Abstract：
Hand, Foot and Mouth disease (HFMD) is a contagious pediatric viral disease caused due to enteroviruses (EV) of the family Picornaviridae. Cases of HFMD were reported from a tertiary care health centre, Udhampur, (Jammu and Kashmir), Northern India. The present study highlights the clinical and molecular virological aspects of HFMD cases.
Cases reported during August 2016-September 2017, and clinically diagnosed as HFMD of all age groups were included. Clinical, Biochemical and molecular virology aspects were compared. Clinical samples (n = 50) such as vesicle swab, buccal and throat swabs were collected for enterovirus detection. EV-RNA was detected by 5\'NCR based RT-PCR and genotyping by VP1 gene amplification and cycle sequencing.
Of the cases of HFMD enrolled (n = 50), highest (84%) were of children aged <5 years, presented either or both anathemas and exanthemas with prodromal symptoms (fever, irritability). Clinical presentations involved mainly oral ulcers on lips and tongue (48%). Oral erosions were either single or multiple in numbers. Exanthemas were seen on hand and palm, widely spread up to buttocks, legs, arms and trunk. Of these, six patients were found anemic. Complete blood count (CBC) indicated lymphocytosis and C-reactive protein (n = 10) in children aged <5 years. EV-RNA was detected in 78% (39/50) of the clinical samples. VP1 gene based typing indicated the presence of CV-A16, CVA6 and EV-A71 types.
The study highlights association of EVs in HFMD cases in the reported region. CV-A16, CV-A6 and EV-A71 types were reported for the first time from Udhampur (J&K), Northern India. No differences were observed in the clinical profile of EV strains detected. Circulation of the strains warrant and alarm outbreaks. More focused studies on HFMD and monitoring of viral strains is mandatory.
Cases reported during August 2016-September 2017, and clinically diagnosed as HFMD of all age groups were included. Clinical, Biochemical and molecular virology aspects were compared. Clinical samples (n = 50) such as vesicle swab, buccal and throat swabs were collected for enterovirus detection. EV-RNA was detected by 5\'NCR based RT-PCR and genotyping by VP1 gene amplification and cycle sequencing.
Of the cases of HFMD enrolled (n = 50), highest (84%) were of children aged <5 years, presented either or both anathemas and exanthemas with prodromal symptoms (fever, irritability). Clinical presentations involved mainly oral ulcers on lips and tongue (48%). Oral erosions were either single or multiple in numbers. Exanthemas were seen on hand and palm, widely spread up to buttocks, legs, arms and trunk. Of these, six patients were found anemic. Complete blood count (CBC) indicated lymphocytosis and C-reactive protein (n = 10) in children aged <5 years. EV-RNA was detected in 78% (39/50) of the clinical samples. VP1 gene based typing indicated the presence of CV-A16, CVA6 and EV-A71 types.
The study highlights association of EVs in HFMD cases in the reported region. CV-A16, CV-A6 and EV-A71 types were reported for the first time from Udhampur (J&K), Northern India. No differences were observed in the clinical profile of EV strains detected. Circulation of the strains warrant and alarm outbreaks. More focused studies on HFMD and monitoring of viral strains is mandatory.
摘要：
目标：手，口蹄疫（HFMD）是一种传染性的儿科病毒性疾病，是由于小牛科的肠道病毒（EV）引起的。一家三级保健中心报告了手足口病病例，乌德汉普尔,（查谟和克什米尔），印度北部。本研究强调了HFMD病例的临床和分子病毒学方面。
方法：纳入2016年8月至2017年9月期间报告的、临床诊断为HFMD的所有年龄组的病例。临床,比较了生化和分子病毒学方面。临床样本(n=50)，如囊泡拭子，收集口腔和咽拭子进行肠道病毒检测。通过基于5'NCR的RT-PCR检测EV-RNA，并通过VP1基因扩增和循环测序进行基因分型。
结果：在登记的手足口病病例中（n=50），最高(84%)的是5岁以下的儿童，表现出一种或两种症状都有前驱症状(发烧，烦躁)。临床表现主要涉及嘴唇和舌头上的口腔溃疡（48％）。口腔糜烂为单个或多个。在手上和手掌上都能看到exanthemas,广泛传播到臀部，腿,手臂和躯干。其中,六名患者被发现贫血。全血细胞计数（CBC）显示5岁以下儿童的淋巴细胞增多和C反应蛋白（n=10）。在78%(39/50)的临床样品中检测到EV-RNA。基于VP1基因的分型表明存在CV-A16，CVA6和EV-A71类型。
结论：该研究强调了报告地区手足口病病例中EVs的相关性。Udhampur（J＆K）首次报道了CV-A16，CV-A6和EV-A71类型，印度北部。在检测到的EV菌株的临床特征中未观察到差异。菌株的传播保证和警报爆发。对手足口病和病毒株的监测更有重点的研究是强制性的。
方法：纳入2016年8月至2017年9月期间报告的、临床诊断为HFMD的所有年龄组的病例。临床,比较了生化和分子病毒学方面。临床样本(n=50)，如囊泡拭子，收集口腔和咽拭子进行肠道病毒检测。通过基于5'NCR的RT-PCR检测EV-RNA，并通过VP1基因扩增和循环测序进行基因分型。
结果：在登记的手足口病病例中（n=50），最高(84%)的是5岁以下的儿童，表现出一种或两种症状都有前驱症状(发烧，烦躁)。临床表现主要涉及嘴唇和舌头上的口腔溃疡（48％）。口腔糜烂为单个或多个。在手上和手掌上都能看到exanthemas,广泛传播到臀部，腿,手臂和躯干。其中,六名患者被发现贫血。全血细胞计数（CBC）显示5岁以下儿童的淋巴细胞增多和C反应蛋白（n=10）。在78%(39/50)的临床样品中检测到EV-RNA。基于VP1基因的分型表明存在CV-A16，CVA6和EV-A71类型。
结论：该研究强调了报告地区手足口病病例中EVs的相关性。Udhampur（J＆K）首次报道了CV-A16，CV-A6和EV-A71类型，印度北部。在检测到的EV菌株的临床特征中未观察到差异。菌株的传播保证和警报爆发。对手足口病和病毒株的监测更有重点的研究是强制性的。
