An outbreak of coxsackievirus A6 hand, foot, and mouth disease associated with onychomadesis in Taiwan, 2010

Abstract

BackgroundIn 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.MethodsPatients 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.ResultsOf 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.ConclusionsHFMD patients with CA6 infection experienced symptoms targeting a broader spectrum of skin sites and more profound tissue destruction, i.e., desquamation and nail abnormalities.

“Eczema Coxsackium” and Unusual Cutaneous Findings in an Enterovirus Outbreak

“…Onychomadesis (separation of the proximal nail plate from the nail matrix and nail bed), and Beau' s lines (horizontal ridging of the nail plate) were a common feature of CVA6 infection in previous reports 23,34 and were documented in 9 of 38 cases with available follow-up data in this series. However, this may be an underestimate because only a minority of patients was followed beyond their acute illness.…”

Nail Changes in Case of Enteroviral Infections in Western Ukraine: A Report of 34 Cases

“…Frequently onychomadesis was associated with coxsackievirus (C) A6 serotype of enterovirus [10,11]. However identification of other enteroviral strains (CA10, CA16 and ente rovirus 71) was reported too [9,10,12].…”

“…Since 2000 a lot of enteroviral infection outbreaks associated with nail matrix arrest have been reported throughout the world [8][9][10][11][12]. Hand-foot-mouth disease was mostly followed by nail changes.…”

Onicomadesis asociada a la enfermedad de boca, mano y pie

“…7 En nuestros pacientes predominó coxsackie B. Salazar y cols., comunicaron un 59,6% de antecedentes de EBMP en los casos que estudiaron, en comparación con un 13,6% de los controles. Hallaron que la enfermedad de boca, mano y pie ocurrió en promedio 39 días antes de la onicomadesis, de manera similar a un brote en Valladolid, España, con un promedio de 42 días, a Clementz (3 a 8 semanas) 3 y a Österback (1 a 2 meses), 11,12 cifras similares a las de nuestro trabajo (60,7% y 4 a 10 semanas respectivamente).…”

“…Hallaron que la enfermedad de boca, mano y pie ocurrió en promedio 39 días antes de la onicomadesis, de manera similar a un brote en Valladolid, España, con un promedio de 42 días, a Clementz (3 a 8 semanas) 3 y a Österback (1 a 2 meses), 11,12 cifras similares a las de nuestro trabajo (60,7% y 4 a 10 semanas respectivamente). En Asia, las erupciones tuvieron localizaciones inusuales 7,8 y afectaron a adultos, con síntomas sistémicos graves.…”