Clinical features and phylogenetic analysis of Coxsackievirus A9 in Northern Taiwan in 2011

Abstract

BackgroundCoxsackievirus A9 (CA9) was one of the most prevalent serotype of enteroviral infections in Taiwan in 2011. After several patient series were reported in the 1960s and 1970s, few studies have focused on the clinical manifestations of CA9 infections. Our study explores and deepens the current understanding of CA9.MethodsWe analyzed the clinical presentations of 100 culture-proven CA9-infected patients in 2011 by reviewing their medical records and depicted the CA9 phylogenetic tree.ResultsOf the 100 patients with culture-proven CA9 infections, the mean (SD) age was 4.6 (3.4) years and the male to female ratio was 1.9. For clinical manifestations, 96 patients (96%) had fever and the mean (SD) duration of fever was 5.9 (3.4) days. Sixty one patients (61%) developed a skin rash, and the predominant pattern was a generalized non-itchy maculopapular rash without vesicular changes. While most patients showed injected throat, oral ulcers were found in only 19 cases (19%), among whom, 6 were diagnosed as herpangina. Complicated cases included: aseptic meningitis (n=8), bronchopneumonia (n=6), acute cerebellitis (n=1), and polio-like syndrome (n=1). Phylogenetic analysis for current CA9 strains is closest to the CA9 isolate 27-YN-2008 from the border area of mainland China and Myanmar.ConclusionsThe most common feature of CA9 during the 2011 epidemic in Taiwan is generalized febrile exanthema rather than herpangina or hand, foot, and mouth disease. Given that prolonged fever and some complications are possible, caution should be advised in assessing patients as well as in predicting the clinical course.

Early Detection for Cases of Enterovirus- and Influenza-Like Illness through a Newly Established School-Based Syndromic Surveillance System in Taipei, January 2010 ~ August 2011

“…The risk factors of pediatric infectious diseases are multi-factorial. Higher male to female ratios of EVI and red eye cases in the SID-SSS, similar to previous findings [32], may be attributed to gender-related behaviors. This implies that hygiene education should be targeted more towards boys.…”

Hand, Foot and Mouth disease in northeastern part of Romania in 2012

“…There are more than 100 human enterovirus serotypes, including 3 poliovirus serotypes, 23 coxsackievirus A (CA) serotypes, 6 coxsackievirus B (CB) serotypes, 31 echovirus serotypes, and 39 numbered enterovirus serotypes (EV68-71, EV73-102, EV104-107, and EV109). (2008)(2009), Korea (2008Korea ( -2009, and Hong Kong (2008) [5]. The viruses implicate in HMFD spread by fecal-oral and respiratory routes,the contamination of other family members commonly occurs and the reinfection within the same family was recently described.…”

Coxsackieviruses in Ontario, January 2005 to December 2011

“…9 Coxsackievirus A9 (A9) has been associated with various illnesses, with generalized febrile exanthem being the most common. 10 A9 is the most commonly identified enterovirus associated with central nervous system infections. 8,11 Similar to other enteroviruses, A9 demonstrates seasonal circulation patterns, with a peak incidence occurring in the summer months in temperate climates.…”

“…8,11 Similar to other enteroviruses, A9 demonstrates seasonal circulation patterns, with a peak incidence occurring in the summer months in temperate climates. 1,10 A9 has been identified in sporadic disease occurrence as well as community outbreaks. [12][13][14] The incidence of A9 has been reported to be highest in infants and young children.…”

“…[12][13][14] The incidence of A9 has been reported to be highest in infants and young children. 3,9,10 In September 2010, an increase in the number of A9-positive specimens was reported by the Provincial Laboratory in Alberta, Canada. 15 During that timeframe, staff at Public Health Ontario were notified that three of Ontario's 36 health units were experiencing an increase in the number of cases of enterovirus meningitis and aseptic, presumed viral meningitis.…”