Evaluation of different clinical sample types in diagnosis of human enterovirus 71-associated hand-foot-and-mouth disease.
Human enterovirus 71 and coxsackievirus A16 are important causes of hand-foot-and-mouth disease (HFMD). Like other enteroviruses, they can be isolated from a range of sterile and nonsterile sites, but which clinical sample, or combination of samples, is the most useful for laboratory diagnosis of HFMD is not clear. We attempted virus culture for 2,916 samples from 628 of 725 children with HFMD studied over a 3 1/2-year period, which included two large outbreaks. Overall, throat swabs were the single most useful specimen, being positive for any enterovirus for 288 (49%) of 592 patients with a full set of samples. Vesicle swabs were positive for 169 (48%) of 333 patients with vesicles, the yield being greater if two or more vesicles were swabbed. The combination of throat plus vesicle swabs enabled the identification of virus for 224 (67%) of the 333 patients with vesicles; for this patient group, just 27 (8%) extra patients were diagnosed when rectal and ulcer swabs were added. Of 259 patients without vesicles, use of the combination of throat plus rectal swab identified virus for 138 (53%). For 60 patients, virus was isolated from both vesicle and rectal swabs, but for 12 (20%) of these, the isolates differed. Such discordance occurred for just 11 (10%) of 112 patients with virus isolated from vesicle and throat swabs. During large HFMD outbreaks, we suggest collecting swabs from the throat plus one other site: vesicles, if these are present (at least two should be swabbed), or the rectum if there are no vesicles. Vesicle swabs give a high diagnostic yield, with the added advantage of being from a sterile site.
Ooi
Mong How
MH
Department of Paediatrics, Sibu Hospital, Ulu Oya Road, 96000 Sibu, Sarawak, Malaysia. monghow@pd.jaring.my
Solomon
Tom
T
Podin
Yuwana
Y
Mohan
Anand
A
Akin
Winnie
W
Yusuf
Mohd Apandi
MA
del Sel
Syvia
S
Kontol
Kamsiah Mohd
KM
Lai
Boon Fu
BF
Clear
Daniela
D
Chieng
Chae Hee
CH
Blake
Emma
E
Perera
David
D
Wong
See Chang
SC
Cardosa
Jane
J
D000293:Adolescent; D001769:Blood / Q000821:virology; D002555:Cerebrospinal Fluid / Q000821:virology; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D004770:Enterovirus / Q000145:classification* / Q000302:isolation & purification*; D004769:Enterovirus Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D005260:Female; D006232:Hand, Foot and Mouth Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D006801:Humans; D007223:Infant; D008297:Male; D010614:Pharynx / Q000821:virology; D012007:Rectum / Q000821:virology; D013048:Specimen Handling / Q000379:methods; D014456:Ulcer / Q000821:virology; D014776:Virus Cultivation