Hand, Foot, and Mouth Disease Caused by Coxsackievirus A6

Flett, Kelly B.; Youngster, Ilan; Huang, Jennifer T.; McAdam, Alexander J.; Sandora, Thomas J.; Rennick, Marcus; Smole, Sandra; Rogers, Shannon; Nix, W. Allan; Oberste, M. Steven; Gellis, Stephen E.; Ahmed, Asim A.

doi:10.3201/eid1810.120813

Cited by 95 publications

(71 citation statements)

References 9 publications

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“…Eruptions observed in areas of previous eczematous dermatitis, including extremities and the trunk, led to initial clinical diagnoses of eczema herpeticum in 14 of the 33 patients with atypical HFMD, consistent with previous reports describing this disease entity as eczema coxsackium [7,11,12]. The remaining 19 of the 33 patients with atypical symptoms were clinically suspected as having chickenpox.…”

Section: Clinical Picture and Seasonalitysupporting

confidence: 71%

Atypical hand, foot, and mouth disease associated with coxsackievirus A6 infection, Edinburgh, United Kingdom, January to February 2014

Sinclair¹,

Gaunt

Simmonds

et al. 2014

Eurosurveillance

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In January to February 2014, 16 hand, foot and mouth disease (HFMD) cases were identified in Edinburgh, United Kingdom. All presented with atypical features, with most (n=13) resembling eczema herpeticum or chickenpox. Coxsackievirus A6 (CV-A6) was identified in all the typed cases (n=11). As atypical forms of HFMD associated with CV-A6 are likely to emerge throughout Europe, clinicians should be alert to unusual clinical presentations of HFMD and virologists aware of effective diagnostic testing and enterovirus typing methods.

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Section: Clinical Picture and Seasonalitysupporting

confidence: 71%

Atypical hand, foot, and mouth disease associated with coxsackievirus A6 infection, Edinburgh, United Kingdom, January to February 2014

Sinclair¹,

Gaunt

Simmonds

et al. 2014

Eurosurveillance

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“…Other recent studies have also emphasized the perioral distribution of CVA6-associated disease. 10 A distribution similar to Gianotti-Crosti was documented in one-third of the patients in our study, with lesions involving the cheeks, extensor surfaces of the extremities, and buttocks, but sparing the trunk. 30 Classic GianottiCrosti is characterized by monomorphous lichenoid papules and/or papulovesicles, whereas the eruption associated with this outbreak was more often papulovesicular with prominent erosions.…”

Section: Figurementioning

confidence: 70%

“…Classically, the vesicular exanthem of HFMD is restricted to the hands, feet, and occasionally the buttocks. 10,13,14,19,21,22 The accompanying enanthem consists of small vesicles and erosions on the oral mucosa. 12,13 The exanthem in our series differed by commonly involving the perioral area, extremities, and torso in addition to more classic HFMD locations.…”

Section: Figurementioning

confidence: 99%

See 1 more Smart Citation

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

Oza²,

et al. 2013

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OBJECTIVE: To characterize the atypical cutaneous presentations in the coxsackievirus A6 (CVA6)–associated North American enterovirus outbreak of 2011–2012. METHODS: We performed a retrospective case series of pediatric patients who presented with atypical cases of hand, foot, and mouth disease (HFMD) from July 2011 to June 2012 at 7 academic pediatric dermatology centers. Patients were included if they tested positive for CVA6 or if they met clinical criteria for atypical HFMD (an enanthem or exanthem characteristic of HFMD with unusual morphology or extent of cutaneous findings). We collected demographic, epidemiologic, and clinical data including history of skin conditions, morphology and extent of exanthem, systemic symptoms, and diagnostic test results. RESULTS: Eighty patients were included in this study (median age 1.5 years, range 4 months–16 years). Seventeen patients were CVA6-positive, and 63 met clinical inclusion criteria. Ninety-nine percent of patients exhibited a vesiculobullous and erosive eruption; 61% of patients had rash involving >10% body surface area. The exanthem had a perioral, extremity, and truncal distribution in addition to involving classic HFMD areas such as palms, soles, and buttocks. In 55% of patients, the eruption was accentuated in areas of eczematous dermatitis, termed “eczema coxsackium.” Other morphologies included Gianotti-Crosti–like (37%), petechial/purpuric (17%) eruptions, and delayed onychomadesis and palm and sole desquamation. There were no patients with serious systemic complications. CONCLUSIONS: The CVA6-associated enterovirus outbreak was responsible for an exanthem potentially more widespread, severe, and varied than classic HFMD that could be confused with bullous impetigo, eczema herpeticum, vasculitis, and primary immunobullous disease.

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“…Clinical manifestations usually begin with fever and malaise and can progress to painful oral lesions and a rash involving the hands and feet; infected adults often are asymptomatic. Although coxsackievirus A16 has historically been the primary etiologic agent of HFMD in the United States, CVA6 has emerged as the cause in many recently reported outbreaks (1)(2)(3)(4)(5). Young adults appear to be more susceptible to infection with CVA6, which causes atypical perioral eruptions and skin manifestations that extend beyond the palmar and plantar surfaces (1).…”

mentioning

confidence: 99%