Coxsackievirus A6-related hand foot and mouth disease: skin manifestations in a cluster of adult patients.
BACKGROUND
Hand foot and mouth disease (HFMD) is a common childhood manifestation of enterovirus (EV) infection. It predominantly affects young children, and has been mainly associated with coxsackievirus (CV) A16 and EV 71.


OBJECTIVE
We report an unusual cluster of adult patients with HFMD.


METHODS
Throat swabs and vesicular fluid samples obtained from patients admitted to the emergency room (ER) with HFMD were tested for EV by reverse transcription (RT)-real time PCR, and further subjected to sequencing and phylogenetic analysis.


RESULTS
CVA6 was identified as the causative agent of HFMD in five epidemiologically-unrelated adult patients (28-37 years old) admitted to the ER between December 2012 and February 2013. Phylogenetic analysis mapped the CVA6 strains into one cluster. All patients manifested with fever and a severe vasculitis-like rash, followed by spontaneous recovery.


CONCLUSIONS
This cluster identifies CVA6 as an emerging cause of HFMD of unusual age distribution, seasonality, and clinical severity, underscoring the need for continued alertness and clinical-genotypic surveillance of EV HFMD.
Shaare Zedek Medical Center Affiliated with the Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Electronic address: elibc1@yahoo.com.
Eli
E
Ben-Chetrit
Shaare Zedek Medical Center Affiliated with the Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Yonit
Y
Wiener-Well
Public Health Services, Israel Ministry of Health, Sheba Medical Center, Tel Hashomer 52621, Israel.
Lester M
LM
Shulman
Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Matan J
MJ
Cohen
Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Hila
H
Elinav
Public Health Services, Israel Ministry of Health, Sheba Medical Center, Tel Hashomer 52621, Israel.
Danit
D
Sofer
Shaare Zedek Medical Center Affiliated with the Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Itamar
I
Feldman
Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Eytan
E
Marva
Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Dana G
DG
Wolf
D000328:Adult; D004196:Disease Outbreaks; D004770:Enterovirus / Q000235:genetics / Q000302:isolation & purification*; D005076:Exanthema / Q000473:pathology / Q000821:virology; D005528:Foot / Q000473:pathology; D006232:Hand, Foot and Mouth Disease / Q000453:epidemiology / Q000473:pathology / Q000821:virology; D006801:Humans; D007557:Israel; D008297:Male; D010614:Pharynx / Q000821:virology
Adult; Coxsackievirus A6; Enterovirus; Hand foot and mouth disease