title: Clinical and Etiological Characteristics of Atypical Hand-Foot-and-Mouth Disease in Children from Chongqing, China: A Retrospective Study.
abstract: BACKGROUND
  Hand-foot-and-mouth disease (HFMD) is a disease that had similar manifestations to chickenpox, impetigo, and measles, which is easy to misdiagnose and subsequently causes delayed therapy and subsequent epidemic. To date, no study has been conducted to report the clinical and epidemiological characteristics of atypical HFMD.
  
  
  METHODS
  64 children with atypical HFMD out of 887 HFMD children were recruited, stool was collected, and viral VP1 was detected.
  
  
  RESULTS
  The atypical HFMD accounted for 7.2% of total HFMD in the same period (64/887) and there were two peaks in its prevalence in nonepidemic seasons. Ten children (15.6%) had manifestations of neurologic involvement, of whom 4 (6.3%) were diagnosed with severe HFMD and 1 with critically severe HFMD, but all recovered smoothly. Onychomadesis and desquamation were found in 14 patients (21.9%) and 15 patients (23.4%), respectively. The most common pathogen was coxsackievirus A6 (CV-A6) which accounted for 67.2%, followed by nontypable enterovirus (26.6%), enterovirus 71 (EV-A71) (4.7%), and coxsackievirus A16 (A16) (1.5%).
  
  
  CONCLUSIONS
  Atypical HFMD has seasonal prevalence. The manifestations of neurologic involvement in atypical HFMD are mild and usually have a good prognosis. CV-A6 is a major pathogen causing atypical HFMD, but not a major pathogen in Chongqing, China.
authors.affiliation: Department of Infectious Disease, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China ; Department of Epidemiology, School of Public Health, University of Michigan, M5124 SPH II, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
authors.forename: Xiang
authors.initials: X
authors.lastname: Yan
authors.affiliation: Department of Infectious Disease, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.
authors.forename: Zhen-Zhen
authors.initials: ZZ
authors.lastname: Zhang
authors.affiliation: Department of Epidemiology, School of Public Health, University of Michigan, M5124 SPH II, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
authors.forename: Zhen-Hua
authors.initials: ZH
authors.lastname: Yang
authors.affiliation: Department of Infectious Disease, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.
authors.forename: Chao-Min
authors.initials: CM
authors.lastname: Zhu
authors.affiliation: Department of Infectious Disease, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.
authors.forename: Yun-Ge
authors.initials: YG
authors.lastname: Hu
authors.affiliation: Department of Infectious Disease, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.
authors.forename: Quan-Bo
authors.initials: QB
authors.lastname: Liu
mesh_terms: D036022:Capsid Proteins / Q000235:genetics / Q000302:isolation & purification; D002675:Child, Preschool; D004770:Enterovirus / Q000235:genetics / Q000302:isolation & purification* / Q000472:pathogenicity; D029821:Enterovirus A, Human / Q000235:genetics / Q000302:isolation & purification / Q000472:pathogenicity; D005243:Feces / Q000821:virology; D005260:Female; D029544:Foot-and-Mouth Disease Virus / Q000235:genetics / Q000302:isolation & purification / Q000472:pathogenicity; D006232:Hand, Foot and Mouth Disease / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology / Q000821:virology*; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D017422:Sequence Analysis, DNA
chemical_list: D036022:Capsid Proteins; C442501:VP1 protein, Foot-and-mouth disease virus