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Zhang L, Peng W, Wu J, Wei X, Rong N, Zhang G, Yang H, Ding X, Zhao B, Liu J. Pathogenicity and landscape of differential gene expression in mice orally infected with clinical coxsackievirus A6 (CA6). J Virol 2024; 98:e0135823. [PMID: 38226810 PMCID: PMC10878243 DOI: 10.1128/jvi.01358-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/15/2023] [Indexed: 01/17/2024] Open
Abstract
Hand, foot, and mouth disease (HFMD) is caused by more than 20 pathogenic enteroviruses belonging to the Picornaviridae family and Enterovirus genus. Since the introduction of the enterovirus-71 (EV71) vaccine in 2016, the number of HFMD cases caused by EV71 has decreased. However, cases of infections caused by other enteroviruses, such as coxsackievirus A6 (CA6) and coxsackievirus A10, have been increasing accordingly. In this study, we used a clinical isolate of CA6 to establish an intragastric infection mouse model using 7-day-old mice to mimic the natural transmission route, by which we investigated the differential gene expression profiles associated with virus infection and pathogenicity. After intragastric infection, mice exhibited hind limb paralysis symptoms and weight loss, similar to those reported for EV71 infection in mice. The skeletal muscle was identified as the main site of virus replication, with a peak viral load reaching 2.31 × 107 copies/mg at 5 dpi and increased infiltration of inflammatory cells. RNA sequencing analysis identified differentially expressed genes (DEGs) after CA6 infection. DEGs in the blood, muscle, brain, spleen, and thymus were predominantly enriched in immune system responses, including pathways such as Toll-like receptor signaling and PI3K-Akt signaling. Our study has unveiled the genes involved in the host immune response during CA6 infection, thereby enhancing our comprehension of the pathological mechanism of HFMD.IMPORTANCEThis study holds great significance for the field of hand, foot, and mouth disease (HFMD). It not only delves into the disease's etiology, transmission pathways, and severe complications but also establishes a novel mouse model that mimics the natural coxsackievirus A6 infection process, providing a pivotal platform to delve deeper into virus replication and pathogenic mechanisms. Additionally, utilizing RNA-seq technology, it unveils the dynamic gene expression changes during infection, offering valuable leads for identifying novel therapeutic drug targets. This research has the potential to enhance our understanding of HFMD, offering fresh perspectives for disease prevention and treatment and positively impacting children's health worldwide.
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Affiliation(s)
- Lihong Zhang
- Institute of Laboratory Animal Science, Chinese Academy of Medical Sciences and Comparative Medicine Center, Peking Union Medical College, Beijing, China
- NHC Key Laboratory of Human Disease Comparative Medicine, Beijing, China
- National Center of Technology Innovation for Animal Models, Beijing, China
| | - Wanjun Peng
- Institute of Laboratory Animal Science, Chinese Academy of Medical Sciences and Comparative Medicine Center, Peking Union Medical College, Beijing, China
- NHC Key Laboratory of Human Disease Comparative Medicine, Beijing, China
- National Center of Technology Innovation for Animal Models, Beijing, China
| | - Jing Wu
- Institute of Laboratory Animal Science, Chinese Academy of Medical Sciences and Comparative Medicine Center, Peking Union Medical College, Beijing, China
- NHC Key Laboratory of Human Disease Comparative Medicine, Beijing, China
- National Center of Technology Innovation for Animal Models, Beijing, China
| | - Xiaohui Wei
- Institute of Laboratory Animal Science, Chinese Academy of Medical Sciences and Comparative Medicine Center, Peking Union Medical College, Beijing, China
- NHC Key Laboratory of Human Disease Comparative Medicine, Beijing, China
- National Center of Technology Innovation for Animal Models, Beijing, China
| | - Na Rong
- Institute of Laboratory Animal Science, Chinese Academy of Medical Sciences and Comparative Medicine Center, Peking Union Medical College, Beijing, China
- NHC Key Laboratory of Human Disease Comparative Medicine, Beijing, China
- National Center of Technology Innovation for Animal Models, Beijing, China
| | - Gengxin Zhang
- Institute of Laboratory Animal Science, Chinese Academy of Medical Sciences and Comparative Medicine Center, Peking Union Medical College, Beijing, China
- NHC Key Laboratory of Human Disease Comparative Medicine, Beijing, China
- National Center of Technology Innovation for Animal Models, Beijing, China
| | - Hekai Yang
- Institute of Laboratory Animal Science, Chinese Academy of Medical Sciences and Comparative Medicine Center, Peking Union Medical College, Beijing, China
- NHC Key Laboratory of Human Disease Comparative Medicine, Beijing, China
- National Center of Technology Innovation for Animal Models, Beijing, China
| | | | - Binbin Zhao
- Institute of Laboratory Animal Science, Chinese Academy of Medical Sciences and Comparative Medicine Center, Peking Union Medical College, Beijing, China
- NHC Key Laboratory of Human Disease Comparative Medicine, Beijing, China
- National Center of Technology Innovation for Animal Models, Beijing, China
| | - Jiangning Liu
- Institute of Laboratory Animal Science, Chinese Academy of Medical Sciences and Comparative Medicine Center, Peking Union Medical College, Beijing, China
- NHC Key Laboratory of Human Disease Comparative Medicine, Beijing, China
- National Center of Technology Innovation for Animal Models, Beijing, China
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Starkey SY, Mar K, Khaslavsky S, Seeburruth D, Khalid B, Virmani D, Lam JM, Mukovozov I. Atypical cutaneous findings of hand-foot-mouth disease in children: A systematic review. Pediatr Dermatol 2024; 41:23-27. [PMID: 37877202 DOI: 10.1111/pde.15461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/08/2023] [Indexed: 10/26/2023]
Abstract
INTRODUCTION Hand-foot-mouth disease (HFMD) is a common childhood infectious disease. Atypical skin findings of HFMD, often associated with coxsackievirus A6 (CVA6), were first reported in 2008, with increasing reports worldwide since. Atypical lesions of HFMD often involve sites beyond the palms and soles and tend to have unusual, polymorphic morphology. METHODS A systematic review was conducted on clinical features and outcomes of pediatric HFMD with atypical cutaneous manifestations. RESULTS Eighty-five studies were included, representing 1359 cases with mean age 2.4 years and a male predominance of 61%. The most reported morphologies were vesicles (53%), papules (49%), and bullae (36%). Other morphologies included eczema herpeticum-like (19%), purpuric/petechial (7%), and Gianotti Crosti-like (4%). Common atypical sites included the arms and/or legs (47%), face (45%), and trunk (27%). CVA6 was identified in 63% of cases. Symptoms resolved in a mean of 10 days. Overall, 16% of cases received treatment, most commonly with acyclovir, intravenous antibiotics, or topical steroids. The most common complications were nail changes (21%) and desquamation (4%) which occurred a mean of 3 and 2 weeks after symptoms, respectively. CONCLUSION Due to unusual morphologies resembling other conditions, HFMD with atypical cutaneous findings may be misdiagnosed, leading to inappropriate and unnecessary investigations, hospitalization, and treatment. Greater awareness of atypical presentations of HFMD is warranted to improve patient care and counseling on infection control precautions.
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Affiliation(s)
- Samantha Y Starkey
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Nemours Children's Hospital Delaware, Wilmington, Delaware, USA
| | - Kristie Mar
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Bushra Khalid
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Divya Virmani
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Island Infectious Disease Consultants, Victoria, British Columbia, Canada
| | - Joseph M Lam
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Ilya Mukovozov
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
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Foronda JLM, Jiao MMAD, Climacosa FMM, Oshitani H, Apostol LNG. Epidemiological and molecular characterization of Coxsackievirus A6 causing hand, foot, and mouth disease in the Philippines, 2012-2017. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2023; 114:105498. [PMID: 37657679 DOI: 10.1016/j.meegid.2023.105498] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 09/03/2023]
Abstract
Coxsackievirus A6 (CVA6) is emerging as the dominant serotype among enteroviruses (EVs) responsible for hand, foot, and mouth disease (HFMD) outbreaks in multiple countries. However, details regarding this serotype in the Philippines are limited. In this study, we investigated the epidemiological and molecular characteristics of laboratory-confirmed CVA6 HFMD cases in the Philippines between 2012 and 2017. Data collected from case report forms submitted to the National Reference Laboratory for Poliovirus and other Enteroviruses were used to determine the distribution and clinical findings of laboratory-confirmed CVA6 HFMD. Phylogenetic analyses of the complete viral protein 1 (VP1) and partial 3D polymerase (3Dpol) gene sequences were performed to determine the genotype and recombinant (RF) form of the selected samples. An increase in the detection rate of CVA6 among enterovirus-positive HFMD cases was observed from 61.9% (140/226) in 2012 to 88.1% (482/587) in 2017, with most cases coming from the Luzon island group. Among the detected cases, the majority were children, with a median age of 2 years old (interquartile range: 1.17-3.40). Respiratory-related morbidities were the commonly reported complications (7.9%; 72/907). Based on the VP1 and 3Dpol gene sequence analysis, the CVA6 strains in this study were classified as genotype D3b and RF-A group, respectively. This study elucidated that CVA6 was the most prevalent enterovirus serotype causing HFMD in the Philippines in 2012-2017, with genotype D3b/RF-A circulating within this period. This study highlights the importance of viral surveillance and molecular epidemiological analysis to broaden our understanding of HFMD in the Philippines.
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Affiliation(s)
- Janiza Lianne M Foronda
- Department of Virology, Research Institute for Tropical Medicine, Muntinlupa City, Philippines; Department of Medical Microbiology, College of Public Health, University of the Philippines, Manila City, Philippines
| | | | - Fresthel Monica M Climacosa
- Department of Medical Microbiology, College of Public Health, University of the Philippines, Manila City, Philippines
| | - Hitoshi Oshitani
- Department of Virology, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Lea Necitas G Apostol
- Department of Virology, Research Institute for Tropical Medicine, Muntinlupa City, Philippines.
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Chen Y, Dai B, Han S, Duan G, Yang H, Chen S, Ji W, Jin Y. Arising Concerns of Atypical Manifestations in Patients with Hand, Foot, and Mouth Disease. Vaccines (Basel) 2023; 11:vaccines11020405. [PMID: 36851282 PMCID: PMC9966249 DOI: 10.3390/vaccines11020405] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
Hand, foot, and mouth disease (HFMD) is a mild exanthematous, febrile disease, but it also remains a threat to global public health. HFMD is characterized by a brief febrile illness in children and with a typical skin rash of the hand and foot, with or without mouth ulcers. However, the morphology and distribution of vesicles, as well as accompanying symptoms, are varied among atypical HFMD. An upsurge in atypical presentations of HFMD caused by Coxsackievirus A6 (CVA6), including Gianotti-Crosti-like eruptions, eczema coxsackium, petechial/purpuric eruption, and vesiculobullous exanthema, can be difficult to diagnose clinically as it may mimic other severe skin diseases, such as eczema herpeticum, varicella, disseminated zoster, and erythema multiforme major. The recognition of the distinguishing features of atypical HFMD is vital for an accurate and timely diagnosis, as is initiating appropriate laboratory evaluation and supportive care. Clinicians must identify the wide range of cutaneous and mucosal alterations caused by atypical HFMD. A systemic, high-quality overview of atypical HFMD is needed for advances in better strategies for clinical diagnosis and treatment. Hence, this review is aimed at summarizing the available data on clinical investigations and differential diagnostics to provide a scientific guide for the timely diagnosis of HFMD for preventing serious complications.
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Affiliation(s)
- Yu Chen
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Bowen Dai
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Shujie Han
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Guangcai Duan
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou 450001, China
| | - Haiyan Yang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Shuaiyin Chen
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Wangquan Ji
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou 450001, China
- Correspondence: (W.J.); (Y.J.)
| | - Yuefei Jin
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
- Correspondence: (W.J.); (Y.J.)
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Insertion of an Amphipathic Linker in a Tetrapodal Tryptophan Derivative Leads to a Novel and Highly Potent Entry Inhibitor of Enterovirus A71 Clinical Isolates. Int J Mol Sci 2023; 24:ijms24043539. [PMID: 36834952 PMCID: PMC9959982 DOI: 10.3390/ijms24043539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
AL-471, the leading exponent of a class of potent HIV and enterovirus A71 (EV-A71) entry inhibitors discovered in our research group, contains four l-tryptophan (Trp) units bearing an aromatic isophthalic acid directly attached to the C2 position of each indole ring. Starting from AL-471, we (i) replaced l-Trp with d-Trp, (ii) inserted a flexible linker between C2 and the isophthalic acid, and (iii) substituted a nonaromatic carboxylic acid for the terminal isophthalic acid. Truncated analogues lacking the Trp motif were also synthesized. Our findings indicate that the antiviral activity seems to be largely independent of the stereochemistry (l- or d-) of the Trp fragment and also that both the Trp unit and the distal isophthalic moiety are essential for antiviral activity. The most potent derivative, 23 (AL-534), with the C2 shortest alkyl urea linkage (three methylenes), showed subnanomolar potency against different EV-71 clinical isolates. This finding was only observed before with the early dendrimer prototype AL-385 (12 l-Trp units) but remained unprecedented for the reduced-size prototype AL-471. Molecular modeling showed the feasibility of high-affinity binding of the novel l-Trp-decorated branches of 23 (AL-534) to an alternative site on the VP1 protein that harbors significant sequence variation among EV-71 strains.
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Chavda VP, Patel K, Mod H, Apostolopoulos V. Tomato flu: misnomer for a common disease? - Authors' reply. THE LANCET. RESPIRATORY MEDICINE 2023; 11:e4. [PMID: 36566076 DOI: 10.1016/s2213-2600(22)00497-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Vivek P Chavda
- Department of Pharmaceutics and Pharmaceutical Technology, L M College of Pharmacy, Ahmedabad 380009, Gujarat, India.
| | - Kaushika Patel
- Department of Pharmaceutical Technology, L J Institute of Pharmacy, L J University, Ahmedabad, Gujarat, India
| | - Harsh Mod
- Department of Pediatrics, GCS Medical College, Ahmedabad, Gujarat, India
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Puenpa J, Saengdao N, Khanarat N, Korkong S, Chansaenroj J, Yorsaeng R, Wanlapakorn N, Poovorawan Y. Evolutionary and Genetic Recombination Analyses of Coxsackievirus A6 Variants Associated with Hand, Foot, and Mouth Disease Outbreaks in Thailand between 2019 and 2022. Viruses 2022; 15:73. [PMID: 36680113 PMCID: PMC9863931 DOI: 10.3390/v15010073] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 12/30/2022] Open
Abstract
Coxsackievirus (CV)-A6 infections cause hand, foot, and mouth disease (HFMD) in children and adults. Despite the serious public health threat presented by CV-A6 infections, our understanding of the mechanisms by which new CV-A6 strains emerge remains limited. This study investigated the molecular epidemiological trends, evolutionary dynamics, and recombination characteristics of CV-A6-associated HFMD in Thailand between 2019 and 2022. In the HFMD patient samples collected during the 4-year study period, we identified enterovirus (EV) RNA in 368 samples (48.7%), of which CV-A6 (23.7%) was the predominant genotype, followed by CV-A4 (6%), EV-A71 (3.7%), and CV-A16 (3.4%). According to the partial viral protein (VP) 1 sequences, all these CV-A6 strains belonged to the D3 clade. Based on the viral-RNA-dependent RNA polymerase (RdRp) gene, four recombinant forms (RFs), RF-A (147, 84.5%), RF-N (11, 6.3%), RF-H (1, 0.6%), and newly RF-Y (15, 8.6%), were identified throughout the study period. Results from the similarity plot and bootscan analyses revealed that the 3D polymerase (3Dpol) region of the D3/RF-Y subclade consists of sequences highly similar to CV-A10. We envisage that the epidemiological and evolutionarily insights presented in this manuscript will contribute to the development of vaccines to prevent the spread of CV-A6 infection.
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Affiliation(s)
- Jiratchaya Puenpa
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Nutsada Saengdao
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
- Department of Microbiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Nongkanok Khanarat
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Sumeth Korkong
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Jira Chansaenroj
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Ritthideach Yorsaeng
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Nasamon Wanlapakorn
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Yong Poovorawan
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
- FRS(T), The Royal Society of Thailand, Sanam Sueapa, Dusit, Bangkok 10300, Thailand
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Cheng FF, Zhang BB, Cao ML, Zhang Q, Chen QH, Hui ZF, Tian JM, Yan WH. Clinical characteristics of 68 children with atypical hand, foot, and mouth disease caused by coxsackievirus A6: a single-center retrospective analysis. Transl Pediatr 2022; 11:1502-1509. [PMID: 36247893 PMCID: PMC9561509 DOI: 10.21037/tp-22-352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/26/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Hand, foot, and mouth disease (HFMD) caused by coxsackievirus A6 (CV-A6) has become prevalent in many parts of the world. It is commonly referred to as atypical HFMD which more likely to present as bullous lesions. Compared with traditional HFMD, its misdiagnosis rate is relatively high, which brings difficulties to clinical diagnosis. We retrospectively analyze the clinical characteristics of children with HFMD with bullous lesions caused by CV-A6. METHODS The study included 68 children with atypical HFMD caused by CV-A6 who were hospitalized from 2018 to 2020. Data of the children including age, sex, month of HFMD onset, the morphologies and distribution of rashes, the details of fever, the presence or absence of onychomadesis, and laboratory test results were analyzed and compared between an infant group (<1 year), a toddler group (1-<3 years), and a preschool group (3-<6 years). RESULTS Of the 68 children, 67 were younger than 5 years old, with a male to female ratio of 1.62:1. The disease peaked in the period from June to September. With 75.0% of the infant group had more than three kinds of rashes; 95.0% of the preschool group had rashes in more than five locations. These differences were statistically significant (P<0.05). All children had fever. The peak fever in the toddler group was lower (P=0.033). No critical cases were observed in any of the groups. Of the 61 children who were successfully followed up, 68.9% developed onychomadesis within 2-3 weeks. The proportion of cases with abnormal liver function was 83.3%, 41.7%, and 10.0% in the infant, toddler, and preschool groups (P<0.001). The proportion of cases with increased serum creatine kinase MB isoenzyme (CK-MB) were significantly higher in the toddler group (P<0.05). CONCLUSIONS Atypical HFMD caused by CV-A6 infection usually occurred in children under 5 years old. The morphologies of the rashes in the infant group changed more, while the rashes in the preschool group was more widely distributed. The incidence of critical cases was low. More than half of the cases can develop onychomadesis in the recovery period. Organ damage was relatively mild in the preschool group.
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Affiliation(s)
- Fang-Fang Cheng
- Infectious Diseases Department, Children's Hospital of Soochow University, Suzhou, China
| | - Bing-Bing Zhang
- Neurology Department, Children's Hospital of Soochow University, Suzhou, China
| | - Meng-Lu Cao
- Infectious Diseases Department, Children's Hospital of Soochow University, Suzhou, China
| | - Qian Zhang
- Infectious Diseases Department, Children's Hospital of Soochow University, Suzhou, China
| | - Qing-Hui Chen
- Infectious Diseases Department, Children's Hospital of Soochow University, Suzhou, China
| | - Zhao-Fang Hui
- Infectious Diseases Department, Children's Hospital of Soochow University, Suzhou, China
| | - Jian-Mei Tian
- Infectious Diseases Department, Children's Hospital of Soochow University, Suzhou, China
| | - Wen-Hua Yan
- Cardiovascular Department, Children's Hospital of Soochow University, Suzhou, China
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Yu Y, Luo Z, Jin W, Mai J, Qian S, Lu J, Wei Z, Meng S, Wang Z, Guan X, Tong Y, Shen S. Emergence of a novel recombinant of CV-A5 in HFMD epidemics in Xiangyang, China. BMC Med Genomics 2021; 14:279. [PMID: 34819054 PMCID: PMC8611921 DOI: 10.1186/s12920-021-01107-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 10/21/2021] [Indexed: 11/19/2022] Open
Abstract
Background Hand, foot and mouth disease (HFMD) is caused by a variety of enterovirus serotypes and the etiological spectrum worldwide has changed since a large scale of outbreaks occurred in 1997. Methods A large number of clinical specimens of HFMD patients were collected in Xiangyang and genotyping was performed by qRT-PCR, conventional PCR amplification and sequencing. Among the 146 CV-A5 detected cases, the complete genome sequences of representative strains were determined for genotyping and for recombination analysis. Results It was found that CV-A5 was one of the six major serotypes that caused the epidemic from October 2016 to December 2017. Phylogenetic analyses based on the VP1 sequences showed that these CV-A5 belonged to the genotype D which dominantly circulated in China. Recombination occurred between the CV-A5 and CV-A2 strains with a breakpoint in the 2A region at the nucleotide 3791. Conclusions The result may explain the emergence of CV-A5 as one of the major pathogens of HFMD. A multivalent vaccine against HFMD is urgently needed to control the disease and to prevent emerging and spreading of new recombinants.
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Affiliation(s)
- Yuting Yu
- Wuhan Institute of Biological Products, Co. Ltd, Wuhan, 430207, People's Republic of China
| | - Zhiyu Luo
- Wuhan Institute of Biological Products, Co. Ltd, Wuhan, 430207, People's Republic of China
| | - Weiping Jin
- Wuhan Institute of Biological Products, Co. Ltd, Wuhan, 430207, People's Republic of China
| | - Jianyi Mai
- Wuhan Institute of Biological Products, Co. Ltd, Wuhan, 430207, People's Republic of China
| | - Shasha Qian
- Wuhan Institute of Biological Products, Co. Ltd, Wuhan, 430207, People's Republic of China
| | - Jia Lu
- Wuhan Institute of Biological Products, Co. Ltd, Wuhan, 430207, People's Republic of China
| | - Zhenni Wei
- Wuhan Institute of Biological Products, Co. Ltd, Wuhan, 430207, People's Republic of China
| | - Shengli Meng
- Wuhan Institute of Biological Products, Co. Ltd, Wuhan, 430207, People's Republic of China
| | - Zejun Wang
- Wuhan Institute of Biological Products, Co. Ltd, Wuhan, 430207, People's Republic of China
| | - Xuhua Guan
- Xiangyang Center for Disease Control and Prevention, Hubei, People's Republic of China.
| | - Yeqing Tong
- Xiangyang Center for Disease Control and Prevention, Hubei, People's Republic of China.
| | - Shuo Shen
- Wuhan Institute of Biological Products, Co. Ltd, Wuhan, 430207, People's Republic of China.
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Mirand A, Cohen R, Bisseux M, Tomba S, Sellem FC, Gelbert N, Béchet S, Frandji B, Archimbaud C, Brebion A, Chabrolles H, Regagnon C, Levy C, Bailly JL, Henquell C. A large-scale outbreak of hand, foot and mouth disease, France, as at 28 September 2021. ACTA ACUST UNITED AC 2021; 26. [PMID: 34713796 PMCID: PMC8555367 DOI: 10.2807/1560-7917.es.2021.26.43.2100978] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We report a large-scale outbreak of hand, foot and mouth disease (HFMD) in France. As at 28 September 2021, 3,403 cases have been reported (47% higher than in 2018–19). We prospectively analysed 210 clinical samples; 190 (90.5%) were enterovirus-positive. Most children presented with atypical HFMD. Coxsackievirus (CV)A6 (49.5%; 94/190) was predominant; no enterovirus A71 was detected. Dermatological and neurological complications of HFMD justify prospective syndromic and virological surveillance for early detection of HFMD outbreaks and identification of associated types.
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Affiliation(s)
- Audrey Mirand
- CHU Clermont-Ferrand, Laboratoire de Virologie, Centre National de Référence des entérovirus et parechovirus - Laboratoire Associé, Clermont-Ferrand, France.,Université d'Auvergne, LMGE UMR CNRS 6023 Equipe EPIE - Epidémiologie et physiopathologie des infections à entérovirus, Faculté de Médecine, Clermont-Ferrand, France
| | - Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Créteil, France
| | - Maxime Bisseux
- CHU Clermont-Ferrand, Laboratoire de Virologie, Centre National de Référence des entérovirus et parechovirus - Laboratoire Associé, Clermont-Ferrand, France.,Université d'Auvergne, LMGE UMR CNRS 6023 Equipe EPIE - Epidémiologie et physiopathologie des infections à entérovirus, Faculté de Médecine, Clermont-Ferrand, France
| | - Stéphanie Tomba
- Université d'Auvergne, LMGE UMR CNRS 6023 Equipe EPIE - Epidémiologie et physiopathologie des infections à entérovirus, Faculté de Médecine, Clermont-Ferrand, France
| | | | - Nathalie Gelbert
- Association Française de Pédiatrie Ambulatoire (AFPA), Orléans, France
| | - Stéphane Béchet
- Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Créteil, France
| | | | - Christine Archimbaud
- CHU Clermont-Ferrand, Laboratoire de Virologie, Centre National de Référence des entérovirus et parechovirus - Laboratoire Associé, Clermont-Ferrand, France.,Université d'Auvergne, LMGE UMR CNRS 6023 Equipe EPIE - Epidémiologie et physiopathologie des infections à entérovirus, Faculté de Médecine, Clermont-Ferrand, France
| | - Amélie Brebion
- CHU Clermont-Ferrand, Laboratoire de Virologie, Centre National de Référence des entérovirus et parechovirus - Laboratoire Associé, Clermont-Ferrand, France
| | - Hélène Chabrolles
- CHU Clermont-Ferrand, Laboratoire de Virologie, Centre National de Référence des entérovirus et parechovirus - Laboratoire Associé, Clermont-Ferrand, France.,Université d'Auvergne, LMGE UMR CNRS 6023 Equipe EPIE - Epidémiologie et physiopathologie des infections à entérovirus, Faculté de Médecine, Clermont-Ferrand, France
| | - Christel Regagnon
- CHU Clermont-Ferrand, Laboratoire de Virologie, Centre National de Référence des entérovirus et parechovirus - Laboratoire Associé, Clermont-Ferrand, France
| | - Corinne Levy
- Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Créteil, France
| | - Jean-Luc Bailly
- CHU Clermont-Ferrand, Laboratoire de Virologie, Centre National de Référence des entérovirus et parechovirus - Laboratoire Associé, Clermont-Ferrand, France.,Université d'Auvergne, LMGE UMR CNRS 6023 Equipe EPIE - Epidémiologie et physiopathologie des infections à entérovirus, Faculté de Médecine, Clermont-Ferrand, France
| | - Cécile Henquell
- CHU Clermont-Ferrand, Laboratoire de Virologie, Centre National de Référence des entérovirus et parechovirus - Laboratoire Associé, Clermont-Ferrand, France.,Université d'Auvergne, LMGE UMR CNRS 6023 Equipe EPIE - Epidémiologie et physiopathologie des infections à entérovirus, Faculté de Médecine, Clermont-Ferrand, France
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11
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Characterization of oral virome and microbiome revealed distinctive microbiome disruptions in paediatric patients with hand, foot and mouth disease. NPJ Biofilms Microbiomes 2021; 7:19. [PMID: 33608551 PMCID: PMC7895916 DOI: 10.1038/s41522-021-00190-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 01/20/2021] [Indexed: 01/01/2023] Open
Abstract
While the underlying determinants are unclear, hand, foot and mouth disease (HFMD) presents a wide spectrum of clinical manifestations with varying severity in different individuals. Recently, many studies identified the human microbiome as a critical factor in the pathogenesis of various diseases. Therefore, we here investigated the ecological dynamics of the oral microbiome changes during the HFMD infection. After targeted enrichment of all known vertebrate viruses, the virome profiles of symptomatic and asymptomatic HFMD patients were examined and revealed to be significantly altered from those of healthy individuals, with nine discriminative viruses detected. Further characterization of the prokaryotic microbiome revealed an elevated level of Streptococcus sp. as the most important signature of the symptomatic HFMD cohort, positively correlating to the level of enterovirus A RNA. In addition, we found that while coxsackievirus A5 is detected in saliva RNA of all asymptomatic cases, coxsackievirus A6 dominates the majority of the symptomatic cohort.
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12
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Brown DM, Zhang Y, Scheuermann RH. Epidemiology and Sequence-Based Evolutionary Analysis of Circulating Non-Polio Enteroviruses. Microorganisms 2020; 8:microorganisms8121856. [PMID: 33255654 PMCID: PMC7759938 DOI: 10.3390/microorganisms8121856] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 02/07/2023] Open
Abstract
Enteroviruses (EVs) are positive-sense RNA viruses, with over 50,000 nucleotide sequences publicly available. While most human infections are typically associated with mild respiratory symptoms, several different EV types have also been associated with severe human disease, especially acute flaccid paralysis (AFP), particularly with endemic members of the EV-B species and two pandemic types—EV-A71 and EV-D68—that appear to be responsible for recent widespread outbreaks. Here we review the recent literature on the prevalence, characteristics, and circulation dynamics of different enterovirus types and combine this with an analysis of the sequence coverage of different EV types in public databases (e.g., the Virus Pathogen Resource). This evaluation reveals temporal and geographic differences in EV circulation and sequence distribution, highlighting recent EV outbreaks and revealing gaps in sequence coverage. Phylogenetic analysis of the EV genus shows the relatedness of different EV types. Recombination analysis of the EV-A species provides evidence for recombination as a mechanism of genomic diversification. The absence of broadly protective vaccines and effective antivirals makes human enteroviruses important pathogens of public health concern.
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Affiliation(s)
- David M Brown
- Department of Synthetic Biology, J. Craig Venter Institute, Rockville, MD 20850, USA
| | - Yun Zhang
- Department of Informatics, J. Craig Venter Institute, La Jolla, CA 92037, USA
| | - Richard H Scheuermann
- Department of Informatics, J. Craig Venter Institute, La Jolla, CA 92037, USA
- Department of Pathology, University of California San Diego, La Jolla, CA 92093, USA
- La Jolla Institute for Immunology, La Jolla, CA 92065, USA
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13
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Atypical hand-foot-mouth disease in Belém, Amazon region, northern Brazil, with detection of coxsackievirus A6. J Clin Virol 2020; 126:104307. [DOI: 10.1016/j.jcv.2020.104307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/05/2020] [Indexed: 12/16/2022]
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14
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Knöpfel N, Noguera-Morel L, Latour I, Torrelo A. Viral exanthems in children: A great imitator. Clin Dermatol 2019; 37:213-226. [PMID: 31178104 DOI: 10.1016/j.clindermatol.2019.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Viral exanthems are frequent in children and are mostly self-limited. Early recognition and differentiation from other childhood illnesses are important to direct further investigations and treatment initiation. The clinical presentation of viral exanthems in children includes a polymorphic spectrum of skin eruptions ranging from classic viral exanthems to "atypical" presentations that can mimic nonviral diseases; thus, viral exanthems of childhood can be readily diagnosed on clinical grounds, but not rarely do they represent a diagnostic challenge. In this review, we focus on viral diseases in children that may be difficult to diagnose due to their clinical similarities with nonviral diseases, and we offer clues for the differential diagnosis and proper diagnostic testing in such cases.
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Affiliation(s)
- Nicole Knöpfel
- Department of Pediatric Dermatology, University Children's Hospital Zurich, Zurich, Switzerland; Department of Dermatology, University Children's Hospital Niño Jesús, Madrid, Spain
| | - Lucero Noguera-Morel
- Department of Dermatology, University Children's Hospital Niño Jesús, Madrid, Spain
| | - Irene Latour
- Department of Dermatology, University Children's Hospital Niño Jesús, Madrid, Spain
| | - Antonio Torrelo
- Department of Dermatology, University Children's Hospital Niño Jesús, Madrid, Spain.
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15
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Lin CJ, Liu CH, Wang JY, Lin CC, Li YF, Richardson CD, Lin LT. Small molecules targeting coxsackievirus A16 capsid inactivate viral particles and prevent viral binding. Emerg Microbes Infect 2018; 7:162. [PMID: 30254193 PMCID: PMC6156566 DOI: 10.1038/s41426-018-0165-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 08/29/2018] [Accepted: 08/29/2018] [Indexed: 01/13/2023]
Abstract
Coxsackievirus A16 (CVA16) is an etiologic agent of hand, foot, and mouth disease (HFMD) that affects young children, and although typically self-limited, severe complications, and fatal cases have been reported. Due to the lack of specific medication and vaccines against CVA16, there is currently a need to develop effective antivirals to better control CVA16 infections in epidemic areas. In this study, we identified the tannins chebulagic acid (CHLA) and punicalagin (PUG) as small molecules that can efficiently disrupt the CVA16 infection of human rhabdomyosarcoma cells. Both compounds significantly reduced CVA16 infectivity at micromolar concentrations without apparent cytotoxicity. A mechanistic analysis revealed that the tannins particularly targeted the CVA16 entry phase by inactivating cell-free viral particles and inhibiting viral binding. Further examination by molecular docking analysis pinpointed the targets of the tannins in the fivefold axis canyon region of the CVA16 capsid near the pocket entrance that functions in cell surface receptor binding. We suggest that CHLA and PUG are efficient antagonists of CVA16 entry and could be of value as antiviral candidates or as starting points for developing molecules to treat CVA16 infections.
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Affiliation(s)
- Chien-Ju Lin
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan
| | - Ching-Hsuan Liu
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, 11031, Taiwan
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Jonathan Y Wang
- Department of Molecular Biosciences, The University of Texas at Austin, Austin, TX, 78712, USA
| | - Chun-Ching Lin
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan
- Graduate Institute of Natural Products, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan
| | - Yi-Fang Li
- Graduate Institute of Natural Products, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan
| | - Christopher D Richardson
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada
- Department of Pediatrics and Canadian Center for Vaccinology, Izaak Walton Killam Health Centre, Halifax, Nova Scotia, B3K 6R8, Canada
| | - Liang-Tzung Lin
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, 11031, Taiwan.
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, , Taipei Medical University, Taipei, 11031, Taiwan.
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16
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Wang C, Zhou S, Xue W, Shen L, Huang W, Zhang Y, Li X, Wang J, Zhang H, Ma X. Comprehensive virome analysis reveals the complexity and diversity of the viral spectrum in pediatric patients diagnosed with severe and mild hand-foot-and-mouth disease. Virology 2018; 518:116-125. [PMID: 29471150 DOI: 10.1016/j.virol.2018.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 02/03/2018] [Accepted: 02/03/2018] [Indexed: 10/18/2022]
Abstract
The management of hand-foot-and-mouth disease(HFMD) epidemic is difficult due to the frequent emergence of non-EV71 and non-CVA16 enteroviruses and some cases testing negative for HFMD-associated causative agents. To clarify the virus spectrum of mild and severe HFMD, a comprehensive virome analysis of 238 samples was performed using next-generation sequencing (NGS). The data revealed total thirteen mammalian- and plant- virus families and diverse viral populations including enteroviruses, common respiratory viruses, diarrhea-related viruses, plant viruses and anelloviruses. A total of 18 viruses from 7 virus families were identified in severe cases, versus 37 viruses from 12 virus families in mild cases. Moreover, complicated mixed-infections of enteroviruses with common respiratory viruses were mainly found in severe cases(P = 0.013), while diarrhea-related viruses were mainly found in mild cases(P < 0.001). This study provides the preliminary understanding of viromes both in mild and severe cases, which may benefit the detection of etiologic agents and prevention of HFMD.
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Affiliation(s)
- Chunhua Wang
- National Institutes for Food and Drug Control, Beijing 100050, China; Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; Institute of Process Engineering, Chinese Academy of Sciences, Beijing 100190, China
| | - Shuaifeng Zhou
- Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan, 410005, China
| | - Wanhua Xue
- Dezhou People's Hospital, Dezhou, Shandong, 253056, China
| | - Liang Shen
- Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Wei Huang
- Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan, 410005, China
| | - Yi Zhang
- Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Xuguang Li
- Biologics and Genetic Therapies Directorate, Health Canada, Tunney's Pasture, Ottawa, AL 2201C, Canada
| | - Junzhi Wang
- National Institutes for Food and Drug Control, Beijing 100050, China.
| | - Hong Zhang
- Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan, 410005, China.
| | - Xuejun Ma
- Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
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17
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Mirand A, le Sage FV, Pereira B, Cohen R, Levy C, Archimbaud C, Peigue-Lafeuille H, Bailly JL, Henquell C. Ambulatory Pediatric Surveillance of Hand, Foot and Mouth Disease as Signal of an Outbreak of Coxsackievirus A6 Infections, France, 2014-2015. Emerg Infect Dis 2018; 22:1884-1893. [PMID: 27767012 PMCID: PMC5088007 DOI: 10.3201/eid2211.160590] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Outbreaks can be detected by syndromic surveillance, rapid enterovirus testing, and genotyping. The clinical impact of enteroviruses associated with hand, foot and mouth disease (HFMD) is unknown outside Asia, and the prevalence of enterovirus A71 (EV-A71) in particular might be underestimated. To investigate the prevalence of enterovirus serotypes and the clinical presentations associated with HFMD in France, we conducted prospective ambulatory clinic–based surveillance of children during April 2014–March 2015. Throat or buccal swabs were collected from children with HFMD and tested for the enterovirus genome. Physical examinations were recorded on a standardized form. An enterovirus infection was detected in 523 (79.3%) of 659 children tested. Two epidemic waves occurred, dominated by coxsackievirus (CV) A6, which was detected in 53.9% of enterovirus-infected children. CV-A6 was more frequently related to atypical HFMD manifestations (eruptions extended to limbs and face). Early awareness and documentation of HFMD outbreaks can be achieved by syndromic surveillance of HFMD by ambulatory pediatricians and rapid enterovirus testing and genotyping.
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MESH Headings
- Adolescent
- Age Factors
- Child
- Child, Preschool
- Disease Outbreaks
- Enterovirus A, Human/classification
- Enterovirus A, Human/genetics
- Female
- France/epidemiology
- Hand, Foot and Mouth Disease/diagnosis
- Hand, Foot and Mouth Disease/epidemiology
- Hand, Foot and Mouth Disease/history
- Hand, Foot and Mouth Disease/virology
- History, 21st Century
- Humans
- Infant
- Infant, Newborn
- Male
- Molecular Typing
- Phylogeny
- Population Surveillance
- Prospective Studies
- RNA, Viral
- Serogroup
- Symptom Assessment
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18
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Riemenschneider K, Creech CB, Thomsen I. Diffuse Papulovesicular Rash in an Infant With Eczema. J Pediatric Infect Dis Soc 2017; 6:403-405. [PMID: 29186591 DOI: 10.1093/jpids/pix032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 04/13/2017] [Indexed: 11/14/2022]
Affiliation(s)
| | - C Buddy Creech
- Department of Pediatrics, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Isaac Thomsen
- Department of Pediatrics, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
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19
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Rübben A. Viruserkrankungen in der Dermatologie. Hautarzt 2017; 68:180. [DOI: 10.1007/s00105-017-3947-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Mammas IN, Theodoridou M, Kramvis A, Thiagarajan P, Gardner S, Papaioannou G, Melidou A, Koutsaki M, Kostagianni G, Achtsidis V, Koutsaftiki C, Calachanis M, Zaravinos A, Greenough A, Spandidos DA. Paediatric Virology: A rapidly increasing educational challenge. Exp Ther Med 2017; 13:364-377. [PMID: 28352303 PMCID: PMC5348700 DOI: 10.3892/etm.2016.3997] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 12/16/2016] [Indexed: 12/12/2022] Open
Abstract
The '2nd Workshop on Paediatric Virology', which took place on Saturday the 8th of October 2016 in Athens, Greece, provided an overview on recent views and advances on Paediatric Virology. Emphasis was given to HIV-1 management in Greece, a country under continuous financial crisis, hepatitis B vaccination in Africa, treatment options for hepatitis C virus in childhood, Zika virus in pregnancy and infancy, the burden of influenza on childhood, hand-foot-mouth disease and myocarditis associated with Coxsackie viruses. Other general topics covered included a critical evaluation of Paediatric Accident and Emergency viral infections, multimodality imaging of viral infections in children, surgical approaches of otolaryngologists to complex viral infections, new advances in the diagnosis and treatment of viral conjunctivitis and novel molecular diagnostic methods for HPV in childhood. A brief historical overview of the anti-vaccination movement was also provided, as well as presentations on the educational challenge of Paediatric Virology as a new subspecialty of Paediatrics. This review highlights selected lectures and discussions of the workshop.
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Affiliation(s)
- Ioannis N. Mammas
- Department of Clinical Virology, School of Medicine, University of Crete, Heraklion 71003, Greece
| | - Maria Theodoridou
- 1st Department of Paediatrics, ‘Aghia Sophia’ Children's Hospital, University of Athens School of Medicine, Athens 11527, Greece
| | - Anna Kramvis
- Hepatitis Virus Diversity Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Prakash Thiagarajan
- Neonatal Unit, Division for Women's and Children's Health, Noble's Hospital, Douglas, Isle of Man IM4 4RJ, British Isles
| | - Sharryn Gardner
- Department of Children's Accident and Emergency, Southport and Ormskirk Hospital NHS Trust, Ormskirk L39 2AZ, UK
| | - Georgia Papaioannou
- Department of Paediatric Radiology, ‘Mitera’ Children's Hospital, Athens 15123, Greece
| | - Angeliki Melidou
- 2nd Laboratory of Microbiology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Maria Koutsaki
- Paediatric Neurology Division, 3rd Department of Paediatrics, School of Medicine, University of Athens, ‘Attikon’ University Hospital, Athens 12462, Greece
| | - Georgia Kostagianni
- Department of Otorhinolaryngology - Head and Neck Surgery, ‘Triassio’ General Hospital, Elefsina 19200, Greece
| | - Vassilis Achtsidis
- Department of Ophthalmology, Royal Cornwall Hospitals, Truro, Cornwall TR1 3LQ, UK
| | - Chryssie Koutsaftiki
- Paediatric Intensive Care Unit (PICU), ‘Penteli’ Children's Hospital, Penteli 15236, Greece
| | - Marcos Calachanis
- Department of Paediatric Cardiology, ‘Penteli’ Children's Hospital, Penteli 15236, Greece
| | - Apostolos Zaravinos
- Department of Life Sciences, School of Sciences, European University Cyprus, Nicosia 1516, Cyprus
| | - Anne Greenough
- Division of Asthma, Allergy and Lung Biology, King's College London, London SE5 9RS, UK
| | - Demetrios A. Spandidos
- Department of Clinical Virology, School of Medicine, University of Crete, Heraklion 71003, Greece
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21
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Huang WC, Chen HL, Chen HY, Peng KP, Lee Y, Huang LM, Chang LY, Liu FT. Galectin-3 and Its Genetic Variation rs4644 Modulate Enterovirus 71 Infection. PLoS One 2016; 11:e0168627. [PMID: 28002441 PMCID: PMC5176291 DOI: 10.1371/journal.pone.0168627] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/02/2016] [Indexed: 11/18/2022] Open
Abstract
Galectin-3, a chimeric type β-galactoside-binding protein, is known to modulate viral infection; however, its role in enterovirus 71 (EV71) infection has not been investigated. We generated galectin-3 null rhabdomyosarcoma (RD) cells and evaluated whether EV71 infection would be affected. In galectin-3 null cells, the released and intracellular EV71 viral loads were suppressed after 24 h of infection, and cell death rates were significantly lower, while cell proliferation remained unaltered. In addition, RD cells expressing a nonsynonymous genetic variant of galectin-3, rs4644 (LGALS3 +191C/A, P64H), produced lower virus titers than those with wild-type galectin-3 (C allele). To clarify whether the in vitro viral load reduction correlates with clinical severity, we enrolled children with laboratory-confirmed EV71 infection. Since hyperglycemia is an indicator of severe EV71 infection in children, 152 of 401 enrolled children had glucose examinations at admission, and 59 subjects had serum glucose levels ≥ 150 mg/dL. In comparison to the rs4644 AA genotype (2.2 ± 0.06 log10 mg/dL), serum glucose levels during EV71 infection were higher in patients with CC (2.4 ± 0.17 log10 mg/dL, p = 0.03) and CA (2.4 ± 0.15 log10 mg/dL, p = 0.02) genotypes, respectively. These findings suggest that the rs4644 AA genotype of galectin-3 might exert a protective effect. In summary, galectin-3 affects EV71 replication in our cellular model and its variant, rs4644, is associated with hyperglycemia in the clinical setting. The underlying mechanism and its potential therapeutic application warrant further investigation.
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Affiliation(s)
- Wen-Chan Huang
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
- Ph.D. Program in Translational Medicine, National Taiwan University and Academia Sinica, Taipei, Taiwan
| | - Hung-Lin Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Huan-Yuan Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Kuan-Po Peng
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yungling Lee
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Li-Min Huang
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Luan-Yin Chang
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail: (FTL); (LYC)
| | - Fu-Tong Liu
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
- Department of Dermatology, University of California Davis, Sacramento, California, United States of America
- * E-mail: (FTL); (LYC)
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22
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Wang CR. Role and evolution trend of multiple enteroviruses in epidemic of hand, foot and mouth disease. Shijie Huaren Xiaohua Zazhi 2016; 24:4029-4039. [DOI: 10.11569/wcjd.v24.i29.4029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
There are a variety of enteroviruses (EV) that can cause hand, foot and mouth disease (HFMD), and the major pathogens include enterovirus 71 (EV71) and coxasckievirus A16 (CVA16). EV71 and CVA16 have attracted much attention for their high prevalence and pathogenicity, and disease surveillance and vaccine development are mainly concentrated on them. EV71 can cause serious harm to children with HFMD, especially the damage to the nervous system such as aseptic meningitis, brain stem encephalitis and paralytic disease, or even lead to death. However, in recent years, due to the epidemic of EV71 and CVA16, people have established an immune barrier through natural infection in a certain degree. Although there is no cross protection between types, the immune protection against the relevant type can persist for a long time. Thus, the number of HFMD cases caused by EV71 and CVA16 shows a decreasing trend, while the epidemic of HFMD caused by other EV exhibits an upward trend. Further studies found that non-EV71 and non-CVA16 EV are very complex, and there are also differences in EV prevalence each year, which makes the development, evolution and control of HFMD become complicated. At present, there is no enough attention paid to the sporadic virus in the HFMD epidemic, and a complete research system for non-EV71 and non-CVA16 EV has not formed. Therefore, it is necessary to strengthen the monitoring of multiple non-EV71 and non-CVA16 EV, further investigate their pathogenicity and genetic characteristics, and evaluate the relative frequency and biological hazard of infection. In this review, we summarize a variety of EV changes, molecular evolution, as well as typical epidemics, which may provide clues to the development of antiviral drugs and vaccines, and prevention and control of HFMD.
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23
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Neri I, Dondi A, Wollenberg A, Ricci L, Ricci G, Piccirilli G, Lazzarotto T, Patrizi A. Atypical Forms of Hand, Foot, and Mouth Disease: A Prospective Study of 47 Italian Children. Pediatr Dermatol 2016; 33:429-37. [PMID: 27292085 DOI: 10.1111/pde.12871] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Atypical forms of hand, foot, and mouth disease (HFMD) caused by coxsackievirus A6 have been reported in recent years. High fever and severe cutaneous lesions are common, whereas neurologic complications are rare. Eczematous areas of patients with atopic dermatitis show more lesions. The goal of the current study was to describe the clinical characteristics of children with atypical HFMD and to investigate the involvement of the different enterovirus serotypes associated. METHODS All patients referred to our service for atypical HFMD from January 2012 to February 2014 were enrolled and classified as having the diffuse form (lesions extended to the trunk), the acral form (lesions with a mainly acral distribution), or eczema coxsackium (lesions on preexisting eczematous areas). RESULTS Data from 47 patients were analyzed (median age 22 months [range 4-84 mos]); viral genotyping was performed in 11 cases. Sixty-two percent of the subjects developed the acral form, 23% eczema coxsackium, and 15% the diffuse form. Most patients had a nonclassical vesicular eruption and moderate to severe extent of cutaneous involvement. Approximately 80% of patients had palmoplantar purpuric macules. Most children younger than 2 years old had the acral form, most patients with eczema coxsackium were age 2 years and older, and the diffuse form was similarly distributed between the two age groups. Coxsackievirus A6 was detected in 9 of 11 genotyped cases. CONCLUSION Our prospective study allowed the identification of three HFMD phenotypes differing from the classical form. Clinical care of these patients should include symptomatic treatment of extracutaneous features and, if necessary, hospitalization for complications.
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Affiliation(s)
- Iria Neri
- Dermatology Unit, Department of Specialistic, Diagnostic and Experimental Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Arianna Dondi
- Dermatology Unit, Department of Specialistic, Diagnostic and Experimental Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.,Pediatric Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Andreas Wollenberg
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany
| | - Lorenza Ricci
- Dermatology Unit, Department of Specialistic, Diagnostic and Experimental Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giampaolo Ricci
- Pediatric Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giulia Piccirilli
- Department of Specialistic, Diagnostic and Experimental Medicine, Operative Unit of Clinical Microbiology, Laboratory of Virology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Tiziana Lazzarotto
- Department of Specialistic, Diagnostic and Experimental Medicine, Operative Unit of Clinical Microbiology, Laboratory of Virology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Dermatology Unit, Department of Specialistic, Diagnostic and Experimental Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Li J, Sun Y, Du Y, Yan Y, Huo D, Liu Y, Peng X, Yang Y, Liu F, Lin C, Liang Z, Jia L, Chen L, Wang Q, He Y. Characterization of Coxsackievirus A6- and Enterovirus 71-Associated Hand Foot and Mouth Disease in Beijing, China, from 2013 to 2015. Front Microbiol 2016; 7:391. [PMID: 27065963 PMCID: PMC4812011 DOI: 10.3389/fmicb.2016.00391] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 03/11/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Etiology surveillance of Hand Foot and Mouth disease (HFMD) in Beijing showed that Coxsackievirus A6 (CVA6) became the major pathogen of HFMD in 2013 and 2015. In order to understand the epidemiological characteristics and clinical manifestations of CVA6-associated HFMD, a comparison study among CVA6-, EV71- (Enterovirus 71), and CVA16- (Coxsackievirus A16) associated HFMD was performed. METHODS Epidemiological characteristics and clinical manifestations among CVA6-, EV71- and CVA16-associated mild or severe cases were compared from 2013 to 2015. VP1 gene of CVA6 and EV71 from mild cases, severe cases were sequenced, aligned, and compared with strains from 2009 to 2015 in Beijing and strains available in GenBank. Phylogenetic tree was constructed by neighbor-joining method. RESULTS CVA6 became the predominant causative agent of HFMD and accounted for 35.4 and 36.9% of total positive cases in 2013 and 2015, respectively. From 2013 to 2015, a total of 305 severe cases and 7 fatal cases were reported. CVA6 and EV71 were responsible for 57.5% of the severe cases. Five out six samples from fatal cases were identified as EV71. High fever, onychomadesis, and decrustation were the typical symptoms of CVA6-associated mild HFMD. CVA6-associated severe cases were characterized by high fever with shorter duration and twitch compared with EV71-associated severe cases which were characterized by poor mental condition, abnormal pupil, and vomiting. Poor mental condition, lung wet rales, abnormal pupil, and tachycardia were the most common clinical features of fatal cases. The percentage of lymphocyte in CVA6-associated cases was significantly lower than that of EV71. High percentage of lymphocyte and low percentage of neutrophils were the typical characteristics of fatal cases. VP1 sequences between CVA6- or EV71-associated mild and severe cases were highly homologous. CONCLUSION CVA6 became one of the major pathogens of HFMD in 2013 and 2015 in Beijing. Epidemiological characteristics, clinical manifestations of CVA6-, EV71- and CVA16-associated cases in this study enriched the definition of HFMD caused by different pathogens and shed light to accurate diagnosis, appropriate treatment and effective prevention of HFMD.
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Affiliation(s)
- Jie Li
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical UniversityBeijing, China; Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease ControlBeijing, China
| | - Ying Sun
- Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease Control Beijing, China
| | - Yiwei Du
- Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease Control Beijing, China
| | - Yuxiang Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University Beijing, China
| | - Da Huo
- Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease Control Beijing, China
| | - Yuan Liu
- Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease Control Beijing, China
| | - Xiaoxia Peng
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University Beijing, China
| | - Yang Yang
- Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease Control Beijing, China
| | - Fen Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University Beijing, China
| | - Changying Lin
- Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease Control Beijing, China
| | - Zhichao Liang
- Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease Control Beijing, China
| | - Lei Jia
- Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease Control Beijing, China
| | - Lijuan Chen
- Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease Control Beijing, China
| | - Quanyi Wang
- Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease Control Beijing, China
| | - Yan He
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University Beijing, China
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Clinical and Etiological Characteristics of Atypical Hand-Foot-and-Mouth Disease in Children from Chongqing, China: A Retrospective Study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:802046. [PMID: 26693489 PMCID: PMC4674665 DOI: 10.1155/2015/802046] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/29/2015] [Accepted: 09/07/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Hand-foot-and-mouth disease (HFMD) is a disease that had similar manifestations to chickenpox, impetigo, and measles, which is easy to misdiagnose and subsequently causes delayed therapy and subsequent epidemic. To date, no study has been conducted to report the clinical and epidemiological characteristics of atypical HFMD. METHODS 64 children with atypical HFMD out of 887 HFMD children were recruited, stool was collected, and viral VP1 was detected. RESULTS The atypical HFMD accounted for 7.2% of total HFMD in the same period (64/887) and there were two peaks in its prevalence in nonepidemic seasons. Ten children (15.6%) had manifestations of neurologic involvement, of whom 4 (6.3%) were diagnosed with severe HFMD and 1 with critically severe HFMD, but all recovered smoothly. Onychomadesis and desquamation were found in 14 patients (21.9%) and 15 patients (23.4%), respectively. The most common pathogen was coxsackievirus A6 (CV-A6) which accounted for 67.2%, followed by nontypable enterovirus (26.6%), enterovirus 71 (EV-A71) (4.7%), and coxsackievirus A16 (A16) (1.5%). CONCLUSIONS Atypical HFMD has seasonal prevalence. The manifestations of neurologic involvement in atypical HFMD are mild and usually have a good prognosis. CV-A6 is a major pathogen causing atypical HFMD, but not a major pathogen in Chongqing, China.
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Prevalence of Coxsackievirus A6 and Enterovirus 71 in Hand, Foot and Mouth Disease in Nanjing, China in 2013. Pediatr Infect Dis J 2015; 34:951-7. [PMID: 26090576 DOI: 10.1097/inf.0000000000000794] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although hand, foot and mouth disease (HFMD) has been strongly associated with enterovirus 71 (EV71), coxsackievirus A16 (CVA16) and other enteroviruses, studies regarding coxsackievirus A6 (CVA6) infection in HFMD are limited. The aim of this study was to identify the major etiological agents causing HFMD in Nanjing in 2013 and explore the clinical and genetic characteristics of the prevalent enterovirus (EV) types in HFMD. METHODS A total of 394 throat swabs were collected from hospitalized children diagnosed with HFMD from April to July 2013. EVs were detected by reverse transcription polymerase chain reaction of 5' UTR sequences. Genotyping and phylogenetic analysis were based on VP4 sequences. Demographic and clinical data were obtained. RESULTS Of the specimens, 68.5% (270/394) were positive for EVs. The genotypes and detection rates were CVA6, 30.00% (81/270); EV71, 17.41% (47/270); HRV, 11.11% (30/270); CVA10, 3.33% (9/270); CVA2, 1.11% (3/270); CVA16, 0.74% (2/270); EV68, 0.37% (1/270); echovirus 6, 0.37% (1/270); echovirus 9, 0.37% (1/270), respectively. Patients infected with CVA6 displayed symptoms atypical of HFMD, including larger vesicles on their limbs and buttocks. Phylogenetic analysis revealed 2 genetically distinct CVA6 strains that circulated independently within the region. Patients infected with CVA6 were more likely to have abnormal periphery blood white blood cell and C-reactive protein levels, while EV71 was more likely to infect the central nervous system, as indicated by clinical manifestations and white blood cell analysis of cerebrospinal fluid. CONCLUSIONS Multiple EV genotypes contributed to HFMD in Nanjing in 2013, and CVA6 was the dominant genotype. The clinical presentation of CVA6 infection differs from that of EV71 infection in HFMD.
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Clinical Features for Mild Hand, Foot and Mouth Disease in China. PLoS One 2015; 10:e0135503. [PMID: 26302092 PMCID: PMC4547800 DOI: 10.1371/journal.pone.0135503] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 07/22/2015] [Indexed: 12/12/2022] Open
Abstract
Background Mild hand, foot and mouth disease (HFMD) is at a critical stage owing to its ease of communicability and a higher risk of developing severe complications and death. Clinical diagnosis of mild HFMD was made by the presenting symptoms and signs (symptoms in brief) alone. We aim to evaluate the frequencies of symptoms in a retrospective case series study. Methods We collected epidemiological, demographic, clinical, and laboratory data from outpatient and inpatient settings on the clinical data warehouse system. We principally described the frequencies of symptoms of mild HFMD. Correlations between symptoms with laboratory-confirmed cases were then analyzed. Results The clinical data warehouse system included 3649 probable cases, between 2010 and 2012, of which 956 (26.20%) were laboratory confirmed. The peak incidence was identified in children 2 years of age. A total of 370 of the 956 laboratory confirmed cases (38.70%) were associated with enterovirus 71 (EV71). Logistic regression analysis adjusted for geographical variables, age, sex, month of onset, and time from onset to diagnosis showed that the clinical features constipation (P<0.0001; adjusted OR, 95%CI (2.99, 2.28–3.91)), and blisters (P<0.0001; adjusted OR, 95%CI (2.16, 1.82–2.56)) were positively correlated with the confirmed cases. Conclusions This is the largest case series study, including all the guideline-mentioned symptoms of mild HFMD. Our findings suggest that blisters and constipation should be considered as potential warning signs while front-line clinicians manage surges of children diagnosed with mild HFMD during a pandemic.
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Klein M, Chong P. Is a multivalent hand, foot, and mouth disease vaccine feasible? Hum Vaccin Immunother 2015; 11:2688-704. [PMID: 26009802 DOI: 10.1080/21645515.2015.1049780] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Enterovirus A infections are the primary cause of hand, foot and mouth disease (HFMD) in infants and young children. Although enterovirus 71 (EV-A71) and coxsackievirus A16 (CV-A16) are the predominant causes of HFMD epidemics worldwide, EV-A71 has emerged as a major neurovirulent virus responsible for severe neurological complications and fatal outcomes. HFMD is a serious health threat and economic burden across the Asia-Pacific region. Inactivated EV-A71 vaccines have elicited protection against EV-A71 but not against CV-A16 infections in large efficacy trials. The current development of a bivalent inactivated EV-A71/CV-A16 vaccine is the next step toward that of multivalent HFMD vaccines. These vaccines should ultimately include other prevalent pathogenic coxsackieviruses A (CV-A6 and CV-A10), coxsackieviruses B (B3 and B5) and echovirus 30 that often co-circulate during HFMD epidemics and can cause severe HFMD, aseptic meningitis and acute viral myocarditis. The prospect and challenges for the development of such multivalent vaccines are discussed.
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Affiliation(s)
| | - Pele Chong
- b Vaccine R&D Center; National Health Research Institutes ; Zhunan Town, Miaoli County , Taiwan.,c Graduate Institute of Immunology; China Medical University ; Taichung , Taiwan
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Huang Y, Zhou Y, Lu H, Yang H, Feng Q, Dai Y, Chen L, Yu S, Yao X, Zhang H, Jiang M, Wang Y, Han N, Hu G, He Y. Characterization of severe hand, foot, and mouth disease in Shenzhen, China, 2009-2013. J Med Virol 2015; 87:1471-9. [PMID: 25951788 DOI: 10.1002/jmv.24200] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2015] [Indexed: 11/07/2022]
Abstract
Hand, foot, and mouth disease (HFMD) is caused by human enteroviruses, especially by enterovirus 71 (EV71) and coxsackievirus A16 (CA16). Patients infected with different enteroviruses show varied clinical symptoms. The aim of this study was to determine whether the etiological spectrum of mild and severe HFMD changed, and the association between pathogens and clinical features. From 2009 to 2013, a total of 2,299 stool or rectal specimens were collected with corresponding patient data. A dynamic view of the etiological spectrum of mild and severe HFMD in Shenzhen city of China was provided. EV71 accounted for the majority proportion of severe HFMD cases and fatalities during 2009-2013. CA16 and EV71 were gradually replaced by coxsackievirus A6 (CA6) as the most common serotype for mild HFMD since 2010. Myoclonic jerk and vomiting were the most frequent severe symptoms. Nervous system complications, including aseptic encephalitis and aseptic meningitis were observed mainly in patients infected by EV71. Among EV71, CA16, CA6, and CA10 infection, fever and pharyngalgia were more likely to develop, vesicles on the hand, foot, elbow, knee and buttock were less likely to develop in patients infected with CA10. Vesicles on the mouth more frequently occurred in the patients with CA6, but less in the patient with EV71. Associations between diverse enterovirus serotypes and various clinical features were discovered in the present study, which may offer further insight into early detection, diagnosis and treatment of HFMD.
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Affiliation(s)
- Yun Huang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - Yuanping Zhou
- First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Hong Lu
- Scientific Research Department of Nanfang Hospital Affiliated to Southern Medical University, Guangzhou, China
| | - Hong Yang
- Major Infectious Disease Control Key Laboratory, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Qianjin Feng
- Department of Health Statistics and Epidemiology, College of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yingchun Dai
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - Long Chen
- Major Infectious Disease Control Key Laboratory, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Shouyi Yu
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - Xiangjie Yao
- Major Infectious Disease Control Key Laboratory, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Hailong Zhang
- Major Infectious Disease Control Key Laboratory, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Ming Jiang
- Major Infectious Disease Control Key Laboratory, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Yujie Wang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - Ning Han
- Department of Occupational and Environmental Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guifang Hu
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - Yaqing He
- First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Major Infectious Disease Control Key Laboratory, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
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Gaunt E, Harvala H, Österback R, Sreenu VB, Thomson E, Waris M, Simmonds P. Genetic characterization of human coxsackievirus A6 variants associated with atypical hand, foot and mouth disease: a potential role of recombination in emergence and pathogenicity. J Gen Virol 2015; 96:1067-1079. [PMID: 25614593 PMCID: PMC4631059 DOI: 10.1099/vir.0.000062] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/15/2015] [Indexed: 01/21/2023] Open
Abstract
Human coxsackievirus A6 (CVA6) is an enterically transmitted enterovirus. Until recently, CVA6 infections were considered as being of minor clinical significance, and only rarely aetiologically linked with hand, foot and mouth disease (HFMD) associated with other species A enteroviruses (particularly EV71 and CVA16). From 2008 onwards, however, CVA6 infections have been associated with several outbreaks worldwide of atypical HFMD (aHFMD) accompanied by a varicelliform rash. We recently reported CVA6-associated eczema herpeticum occurring predominantly in children and young adults in Edinburgh in January and February 2014. To investigate genetic determinants of novel clinical phenotypes of CVA6, we genetically characterized and analysed CVA6 variants associated with eczema herpeticum in Edinburgh in 2014 and those with aHFMD in CAV isolates collected from 2008. A total of eight recombinant forms (RFs) have circulated worldwide over the past 10 years, with the particularly recent appearance of RF-H associated with eczema herpeticum cases in Edinburgh in 2014. Comparison of phylogenies and divergence of complete genome sequences of CVA6 identified recombination breakpoints in 2A-2C, within VP3, and between 5' untranslated region and VP1. A Bayesian temporal reconstruction of CVA6 evolution since 2004 provided estimates of dates and the actual recombination events that generated more recently appearing recombination groups (RF-E, -F, -G and -H). Associations were observed between recombination groups and clinical presentations of herpangina, aHFMD and eczema herpeticum, but not with VP1 or other structural genes. These observations provided evidence that NS gene regions may potentially contribute to clinical phenotypes and outcomes of CVA6 infection.
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Affiliation(s)
- Eleanor Gaunt
- Roslin Institute, University of Edinburgh, Easter Bush, Edinburgh EH25 9RG, UK
| | - Heli Harvala
- Specialist Virology Laboratory, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Riikka Österback
- Department of Virology, University of Turku, 20520 Turku, Finland
| | - Vattipally B Sreenu
- MRC University of Glasgow Centre for Virus Research, 8 Church Street, Glasgow G11 5JR, UK
| | - Emma Thomson
- MRC University of Glasgow Centre for Virus Research, 8 Church Street, Glasgow G11 5JR, UK
| | - Matti Waris
- Department of Virology, University of Turku, 20520 Turku, Finland
| | - Peter Simmonds
- Roslin Institute, University of Edinburgh, Easter Bush, Edinburgh EH25 9RG, UK
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Predicting severe enterovirus 71 infection: Age, comorbidity, and parental behavior matter. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2014; 50:10-16. [PMID: 25678038 DOI: 10.1016/j.jmii.2014.11.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 11/07/2014] [Accepted: 11/17/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Enterovirus 71 (EV71) is one of the major pathogens that cause severe enteroviral infections. Our aim was to study the behavioral and household risk factors for its serious complications. METHODS Between May 2011 and November 2012, we enrolled children who had symptoms of EV71 infection from six hospitals in Taiwan. The caregivers of each patient were interviewed to determine their hand hygiene habits in relation to EV71 infection. The severity of EV71 infection was classified as follows: Stage 1, hand-foot-mouth disease or herpangina; Stage 2, meningitis or myoclonic jerk; Stage 3A, encephalitis; Stage 3B, cardiopulmonary failure. Stages 2 to 3B were defined as severe EV71 infection. Children with Stages 3A and 3B infection were designated as the critical group. RESULTS A total of 399 patients had laboratory-confirmed EV71 infection. Three risks factors were associated with the different degrees of severity in EV71 infection. Children <2 years old had much greater risks for severe EV71 infection [odds ratio (OR) 1.8; 95% confidence interval (CI), 1.2-2.8], delayed medical evaluation for critical infection (OR 9.4; 95% CI, 3.6-24.1), and developmental retardation for cardiopulmonary failure (OR 8.3; 95% CI, 2.0-33.7). Among all the habits and household factors, caregivers in the critical group had a significantly lower rate in terms of cleaning the faucet after washing their hands (OR 2.63; 95% CI, 1.14-6.08). CONCLUSIONS Children <2 years old, developmental retardation, and delayed medical intervention were associated with severe EV71 infection. Cleaning water faucets after hand washing was a protective habit that reduced the risk of complications.
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Affiliation(s)
- Subhash Kashyap
- Department of Dermatology, Venereology and Leprosy, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
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An atypical dermatologic presentation of a child with hand, foot and mouth disease caused by coxsackievirus A6. Pediatr Infect Dis J 2014; 33:889. [PMID: 25222313 DOI: 10.1097/inf.0000000000000310] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gao LD, Hu SX, Zhang H, Luo KW, Liu YZ, Xu QH, Huang W, Deng ZH, Zhou SF, Liu FQ, Zhang F, Chen Y. Correlation analysis of EV71 detection and case severity in hand, foot, and mouth disease in the Hunan Province of China. PLoS One 2014; 9:e100003. [PMID: 24941257 PMCID: PMC4062471 DOI: 10.1371/journal.pone.0100003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 05/20/2014] [Indexed: 12/21/2022] Open
Abstract
An increase in the incidence of hand, foot and mouth disease (HFMD) cases has been observed in the Hunan province of mainland China since 2009 with a particularly higher level of severe cases in 2010-2012. Intestinal viruses of the picornaviridae family are responsible for the human syndrome associated with HFMD with enterovirus 71 (EV71) and Coxsackievirus A16 (Cox A16) being the most common causative strains. HFMD cases associated with EV71 are generally more severe with an increased association of morbidity and mortality. In this study, the etiology surveillance data of HFMD cases in Hunan province from March 2010 to October 2012 were analyzed to determine if there is a statistically relevant linear correlation exists between the detection rate of EV71 in mild cases and the proportion of severe cases among all HFMD patients. As the cases progressed from mild to severe to fatal, the likelihood of EV71 detection increased (25.78%, 52.20% and 84.18%, respectively). For all cases in the timeframe evaluated in this study, the presence of virus was detected in 63.21% of cases; among cases showing positivity for virus, EV71 infection accounted for 50.14%. These results provide evidence to support the observed higher morbidity and mortality associated with this outbreak and emphasizes the importance of early detection in order to implement necessary prevention measures to mitigate disease progression.
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Affiliation(s)
- Li-Dong Gao
- Hunan Provincial Center for Disease Control and Prevention, Hunan, China
| | - Shi-Xiong Hu
- Hunan Provincial Center for Disease Control and Prevention, Hunan, China
| | - Hong Zhang
- Hunan Provincial Center for Disease Control and Prevention, Hunan, China
| | - Kai-Wei Luo
- Hunan Provincial Center for Disease Control and Prevention, Hunan, China
| | - Yun-Zhi Liu
- Hunan Provincial Center for Disease Control and Prevention, Hunan, China
| | - Qiao-Hua Xu
- Hunan Provincial Center for Disease Control and Prevention, Hunan, China
| | - Wei Huang
- Hunan Provincial Center for Disease Control and Prevention, Hunan, China
| | - Zhi-Hong Deng
- Hunan Provincial Center for Disease Control and Prevention, Hunan, China
| | - Shuai-Feng Zhou
- Hunan Provincial Center for Disease Control and Prevention, Hunan, China
| | - Fu-Qiang Liu
- Hunan Provincial Center for Disease Control and Prevention, Hunan, China
| | - Fan Zhang
- Hunan Provincial Center for Disease Control and Prevention, Hunan, China
| | - Yu Chen
- Hunan Provincial Center for Disease Control and Prevention, Hunan, China
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Abstract
BACKGROUND Hand, foot and mouth disease (HFMD) is classically defined as a childhood fever accompanied by a rash with vesicles or erosions of the oral mucosa, hands, feet and sometimes the buttocks. Severe neurological complications are associated with enterovirus 71 outbreaks in Asia. Recently, it has been suggested that HFMD is related to coxsackie virus A6 (CV-A6) when there is an atypical rash. The objective of the study is to determine the dermatological pattern of HFMD and to identify the virus serotypes associated with a specific dermatological pattern. METHODS A prospective, cross-sectional study was conducted in 7 pediatric dermatology units in France from March 2010 to February 2012. All children with clinically suspected diagnosis of HFMD were included. Clinical data were collected and swabs from the nasopharynx and vesicles were taken for reverse transcription polymerase chain reaction and genotyping. Only children with confirmed HFMD--defined by clinical diagnosis of HFMD and positive enterovirus polymerase chain reaction results--were included for analysis. RESULTS One hundred and four children consulted for suspected HFMD, including 89 (mean age: 25.7 months; sex ratio M/F 1.54) with confirmed HFMD. Seventy-eight (87.6%) had skin lesions on sites other than hand, feet and mouth. Thirty-seven (41.5%) had 5 or more anatomical sites involved (hand, feet and mouth, buttocks, legs, arms and trunk) considered as widespread exanthema. Widespread vesicular exanthema was observed with both CV-A6 and CV-A16. Peri-oral rash was associated with CV-A6 (P < 0.001). CONCLUSIONS HFMD has a clinical spectrum ranging from classical to generalized vesicular exanthema. Generalized and atypical exanthema were observed with both CV-A6 and CV-A16 infections. CV-A6 is associated with peri-oral rash.
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Zhang X, Wang H, Ding S, Wang X, Chen X, Wo Y, Wang L, Huang D, Liu W, Cao W. Prevalence of enteroviruses in children with and without hand, foot, and mouth disease in China. BMC Infect Dis 2013; 13:606. [PMID: 24370001 PMCID: PMC3890605 DOI: 10.1186/1471-2334-13-606] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 12/26/2013] [Indexed: 12/11/2022] Open
Abstract
Background To determine the prevalence of human enteroviruses (HEVs) among healthy children, their parents, and children with hand, foot, and mouth disease (HFMD). Methods We conducted a case–control study that included throat samples from 579 children with HFMD and from 254 healthy controls. Throat samples from 49 households (98 parents and 53 healthy children) were also analyzed. Phylogenetic analysis was carried out to study genetic relationships of EV71 strains. Results The HEV positive rate in HFMD patients was significantly higher than that in healthy controls (76.0% vs. 23.2%, P < 0.001). The EV71 (43.7% vs. 15.0%, P < 0.001), CVA16 (18.0% vs. 2.8%, P < 0.001), and CVA10 (5.7% vs. 0.8%, P = 0.001) serotypes were significantly overrepresented in HFMD patients in comparison to healthy children. Other HEV serotypes were detected with comparable frequency in cases and controls. The HEV positive rate in severe HFMD patients was significantly higher than that in mild group (82.1% vs. 73.8%, P = 0.04). The EV71 (55.0% vs. 39.7%, P = 0.001) and CVA16 (11. 9% vs. 20.0%, P = 0.024) positive rate differed significantly between severe and mild HFMD patients. Other HEV serotypes were detected with comparable frequency between severe and mild HFMD patients. Among 49 households, 22 households (44.9%) had at least 1 family member positive for HEV. Children had significantly higher HEV positive rate than adult (28.3% vs. 14.3%, P = 0.037). The HEV positive rate was similar between mothers and fathers (12.24% vs. 16.32%, P = 0.56). The VP1 sequences of EV71 from HFMD patients and healthy children were nearly identical and all were clustered in the same clade, C4a. Conclusions Our study demonstrated the co-circulation of multiple HEV serotypes in children with and without HFMD during epidemic. Our study deserves the attention on HFMD control.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Wei Liu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dong-Da Street, Fengtai District, Beijing 100071, P, R, China.
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Feder HM, Bennett N, Modlin JF. Atypical hand, foot, and mouth disease: a vesiculobullous eruption caused by Coxsackie virus A6. THE LANCET. INFECTIOUS DISEASES 2013; 14:83-86. [PMID: 24287184 DOI: 10.1016/s1473-3099(13)70264-0] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A previously well infant aged 9 months presented with an acute, self-limiting illness characterised by high fever and a papular eruption that started on the face. Although fever subsided within 3 days, the rash worsened and extended over the whole body, with some papules evolving into vesiculobullous lesions. The infant had been exposed to children with a similar illness 1 week before onset. PCR of vesicular swabs and stool samples taken on day 6 of illness showed Coxsackie virus A6. The illness resolved within 10 days of onset, although onychomadesis was seen on both big toes at follow-up 5 weeks later. Our case exemplifies the severe, atypical cases of hand, foot, and mouth disease that have been reported worldwide since 2008, and in the USA since the 2011. Atypical hand, foot, and mouth disease is caused by a new lineage of Coxsackie virus A6 and is characterised by high fever and vesiculobullous eruptions on the calves and backs of the hands. Infants with eczema might be predisposed to severe disease.
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Affiliation(s)
- Henry M Feder
- Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT, USA; Department of Family Medicine, Connecticut Children's Medical Center, Hartford, CT, USA; University of Connecticut Health Center, Farmington, CT, USA.
| | - Nicholas Bennett
- Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT, USA
| | - John F Modlin
- Department of Pediatrics and Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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Kaminska K, Martinetti G, Lucchini R, Kaya G, Mainetti C. Coxsackievirus A6 and Hand, Foot and Mouth Disease: Three Case Reports of Familial Child-to-Immunocompetent Adult Transmission and a Literature Review. Case Rep Dermatol 2013; 5:203-9. [PMID: 24019771 PMCID: PMC3764954 DOI: 10.1159/000354533] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Hand, foot and mouth disease (HFMD) is a highly contagious viral infection characterized by typical maculopapular or vesicular eruptions on the hands and feet and in the oral cavity. It affects predominantly children and/or immunocompromised adults. It usually follows a benign and self-limiting course. However, HFMD cases with severe or lethal complications such as encephalitis, meningitis, pulmonary edema and myocarditis have also been reported, mostly in children, but also in adults. High infectivity of HFMD has contributed to several large outbreaks of this disease in recent decades in East and Southeast Asia, the United States and Finland. The most common pathogens were Coxsackievirus A16, Enterovirus 71 and, recently, also Coxsackieviruses A6 and A10. Differences in the course of HFMD have been observed, depending on the virus type. Recently, many cases of atypical HFMD have been described in the literature with unusual morphology and/or localization of skin lesions. Atypical HFMD manifestations including vesiculobullous exanthema, often on the trunk or extremities, and perioral zone involvement were often caused by Coxsackievirus A6 infections. We present 3 cases of familial transmission of HFMD caused by Coxsackievirus A6 with some atypical features, benign course and complete recovery among immunocompetent adults.
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Affiliation(s)
- Karolina Kaminska
- Department of Dermatology, Regional Hospital of Bellinzona, Bellinzona, Geneva, Switzerland
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