Severe atypical hand-foot-and-mouth disease in adults due to coxsackievirus A6: Clinical presentation and phylogenesis of CV-A6 strains

• Published in: Journal of clinical virology Vol. 110; pp. 1 - 6
• Main Authors: Broccolo, F., Drago, F., Ciccarese, G., Genoni, A., Puggioni, A., Rosa, G.M., Parodi, A., Manukyan, H., Laassri, M., Chumakov, K., Toniolo, A.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.01.2019
• Subjects: Adolescent; Adult; Antibodies, Viral - blood; Atypical; Communicable Diseases, Emerging - epidemiology; Communicable Diseases, Emerging - virology; Coxsackievirus; CV-A6; Disease Outbreaks; Enterovirus; Enterovirus A, Human - classification; Enterovirus A, Human - genetics; Exanthem; Exanthema - virology; Female; Genome, Viral; Hand foot and mouth disease; Hand, Foot and Mouth Disease - diagnosis; Hand, Foot and Mouth Disease - epidemiology; Hand, Foot and Mouth Disease - virology; Hospitalization - statistics & numerical data; Humans; Italy - epidemiology; Male; Middle Aged; Phylogeny; Italy; CV-A6; Coxsackievirus; Enterovirus; Atypical; Exanthem; Hand foot and mouth disease
• ISSN: 1386-6532; 1873-5967
• DOI: 10.1016/j.jcv.2018.11.003

•Typically, HFMD is a mild pediatric illness associated with group-A enteroviruses.•In Italy, unrelated adult cases of severe HFMD were caused by coxsackievirus A6.•Italian CV-A6 strains and that of a German child mapped into a single cluster.•The Italian and German strains were close to previous Chinese and Japanese strains.•CV-A6 is spreading worldwide with skin manifestations in both children and adults. Typically, hand-foot-and-mouth disease (HFMD) is a mild childhood illness associated with coxsackievirus (CV)-A16, CV-A6, enterovirus (EV)-A71. To identify the viral agents associated with severe cases of atypical HFMD in Italy. 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)]. 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. 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.