Clinical characteristics of 68 children with atypical hand, foot, and mouth disease caused by coxsackievirus A6: a single-center retrospective analysis

Abstract

Background: Hand, foot, and mouth disease (HFMD) caused by coxsackievirus A6 (CV-A6) has become prevalent in many parts of the world. It is commonly referred to as atypical HFMD which more likely to present as bullous lesions. Compared with traditional HFMD, its misdiagnosis rate is relatively high, which brings difficulties to clinical diagnosis. We retrospectively analyze the clinical characteristics of children with HFMD with bullous lesions caused by CV-A6. Methods:The study included 68 children with atypical HFMD caused by CV-A6 who were hospitalized from 2018 to 2020. Data of the children including age, sex, month of HFMD onset, the morphologies and distribution of rashes, the details of fever, the presence or absence of onychomadesis, and laboratory test results were analyzed and compared between an infant group (<1 year), a toddler group (1-<3 years), and a preschool group (3-<6 years).Results: Of the 68 children, 67 were younger than 5 years old, with a male to female ratio of 1.62:1. The disease peaked in the period from June to September. With 75.0% of the infant group had more than three kinds of rashes; 95.0% of the preschool group had rashes in more than five locations. These differences were statistically significant (P<0.05). All children had fever. The peak fever in the toddler group was lower (P=0.033). No critical cases were observed in any of the groups. Of the 61 children who were successfully followed up, 68.9% developed onychomadesis within 2-3 weeks. The proportion of cases with abnormal liver function was 83.3%, 41.7%, and 10.0% in the infant, toddler, and preschool groups (P<0.001). The proportion of cases with increased serum creatine kinase MB isoenzyme (CK-MB) were significantly higher in the toddler group (P<0.05).Conclusions: Atypical HFMD caused by CV-A6 infection usually occurred in children under 5 years old.The morphologies of the rashes in the infant group changed more, while the rashes in the preschool group was more widely distributed. The incidence of critical cases was low. More than half of the cases can develop onychomadesis in the recovery period. Organ damage was relatively mild in the preschool group.

The comparisons of procalcitonin and age between mild and severe Hand, foot, and mouth disease

“…In our retrospective study, among the 183 included patients, 97.3% were under 5 years of age [similar to that in a previous study ( 13 )], and 83% were younger than 3 years of age. Consistent with other studies ( 2 , 16 ), we found that age is one of the factors affecting the degree of severity, with severe clinical presentations occurring in younger children. Meanwhile, we also found significant differences in PCT levels between the two groups.…”

“…Recently, atypical HFMD caused by coxsackievirus A6 has gradually increased. Most cases occurred in children under 5 years of age, and some cases developed onychomycosis during recovery ( 2 ). According to previous studies, the incidence rate of severe cases in mainland China is 1.74% and the mortality rate is 0.055%.…”

The upregulation of peripheral blood polyamine metabolites spermidine and spermine in children with hand, foot, mouth disease is related to enterovirus 71 capsid protein VP1, but not VP4

“…Hand, foot, and mouth disease (HFMD) is a common viral infectious disease that is mainly caused by human enterovirus 71 (EV71) and coxsackievirus A6 (CV-A6), usually occurs in infants and preschool children (aged <5 years), and can cause mild fever, oral ulcers, benign skin lesions, and cardiopulmonary symptoms ( 1 , 2 ). EV71-infected HFMD is characterized by severe central nervous system complications, such as encephalitis, aseptic meningitis, acute flaccid paralysis, and even death ( 3 ).…”

Analysis of coxsackievirus A6 circulation in the territories of the Far Eastern Federal district of the Russian Federation in 2014–2019

“…У лиц, страдающих атопическим дерматитом, наблюдались герпесоподобные высыпания, получившие название eczema coxsackium [14][15][16]. Распространённым проявлением КВ-А6-инфекции является онихомадезис [17].…”