Abstract
In January to February 2014, 16 hand, foot and mouth disease (HFMD) cases were identified in Edinburgh, United Kingdom. All presented with atypical features, with most (n=13) resembling eczema herpeticum or chickenpox. Coxsackievirus A6 (CV-A6) was identified in all the typed cases (n=11). As atypical forms of HFMD associated with CV-A6 are likely to emerge throughout Europe, clinicians should be alert to unusual clinical presentations of HFMD and virologists aware of effective diagnostic testing and enterovirus typing methods.
Highlights
HFMD is an acute febrile infection characterised by vesicular exanthema on the hands, feet and oral mucosa, typically occurring in children under the age of 5 years [3]
It is most commonly caused by CV-A16 and EV71 within the species EV-A, members of the virus family Picornaviridae in the genus Enterovirus [3]
Whereas CV-A16, EV71 and coxsackievirus A6 (CV-A6) have been occasionally detected in clinical samples [8], CV-A6 has been known to circulate in Scotland since 2010, based on our previous environmental surveillance [9]
Summary
HFMD is an acute febrile infection characterised by vesicular exanthema on the hands, feet and oral mucosa, typically occurring in children under the age of 5 years [3]. Cutaneous manifestations of CV-A6 -associated atypical HFMD have resembled chickenpox, with vesicles reported to crust in 65% of patients between November 2011 and February 2012 in the United States [13]. In contrast to typical HFMD outbreaks, which occur in the summer and early autumn [3], we saw a cluster of cases (n=24) between October 2013 and February 2014 This is consistent with a previous study from the United States, in which atypical cases of HFMD caused by CV-A6 were seen between November 2011 and February 2012 [13]
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