Coxsackievirus A6-related hand foot and mouth disease: skin manifestations in a cluster of adult patients.

BACKGROUND

Hand foot and mouth disease (HFMD) is a common childhood manifestation of enterovirus (EV) infection. It predominantly affects young children, and has been mainly associated with coxsackievirus (CV) A16 and EV 71.

OBJECTIVES

We report an unusual cluster of adult patients with HFMD.

STUDY

DESIGN

Throat swabs and vesicular fluid samples obtained from patients admitted to the emergency room (ER) with HFMD were tested for EV by reverse transcription (RT)-real time PCR, and further subjected to sequencing and phylogenetic analysis.

RESULTS

CVA6 was identified as the causative agent of HFMD in five epidemiologically-unrelated adult patients (28-37 years old) admitted to the ER between December 2012 and February 2013. Phylogenetic analysis mapped the CVA6 strains into one cluster. All patients manifested with fever and a severe vasculitis-like rash, followed by spontaneous recovery.

CONCLUSIONS

This cluster identifies CVA6 as an emerging cause of HFMD of unusual age distribution, seasonality, and clinical severity, underscoring the need for continued alertness and clinical-genotypic surveillance of EV HFMD.