title: Enterovirus co-infections and onychomadesis after hand, foot, and mouth disease, Spain, 2008.
abstract: Hand, foot, and mouth disease (HFMD), a common disease caused by enteroviruses (EVs), usually affects children. Clustered and sporadic HFMD cases, followed by onychomadesis (nail shedding), occurred during summer and fall 2008 in Valencia, Spain. Fecal samples from onychomadesis patients, who did or did not have previous HFMD, and from healthy children exposed to onychomadesis patients tested positive for EV. The complete viral protein 1 capsid gene sequence was obtained for typing and phylogenetic analysis. Two EV serotypes, coxsackievirus A10 and coxsackievirus B1 (CVB1), were mainly detected as a monoinfection or co-infection in a childcare center where an onychomadesis outbreak occurred. On the basis of our results, and detection of CVB1 in 2 other contemporary onychomadesis outbreaks in childcare centers in Spain, we propose that mixed infection of an EV serotype that causes HFMD, plus the serotype CVB1, could explain the emergence after HFMD of onychomadesis, a rare and late complication.
authors.affiliation: Centro Superior de Investigación en Salud Pública, Valencia, Spain. alma.bracho@uv.es
authors.forename: Maria A
authors.initials: MA
authors.lastname: Bracho
authors.forename: Fernando
authors.initials: F
authors.lastname: González-Candelas
authors.forename: Ana
authors.initials: A
authors.lastname: Valero
authors.forename: Juan
authors.initials: J
authors.lastname: Córdoba
authors.forename: Antonio
authors.initials: A
authors.lastname: Salazar
mesh_terms: D001483:Base Sequence; D016022:Case-Control Studies; D002675:Child, Preschool; D021821:Communicable Diseases, Emerging / Q000453:epidemiology / Q000821:virology; D004279:DNA, Viral / Q000235:genetics; D029821:Enterovirus A, Human / Q000145:classification / Q000235:genetics; D029822:Enterovirus B, Human / Q000145:classification / Q000235:genetics; D004769:Enterovirus Infections / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D005260:Female; D006232:Hand, Foot and Mouth Disease / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D006801:Humans; D007223:Infant; D008297:Male; D009260:Nail Diseases / Q000209:etiology* / Q000821:virology; D010802:Phylogeny; D012703:Serotyping; D013030:Spain / Q000453:epidemiology
chemical_list: D004279:DNA, Viral