Enteroviruses isolated from herpangina and hand-foot-and-mouth disease in Korean children

KwiSung Park,KyoungAh Baek,YoungJin Choi,JoonSoo Park,HaeKyung Cheon,KyungAh Yoon,JaeWan Soh,SangGu Yeo,DooSung Cheon,BaeckHee Lee

doi:10.1186/1743-422x-9-205

Abstract

Hand-foot-and-mouth disease (HFMD) and herpangina are commonly prevalent illness in young children. They are similarly characterized by lesions on the skin and oral mucosa. Both diseases are associated with various enterovirus serotypes. In this study, enteroviruses from patients with these diseases in Korea in 2009 were isolated and analyzed. Demographic data for patients with HFMD and herpangina were compared and all enterovirus isolates were amplified in the VP1 region by reverse transcription-polymerase chain reaction and sequenced. Among the enterovirus isolates, prevalent agents were coxsackievirus A16 in HFMD and coxsackievirus A5 in herpangina. More prevalent months for HFMD were June (69.2%) and May (11.5%), and June (40.0%) and July (24.0%) for herpangina. Age prevalence of HFMD patients with enterovirus infection was 1 year (23.1%), 4 years (19.2%), and over 5 years (19.2%). However, the dominant age group of herpangina patients with enterovirus infection was 1 year (48.0%) followed by 2 years (28.0%). Comparison of pairwise VP1 nucleotide sequence alignment of all isolates within the same serotypes revealed high intra-type variation of CVA2 isolates (84.6–99.3% nucleotide identity). HFMD and herpangina showed differences in demographic data and serotypes of isolated enteroviruses, but there was no notable difference in amino acid sequences by clinical syndromes in multiple comparison of the partial VP1 gene sequence.

Highlights

Hand-foot-and-mouth disease (HFMD) and herpangina, which commonly affect young children, are enterovirus infections causing a variety of exanthems
Sequence analysis of enteroviruses Based on the VP1 amino acid sequence comparison for all isolates, all sequences represented the same intraserotype, except for the Kor09-CVA5-309cn isolate, regardless of syndrome (Figure 3)
The pairwise VP1 nucleotide sequence alignment of all isolates was compared within the same serotypes; CVA2 isolates displayed 84.6–99.3% nucleotide identity within the intra-type

Summary

Introduction

Hand-foot-and-mouth disease (HFMD) and herpangina, which commonly affect young children, are enterovirus infections causing a variety of exanthems. Herpangina produces multiple oral ulcers affecting predominantly the posterior part of the oral cavity only [1,2,3]. These diseases are associated with different strains of enteroviruses, such as coxsackievirus A (CVA) 2, 5, 6, 10, 16; coxsackievirus B (CVB) 1, 2, 5; and enterovirus (EV) 71 [4,5,6,7,8]. Since 1993, when nationwide surveillance began in Korea, there have been reports of summer outbreaks of enteroviruses caused by ECV 5, 6, 7, 9, 13, 18, and 30; CVA 24; CVB 3 and 5; and EV 71 [11,12]. Outbreaks of HFMD and herpangina caused by HEV infection were reported in 2009 in Korea [13,14]

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Results

Conclusion