We searched PubMed for articles published from Jan 1, 1960, to July 31, 2013, with the search terms “coxsackievirus”, “hand, foot, and mouth disease”, “atypical hand, foot, and mouth disease”, and “onychomadesis”. Additionally, each author searched their personal files and the reference lists of retrieved articles were searched manually.
Grand RoundAtypical hand, foot, and mouth disease: a vesiculobullous eruption caused by Coxsackie virus A6
Section snippets
Case report
A boy aged 9 months presented to his primary care paediatrician with a 1 day history of fever and papular exanthem. The skin lesions had appeared first around the mouth and progressed to involve other areas of the face, trunk, buttocks, and extremities with evolution of some papules to larger vesicular lesions. The infant was febrile with a rectal temperature of 39·4°C but seemed to be comfortable. The skin lesions were distributed most prominently on the calves and the backs of the hands, with
Enteroviruses
The human enteroviruses cause a spectrum of acute illnesses, including self-limited syndromes characterised by fever and diffuse lesions involving the skin, oral mucous membranes, or both. Among these is hand, foot, and mouth disease, a common, highly contagious disease that mainly affects young children. Multiple outbreaks of hand, foot, and mouth disease are reported worldwide every year. The principal cause is Coxsackie virus A enteroviruses, especially Coxsackie virus A16, and the closely
Conclusions
Atypical hand, foot, and mouth disease caused by a new strain of Coxsackie virus A6 affects children worldwide. This syndrome is characterised by high fever, generalised vesiculobullous lesions that ulcerate and scab, and onychomadesis and is seen mostly in young children. Skin involvement might be more extensive in patients with eczema than in those without. Differential diagnosis must include a varicella zoster virus infection, eczema herpeticum, and bullous impetigo. Almost all cases of
Search strategy and selection criteria
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Cited by (117)
Epidemiological and molecular characterization of Coxsackievirus A6 causing hand, foot, and mouth disease in the Philippines, 2012–2017
2023, Infection, Genetics and EvolutionInactivated enterovirus A71 vaccines and moving forward
2021, The Lancet Regional Health - Western PacificDetection of coxsackievirus A6 in formalin-fixed, paraffin-embedded skin biopsy specimens using immunohistochemistry and real-time reverse-transcriptase PCR
2021, Journal of Clinical Virology PlusCitation Excerpt :Hand, foot, and mouth disease (HFMD), caused by a subset of viruses in the Picornaviridae family, has historically been considered a mild self-limiting viral disease of infancy and young children [1,2].
Sub-genotype change and recombination of coxsackievirus A6s may be the cause of it being the predominant pathogen for HFMD in children in Beijing, as revealed by analysis of complete genome sequences
2020, International Journal of Infectious DiseasesCitation Excerpt :The clinical manifestations of CVA6-associated HFMD are significantly different from those caused by other EV types (such as EV71 and CVA16). CVA6-associated HFMD often presents with atypical clinical symptoms of HFMD and has been characterized by more severe and extensive dermatologic manifestations (Feder et al., 2014), which poses a challenge to the clinical pediatrician. So far, vaccines have been the best tools to prevent and control severe infectious diseases.