手,脚,和口蹄疫(HFMD)通常被认为是成人的罕见疾病。经典的,手足口病与柯萨奇病毒株A16和肠道病毒71密切相关。自2008年以来,柯萨奇病毒A6(CVA6)毒株与严重的全球疫情有关。CVA6与更严重和更深刻的病程有关,影响儿童和成人。
介绍一系列5例因CVA6而被诊断为HFMD的成年患者。我们研究诊断方法,并比较成人病例与儿童病例的临床表现。
每位患者都接受了全身皮肤检查以及口腔检查。按指示进行了针对柯萨奇病毒B(1-6)和A(2,4,7,9,10,16)的补体结合的快速血浆反应蛋白(RPR)和血清学测定。由于标准血清学检测不检测CVA6,实时逆转录聚合酶链反应(qRT-PCR)的血清,颊拭子,和皮肤刮片由疾病控制和预防中心(CDC)进行。
每位患者的临床表现与HFMD的不同阶段一致。一名患者出现延迟性甲癣和手掌和脚底脱皮。RPR和针对CVB(1-6)和CVA(2,4,7,9,10,16)的补体结合的血清学测定大多为阴性,尽管由于交叉反应性,两名患者升高。qRT-PCR鉴定了来自所有患者的样品中的CVA6遗传物质。
本系列研究表明,在成人中,CVA6相关的HFMD存在广泛的疾病表现。
Hand, foot, and mouth disease (HFMD) is generally considered a rare illness in adults. Classically, HFMD has been strongly associated with coxsackievirus strain A16 and enterovirus 71. The coxsackievirus A6 (CVA6) strain has been linked to severe worldwide outbreaks since 2008. CVA6 is associated with a more severe and profound course of disease, affecting both children and adults.
To present a series of five adult patients diagnosed with HFMD due to CVA6. We investigate method of diagnosis and compare clinical presentation of adult cases to those in children.
Each patient underwent a full-body skin exam as well as inspection of the oral cavity. Rapid plasma reagin (RPR) and serologic assays by complement fixation against coxsackievirus B (1-6) and A (2,4,7,9,10,16) were performed as indicated. As standard serological testing does not detect CVA6, real-time reverse transcription-polymerase chain reaction (qRT-PCR) of serum, buccal swabs, and skin scrapings were performed by the Centers for Disease Control and Prevention (CDC).
Each patient had clinical findings consistent with various stages of HFMD. One patient presented with delayed onychomadesis and desquamation of the palms and soles. RPR and serologic assays by complement fixation against CVB (1-6) and CVA (2,4,7,9,10,16) were mostly negative, although elevated in two patients due to cross-reactivity. qRT-PCR identified CVA6 genetic material in samples from all patients.
This series demonstrates that there is a wide array of disease presentation of CVA6 associated HFMD in adults.