Onychomadesis Outbreak in Valencia, Spain Associated with Hand, Foot, and Mouth Disease Caused by Enteroviruses

Abstract

This report evaluates the June 2008 onychomadesis outbreak in Valencia, Spain. The study sample consisted of 221 onychomadesis cases and 77 nonaffected individuals who lived close to those affected. We collected data on dietary variables, hygiene products, and individual pathological histories. Feces and blood specimens were collected from 44 cases and 24 controls to evaluate exposure to infectious agents. Pathological background data revealed a high frequency (61%) of hand, foot, and mouth disease among the onychomadesis cases. Coxsackievirus A10 was the most commonly detected enterovirus in both case and control groups (49%). Other enteroviruses such as coxsackieviruses A5, A6, A16, B1, and B3; echoviruses 3, 4, and 9; and enterovirus 71 were present in low frequencies in the case and control groups (3-9%). The 2008 onychomadesis outbreak in the metropolitan area of Valencia was associated with an outbreak of hand, foot, and mouth disease primarily caused by coxsackievirus A10.

“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.…”

Onicomadesis asociada a la enfermedad de boca, mano y pie

“…1 Es consecuencia de la detención de la función de la matriz ungular, 2 con la correspondiente inhibición de la proliferación celular 3 y es rara en los niños. 2 Puede ser secundaria a enfermedades sistémicas que cursan con fiebre e insuficiencia renal, o deberse a deficiencias nutricionales, dermatitis de contacto alérgica, 4 dermatosis ampollares, fármacos (penicilina, cefalosporinas, carbamazepina), paroniquia, estrés, dismenorrea, distrofia simpática refleja, enfermedad de Kawasaki, candidiasis, quimioterapia y radioterapia.…”

Not only fever and palmoplantar vesicular eruption

“…The temporal association, with 3-9 weeks interval, between disease and nail injury suggestes the causal relationship [1,3,4]. Complete nail regrowth is typically 1-4 months later [1]. Here, we would want to highlight some new aspects of an old disease and to emphasize the importance of an accurate differential diagnosis.…”

“…Nail matrix arrest is commonly seen following a physiological stress, nutritional deficiencies, drug/chemotherapeutic exposures, infection, and systemic illnesses [1] such as hand-foot-mouth disease (HFMD). Here, we describe a case of onychomadesis due to HFMD.…”

“…Davia et al proposed that the virus, through direct action on the nail matrix keratinocytes, would probably lead to arrest it [1]. The temporal association, with 3-9 weeks interval, between disease and nail injury suggestes the causal relationship [1,3,4]. Complete nail regrowth is typically 1-4 months later [1].…”