F Broccolo1, F Drago2, G Ciccarese2, A Genoni3, A Puggioni3, G M Rosa4, A Parodi2, H Manukyan5, M Laassri5, K Chumakov5, A Toniolo3. 1. Department of Medicine and Surgery, School of Medicine, University of Milano-Bicocca, Monza, Italy. Electronic address: francesco.broccolo@unimib.it. 2. DISSAL Department of Dermatology, IRCCS San Martino-IST, Genoa, Italy. 3. Clinical Microbiology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy. 4. Department of Internal Medicine, Cardiology, Ospedale Policlinico San Martino, Genoa, Italy. 5. Office for Vaccines Research and Review, FDA Center for Biologics Evaluation and Research, Silver Spring, MD, USA.
Abstract
BACKGROUND: Typically, hand-foot-and-mouth disease (HFMD) is a mild childhood illness associated with coxsackievirus (CV)-A16, CV-A6, enterovirus (EV)-A71. OBJECTIVES: To identify the viral agents associated with severe cases of atypical HFMD in Italy. STUDY DESIGN: Epidemiologically unrelated cases of severe atypical HFMD admitted to the Emergency Room (ER) of IRCCS San Martino IST (Genoa, Italy) in 2014-2016 were investigated. Serologic screening for viral positivity was performed against exanthem-inducing agents. Ten cases with serology indicative of recent EV infection were selected. Molecular assays were used to detect viral genomes in blood [EVs, Parvovirus B19 (PVB19), herpesviruses (CMV; EBV, HHV-6, -7, -8)]. RESULTS: CV-A6 was detected in 10 cases of severe atypical HFMD. Two cases were also infected with PVB19. Herpesviruses were not detected. Phylogenetic analysis mapped the CV-A6 strains into a single cluster related to two recent isolates from a German and an Asian child. Fever, systemic symptoms, severe vasculitis-like rash, and enanthem were predominant at presentation. Spontaneous recovery occurred in 1-3 weeks. CONCLUSIONS: CV-A6 is emerging as a frequent cause of severe atypical HFMD in Italian adults. This viral agent is disseminating worldwide. Dermatologists must identify the manifold alterations caused by EVs and understand the diagnostic power of current virology methods.
BACKGROUND: Typically, hand-foot-and-mouth disease (HFMD) is a mild childhood illness associated with coxsackievirus (CV)-A16, CV-A6, enterovirus (EV)-A71. OBJECTIVES: To identify the viral agents associated with severe cases of atypical HFMD in Italy. STUDY DESIGN: Epidemiologically unrelated cases of severe atypical HFMD admitted to the Emergency Room (ER) of IRCCS San Martino IST (Genoa, Italy) in 2014-2016 were investigated. Serologic screening for viral positivity was performed against exanthem-inducing agents. Ten cases with serology indicative of recent EV infection were selected. Molecular assays were used to detect viral genomes in blood [EVs, Parvovirus B19 (PVB19), herpesviruses (CMV; EBV, HHV-6, -7, -8)]. RESULTS:CV-A6 was detected in 10 cases of severe atypical HFMD. Two cases were also infected with PVB19. Herpesviruses were not detected. Phylogenetic analysis mapped the CV-A6 strains into a single cluster related to two recent isolates from a German and an Asian child. Fever, systemic symptoms, severe vasculitis-like rash, and enanthem were predominant at presentation. Spontaneous recovery occurred in 1-3 weeks. CONCLUSIONS:CV-A6 is emerging as a frequent cause of severe atypical HFMD in Italian adults. This viral agent is disseminating worldwide. Dermatologists must identify the manifold alterations caused by EVs and understand the diagnostic power of current virology methods.
Authors: Thomas Kuntz; Bijan Koushk-Jalali; Christian Tigges; Steffi Silling; Veronica di Cristanziano; Ulrike Wieland; Frank Oellig; Alexander Kreuter Journal: Hautarzt Date: 2019-12 Impact factor: 0.751
Authors: Ivanildo Pedro de Sousa; Heloísa Ihle Giamberardino; Sonia Mara Raboni; Maria Carmo Debur; Maria de Lourdes Aguiar Oliveira; Fernanda Marcicano Burlandy; Edson Elias da Silva Journal: Virol J Date: 2021-04-30 Impact factor: 4.099