body skin exam as well as inspection of the oral cavity. Rapid plasma reagin (RPR) and serologic assays by complement fixation against coxsackievirus B (1-6) and A (2,4,7,9,10,16) were performed as indicated. As standard serological testing does not detect CVA6, real-time reverse transcription-polymerase chain reaction (qRT-PCR) of serum, buccal swabs, and skin scrapings were performed by the Centers for Disease Control and Prevention (CDC). Results: Each patient had clinical findings consistent with various stages of HFMD. One patient presented with delayed onychomadesis and desquamation of the palms and soles. RPR and serologic assays by complement fixation against CVB (1-6) and CVA (2,4,7,9,10,16) were mostly negative, although elevated in two patients due to cross-reactivity. qRT-PCR identified CVA6 genetic material in samples from all patients. Conclusion: This series demonstrates that there is a wide array of disease presentation of CVA6 associated HFMD in adults.
KW - Coxsackievirus A6
KW - Enterovirus
KW - Hand foot and mouth disease
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U2 - 10.1016/j.jcv.2014.04.023
DO - 10.1016/j.jcv.2014.04.023
M3 - Article
C2 - 24932735
AN - SCOPUS:84903560571
SN - 1386-6532
VL - 60
SP - 381
EP - 386
JO - Journal of Clinical Virology
JF - Journal of Clinical Virology
IS - 4
ER -