title: Molecular diagnosis and clinical presentations of enteroviral infections in Taipei during the 2008 epidemic.
abstract: BACKGROUND
  In 2008, an epidemic of enterovirus (EV) infection caused hand, foot, and mouth disease (HFMD) and herpangina in children in Taiwan, and some of them died. To establish an early detection and effective management for children with EV71 infection, sensitive molecular diagnostic methods were applied from May to July 2008.
  
  
  METHODS
  We used virus isolation, EV71 real-time reverse-transcription polymerase chain reaction (RT-PCR), and viral protein 1 (VP1) RT-PCR followed by direct sequencing to detect EV71 and the other EVs in the infected outpatient or inpatient children. Clinical presentations of children infected with EV71 and other EVs were compared.
  
  
  RESULTS
  From May 2008 to July 2008, 255 swabs were tested by both PCR diagnostic methods. Based on the viral isolation results, the sensitivities of EV71 real-time RT-PCR and VP1 RT-PCR followed by direct sequencing were 71% and 86%, respectively. Among the 221 children who were enrolled for clinical analysis, 73% (161 of 221) had herpangina, and 27% (60 of 221) had HFMD. Coxsackievirus A2 (CA2) was the most prevalent among the identifiable viruses (65%, 104 of 160), followed by EV71 (28%, 45 of 160). EV71 was the most commonly detected virus among the HFMD cases (63%, 38 of 60), whereas herpangina was mainly caused by CA2 (61%, 98 of 161). Of the CA2 cases, 94% (98 of 104) had herpangina, and the most common manifestation of EV71 infection was HFMD with or without complications (84%, 38 of 45). Phylogenetic study revealed that the genotype of EV71 cases during this epidemic was of B5 lineage.
  
  
  CONCLUSIONS
  During the 2008 EV epidemic, most of the HFMD was caused by EV71, whereas herpangina was mainly caused by CA2. Real-time RT-PCR for EV71 is a time-saving and sensitive diagnostic tool.
authors.affiliation: Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan.
authors.forename: Min-Hsiung
authors.initials: MH
authors.lastname: Lee
authors.forename: Li Min
authors.initials: LM
authors.lastname: Huang
authors.forename: Wing-Wai
authors.initials: WW
authors.lastname: Wong
authors.forename: Tsung-Zu
authors.initials: TZ
authors.lastname: Wu
authors.forename: Ting-Fang
authors.initials: TF
authors.lastname: Chiu
authors.forename: Luan-Yin
authors.initials: LY
authors.lastname: Chang
mesh_terms: D002648:Child; D002675:Child, Preschool; D003384:Coxsackievirus Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology; D004770:Enterovirus / Q000235:genetics; D004769:Enterovirus Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D058872:Epidemics; D006232:Hand, Foot and Mouth Disease / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D006557:Herpangina / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D007223:Infant; D025202:Molecular Diagnostic Techniques; D010802:Phylogeny; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013624:Taiwan / Q000453:epidemiology; D014764:Viral Proteins
chemical_list: D014764:Viral Proteins