title: [Rash and fever illness caused by herpes simplex virus type 1 needs to be distinguished from hand, foot and mouth disease].
abstract: An epidemic of rash and fever illnesses suspected of hand, foot and mouth disease (HFMD) occurred in Gansu Province of China in 2008, laboratory tests were performed in order to identify the pathogen that caused this epidemic. Eight clinical specimens collected from the 4 patients (each patient has throat swab and herpes fluid specimens) with rash and febrile illness, were inoculated onto RD and HEp-2 cells for virus isolation, and the viral nucleic acid was then extracted with the positive virus isolates, the dual-channel real-time reverse transcript-polymerase chain reaction (RT-PCR) was performed to detect the nucleic acid of human enterovirus (HEV) in the viral isolates at the same time. For the viral isolates with the negative results of HEV, a sequence independent single primer amplification technique (SISPA) was used for "unknown pathogen" identification. Totally, 6 viral isolates were identified as herpes simplex virus type 1 (HSV-1). Comprehensive analyses results of the clinical manifestations of the patients, epidemiological findings and laboratory test indicated that this epidemic of rash and febrile illness was caused by HSV-1. The differences among the gG region of 6 HSV-1 isolates at nucleotide level and amino acid level were all small, and the identities were up to 98. 8% and 97.9%, respectively, showing that this outbreak was caused by only one viral transmission chain of HSV-1. HSV-1 and other viruses that cause rash and febrile illnesses need differential diagnosis with HFMD. The etiology of rash and febrile illness is sometimes difficult to distinguish from the clinical symptoms and epidemiological data, the laboratory diagnosis is therefore critical.
authors.affiliation: WHO WPRO Regional Polio Reference Laboratory, Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control Prevention, Beijing 102206, China. zhusli@126.com
authors.forename: Shuang-Li
authors.initials: SL
authors.lastname: Zhu
authors.forename: Jian-Feng
authors.initials: JF
authors.lastname: Liu
authors.forename: Qiang
authors.initials: Q
authors.lastname: Sun
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.forename: Xiao-Lei
authors.initials: XL
authors.lastname: Li
authors.forename: Yong
authors.initials: Y
authors.lastname: Zhang
authors.forename: Ying
authors.initials: Y
authors.lastname: Chen
authors.forename: Xiao-Yun
authors.initials: XY
authors.lastname: Wen
authors.forename: Dong-Mei
authors.initials: DM
authors.lastname: Yan
authors.forename: Guo-Hong
authors.initials: GH
authors.lastname: Huang
authors.forename: Bao-Min
authors.initials: BM
authors.lastname: Zhang
authors.forename: Bo
authors.initials: B
authors.lastname: Zhang
authors.forename: Hong-Qiu
authors.initials: HQ
authors.lastname: An
authors.forename: Hui
authors.initials: H
authors.lastname: Li
authors.forename: Wen-Bo
authors.initials: WB
authors.lastname: Xu
mesh_terms: D001483:Base Sequence; D045744:Cell Line, Tumor; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D017931:DNA Primers / Q000235:genetics; D004279:DNA, Viral / Q000737:chemistry / Q000302:isolation & purification; D003937:Diagnosis, Differential; D004196:Disease Outbreaks; D004770:Enterovirus / Q000235:genetics / Q000302:isolation & purification*; D005076:Exanthema; D005260:Female; D005334:Fever; D005838:Genotype; D006232:Hand, Foot and Mouth Disease / Q000175:diagnosis* / Q000821:virology; D006561:Herpes Simplex / Q000175:diagnosis* / Q000635:transmission / Q000821:virology; D018259:Herpesvirus 1, Human / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D008297:Male; D008969:Molecular Sequence Data; D010802:Phylogeny; D020133:Reverse Transcriptase Polymerase Chain Reaction; D017422:Sequence Analysis, DNA
chemical_list: D017931:DNA Primers; D004279:DNA, Viral