Abstract
BackgroundCoxsackievirus A9 (CA9) was one of the most prevalent serotype of enteroviral infections in Taiwan in 2011. After several patient series were reported in the 1960s and 1970s, few studies have focused on the clinical manifestations of CA9 infections. Our study explores and deepens the current understanding of CA9.MethodsWe analyzed the clinical presentations of 100 culture-proven CA9-infected patients in 2011 by reviewing their medical records and depicted the CA9 phylogenetic tree.ResultsOf the 100 patients with culture-proven CA9 infections, the mean (SD) age was 4.6 (3.4) years and the male to female ratio was 1.9. For clinical manifestations, 96 patients (96%) had fever and the mean (SD) duration of fever was 5.9 (3.4) days. Sixty one patients (61%) developed a skin rash, and the predominant pattern was a generalized non-itchy maculopapular rash without vesicular changes. While most patients showed injected throat, oral ulcers were found in only 19 cases (19%), among whom, 6 were diagnosed as herpangina. Complicated cases included: aseptic meningitis (n=8), bronchopneumonia (n=6), acute cerebellitis (n=1), and polio-like syndrome (n=1). Phylogenetic analysis for current CA9 strains is closest to the CA9 isolate 27-YN-2008 from the border area of mainland China and Myanmar.ConclusionsThe most common feature of CA9 during the 2011 epidemic in Taiwan is generalized febrile exanthema rather than herpangina or hand, foot, and mouth disease. Given that prolonged fever and some complications are possible, caution should be advised in assessing patients as well as in predicting the clinical course.
Highlights
Coxsackievirus A9 (CA9) was one of the most prevalent serotype of enteroviral infections in Taiwan in 2011
Human enteroviruses (HEVs) are RNA viruses consisting of polioviruses, coxsackie A viruses, coxsackie B viruses, echoviruses, and enterovirus 68–71 under the traditional pathogenesis-based taxonomy
Since the 1990s, viral genome analysis has brought about new classifications, HEVA, HEV-B, HEV-C, and HEV-D, based on the nucleotide sequence of the VP1 region and it was accepted by International Committee on Taxonomy of Viruses (ICTV) in the mid of year 2000 [1]
Summary
Coxsackievirus A9 (CA9) was one of the most prevalent serotype of enteroviral infections in Taiwan in 2011. In terms of CA9-related skin rashes, Lerner et al summarized what had been observed in 39 patients as a 2 to 13 mm maculopapular exanthema beginning on the face or trunk during fever and sometimes spreading to the extremities [3,4] In another 20 cases studied by Cherry et al, vesicular, urticarial, or petechial rashes have been reported [5]. These observations have been made, renewed research efforts on an expanded number of patients are still needed to shed light on both the rash morphology and other systemic and local manifestations of CA9 infections. Such understandings may contribute to accurate diagnosis and course prediction that help ease parental worries and avoid serious complications, including pneumonitis, pericarditis, myocarditis, and central nervous inflammation with paralytic sequelae, which have all been seen, though rarely, in literature [6,7]
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