title: Evaluation of different clinical sample types in diagnosis of human enterovirus 71-associated hand-foot-and-mouth disease.
abstract: 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.
authors: Department of Paediatrics, Sibu Hospital, Ulu Oya Road, 96000 Sibu, Sarawak, Malaysia. monghow@pd.jaring.my
authors: Mong How
authors: MH
authors: Ooi
authors: Tom
authors: T
authors: Solomon
authors: Yuwana
authors: Y
authors: Podin
authors: Anand
authors: A
authors: Mohan
authors: Winnie
authors: W
authors: Akin
authors: Mohd Apandi
authors: MA
authors: Yusuf
authors: Syvia
authors: S
authors: del Sel
authors: Kamsiah Mohd
authors: KM
authors: Kontol
authors: Boon Fu
authors: BF
authors: Lai
authors: Daniela
authors: D
authors: Clear
authors: Chae Hee
authors: CH
authors: Chieng
authors: Emma
authors: E
authors: Blake
authors: David
authors: D
authors: Perera
authors: See Chang
authors: SC
authors: Wong
authors: Jane
authors: J
authors: Cardosa
mesh_terms: 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