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Coxsackieviruses-induced infections, particularly in infants and young children, are one of the most important public health issues in low- and middle-income countries, where the surveillance system varies substantially, and these manifestations have been disregarded. They are widespread throughout the world and are responsible for a broad spectrum of human diseases, from mildly symptomatic conditions to severe acute and chronic disorders. Coxsackieviruses (CV) have been found to have 27 identified genotypes, with overlaps in clinical phenotypes between genotypes. In this review, we present a concise overview of the most recent studies and findings of coxsackieviruses-associated disorders, along with epidemiological data that provides comprehensive details on the distribution, variability, and clinical manifestations of different CV types. We also highlight the significant roles that CV infections play in the emergence of neurodegenerative illnesses and their effects on neurocognition. The current role of CVs in oncolytic virotherapy is also mentioned. This review provides readers with a better understanding of coxsackieviruses-associated disorders and pointing the impact that CV infections can have on different organs with variable pathogenicity. A deeper knowledge of these infections could have implications in designing current surveillance and prevention strategies related to severe CVs-caused infections, as well as encourage studies to identify the emergence of more pathogenic types and the etiology of the most common and most severe disorders associated with coxsackievirus infection.
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Infecções por Coxsackievirus , Genótipo , Humanos , Infecções por Coxsackievirus/virologia , Infecções por Coxsackievirus/epidemiologia , Saúde Global , Enterovirus/genética , Enterovirus/classificação , Enterovirus/patogenicidadeRESUMO
SUMMARY OBJECTIVE: This study aimed to test the hypothesis that fibromyalgia is associated with a human enteroviral infection. METHODS: Venous peripheral blood samples from 27 patients fulfilling the American College of Rheumatology revised diagnostic criteria for fibromyalgia and from 26 age- and sex-matched controls, who underwent immunofluorescence assays for coxsackievirus A7 IgG, coxsackievirus B1 IgG, coxsackievirus A7 IgA, coxsackievirus B1 IgA, echovirus IgG, and echovirus IgA. These immunological tests were performed blind to group status. RESULTS: There were no significant differences between the patient and control groups in respect of positive results for coxsackievirus A7 IgG (p=0.467), coxsackievirus B1 IgG (p=0.491), coxsackievirus A7 IgA (p=0.586), coxsackievirus B1 IgA (p=0.467), echovirus IgG (p=0.236), and echovirus IgA (p=1). CONCLUSIONS: The results of this systematic study do not support the hypothesis that fibromyalgia is associated with infection by a human enterovirus.
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Coxsackievirus B5 (CVB5) is one of the most prevalent enteroviruses types in humans and causes annual epidemics worldwide. In the present study, we explored viral genetic diversity, molecular and epidemiological aspects of CVB5 obtained from cerebrospinal fluid and stool samples of patients with aseptic meningitis or acute flaccid paralysis, information that is still scarce in Brazil. From 2005 to 2018, 57 isolates of CVB5 were identified in the scope of the Brazilian Poliomyelitis Surveillance Program. Phylogenetic analyses of VP1 sequences revealed the circulation of two CVB5 genogroups, with genogroup B circulating until 2017, further replaced by genogroup A. Network analysis based on deduced amino acid sequences showed important substitutions in residues known to play critical roles in viral host tropism, cell entry, and viral antigenicity. Amino acid substitutions were investigated by the Protein Variation Effect Analyzer (PROVEAN) tool, which revealed two deleterious substitutions: T130N and T130A. To the best of our knowledge, this is the first report to use in silico approaches to determine the putative impact of amino acid substitutions on the CVB5 capsid structure. This work provides valuable information on CVB5 diversity associated with central nervous system (CNS) infections, highlighting the importance of evaluating the biological impact of certain amino acids substitutions associated with epidemiological and structural analyses.
Assuntos
Infecções do Sistema Nervoso Central , Infecções por Coxsackievirus , Brasil/epidemiologia , Sistema Nervoso Central , Enterovirus Humano B , Variação Genética , Humanos , Epidemiologia Molecular , FilogeniaRESUMO
ABSTRACT Hand-foot-and-mouth disease (HFMD) is a highly contagious viral disease commonly associated to Enteroviruses (EV). During 2018, Brazil faced massive HFMD outbreaks spread across the country. This study aimed to characterize the EV responsible for the HFMD outbreak that occurred in Paraiba State, Brazilian Northeastern region, in 2018, followed by a phylogenetic analysis to detail information on its genetic diversity. A total of 49 serum samples (one from each patient) collected from children ≤ 15 years old, clinically diagnosed with HFMD were tested for EV using conventional RT-PCR and RT-qPCR. EV infection was confirmed in 71.4% (35/49) of samples. The mean and median ages were 1.83 years and one year old, respectively. Twenty-two EV-positive samples were successfully sequenced and classified as EV-A species; 13 samples were also identified with the CV-A6 genotype. The phylogenetic analysis (VP1 region) of three samples revealed that the detected CV-A6 strains belonged to sub-lineage D3. The CV-A6 strains detected here clustered with strains from South America, Europe and West Asia strains that were also involved in HFMD cases during the 2017-2018 seasons, in addition to the previously detected Brazilian CV-A6 strains from 2012 to 2017, suggesting a global co-circulation of a set of different CV-A6 strains introduced in the country at different times. The growing circulation of the emerging CV-A6 associated with HFMD, together with the detection of more severe cases worldwide, suggests the need for a more intense surveillance system of HFMD in Brazil. In addition, this investigation was performed exclusively on serum samples, and the analysis of whole blood samples should be considered and could have shown advantages when employed in the diagnosis of enteroviral HFMD outbreaks.
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Coxsackievirus A24 variant (CVA24v), the main causative agent of acute hemorrhagic conjunctivitis (AHC), can be isolated from both the eyes and lower alimentary tract. However, the molecular features of CVA24v in feces is not well-documented. In this study, we compared the VP1 and 3C sequences of CVA24v strains isolated from feces during AHC epidemics in Cuba in 1997, 2003, and 2008-2009 with those obtained from conjunctival swabs during the same epidemic period. The sequence analyses of the 3C and VP1 region of stool isolates from the three epidemics showed a high degree of nucleotide identity (ranging from 97.3-100%) to the corresponding conjunctival isolates. The phylogenetic analysis showed that fecal CVA24v isolates from the 1997 and 2003 Cuban outbreaks formed a clade with CVA24v strains isolated from conjunctival swabs in Cuba and other countries during the same period. There were three amino acid changes (3C region) and one amino acid change (VP1 region) in seven CVA24v strains isolated sequentially over 20 days from fecal samples of one patient, suggesting viral replication in the intestine. Despite these substitutions, the virus from the conjunctival swab and fecal samples were genetically very similar. Therefore, fecal samples should be considered as a reliable alternative sample type for the routine molecular diagnosis and molecular epidemiology of CVA24v, also during outbreaks of AHC.
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The knowledge about circulation of Human Enteroviruses (EVs) obtained through medical diagnosis in Argentina is scarce. Wastewater samples monthly collected in Córdoba, Argentina during 2011-2012, and then in 2017-2018 were retrospectively studied to assess the diversity of EVs in the community. Partial VP1 gene was amplified by PCR from wastewater concentrates, and amplicons were subject of next-generation sequencing and genetic analyses. There were 41 EVs detected, from which ~50% had not been previously reported in Argentina. Most of the characterized EVs (60%) were detected at both sampling periods, with similar values of intratype nucleotide diversity. Exceptions were enterovirus A71, coxsackievirus B4, echovirus 14, and echovirus 30, which diversified in 2017-2018. There was a predominance of types from EV-C in 2017-2018, evidencing a common circulation of these types throughout the year in the community. Interestingly, high genetic similarity was evidenced among environmental strains of echovirus 30 circulating in 2011-2012 and co-temporal isolates obtained from patients suffering aseptic meningitis in different locations of Argentina. This study provides an updated insight about EVs circulating in an important region of South America, and suggests a valuable role of wastewater-based epidemiology in predicting outbreaks before the onset of cases in the community.
Assuntos
Infecções por Enterovirus/epidemiologia , Infecções por Enterovirus/virologia , Enterovirus/genética , Microbiologia Ambiental , Monitoramento Ambiental , Variação Genética , Argentina/epidemiologia , Biologia Computacional/métodos , Enterovirus/classificação , Enterovirus/isolamento & purificação , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Filogenia , Vigilância em Saúde Pública , Carga Viral , Águas Residuárias/microbiologia , Águas Residuárias/virologiaRESUMO
Abstract Although different etiological agents can cause acute meningoencephalitis, this syndrome is usually associated with viruses. Among these, enteroviruses play a significant role. Here, we describe a fatal case of meningoencephalitis in a previously healthy teenager. Real-time RT-PCR and cell culture assays were performed with serum and cerebrospinal fluid (CSF) from a clinically diagnosed meningoencephalitis case that occurred in Rio de Janeiro State, Brazil. Coxsackievirus B2 (CVB2) was identified. Phylogenetic analysis revealed that the identified CVB2 was genetically related to strains known to cause neurological diseases. This case highlights the importance of continuous laboratory surveillance of central nervous system infections.
Assuntos
Humanos , Adolescente , Meningoencefalite/diagnóstico , Filogenia , BrasilRESUMO
Enteroviruses are main candidates among environmental agents in the development of type 1 diabetes (T1D). However, the relationship between virus and the immune system response during T1D pathogenesis is heterogeneous. This is an interesting paradigm and the search for answers would help to highlight the role of viral infection in the etiology of T1D. The current data is a cross-sectional study of affected and non-affected siblings from T1D multiplex-sib families to analyze associations among T1D, genetic, islet autoantibodies and markers of innate immunity. We evaluated the prevalence of anti-virus antibodies (Coxsackie B and Echo) and its relationships with human leukocyte antigen (HLA) class II alleles, TLR expression (monocytes), serum cytokine profile and islet ß cell autoantibodies in 51 individuals (40 T1D and 11 non-affected siblings) from 20 T1D multiplex-sib families and 54 healthy control subjects. The viral antibody profiles were similar among all groups, except for antibodies against CVB2, which were more prevalent in the non-affected siblings. TLR4 expression was higher in the T1D multiplex-sib family's members than in the control subjects. TLR4 expression showed a positive correlation with CBV2 antibody prevalence (rS: 0.45; P = 0.03), CXCL8 (rS: 0.65, P = 0.002) and TNF-α (rS: 0.5, P = 0.01) serum levels in both groups of T1D multiplex-sib family. Furthermore, within these families, there was a positive correlation between HLA class II alleles associated with high risk for T1D and insulinoma-associated protein 2 autoantibody (IA-2A) positivity (odds ratio: 38.8; P = 0.021). However, the HLA protective haplotypes against T1D prevalence was higher in the non-affected than the affected siblings. This study shows that although the prevalence of viral infection is similar among healthy individuals and members from the T1D multiplex-sib families, the innate immune response is higher in the affected and in the non-affected siblings from these families than in the healthy controls. However, autoimmunity against ß-islet cells and an absence of protective HLA alleles were only observed in the T1D multiplex-sib members with clinical disease, supporting the importance of the genetic background in the development of T1D and heterogeneity of the interaction between environmental factors and disease pathogenesis despite the high genetic diversity of the Brazilian population.
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Anticorpos Neutralizantes/sangue , Anticorpos Antivirais/sangue , Diabetes Mellitus Tipo 1/imunologia , Enterovirus/imunologia , Antígenos HLA/genética , Monócitos/imunologia , Receptores Toll-Like/análise , Adolescente , Adulto , Alelos , Autoanticorpos/sangue , Estudos Transversais , Diabetes Mellitus Tipo 1/genética , Feminino , Haplótipos , Humanos , Imunidade Inata , Interleucinas/análise , Masculino , Irmãos , Adulto JovemAssuntos
Infecções por Coxsackievirus , Degeneração Macular , Doenças Retinianas , Infecções por Coxsackievirus/complicações , Infecções por Coxsackievirus/diagnóstico , Angiofluoresceinografia , Humanos , Doenças Retinianas/diagnóstico , Doenças Retinianas/etiologia , Tomografia de Coerência ÓpticaRESUMO
BACKGROUND: Enterovirus (EV) A71 and coxsackievirus (CV) A16 were the most frequent serotypes involved in hand, foot, and mouth disease (HFMD) outbreaks throughout Asia. In the past 5 years, however, CV-A6 has emerged as a new important pathogen worldwide, and more severe and extensive dermatologic presentations has been reported. OBJECTIVES: Identify the clinical spectrum for atypical HFMD and enterovirus serotypes in Belém, Pará, Amazon region of northern Brazil. STUDY DESIGN: A prospective ambulatory clinic-based surveillance conducted from January to June 2019, involving patients under 15 years with symptoms of HFMD. Stool, serum, oropharyngeal, and skin swab samples were analyzed. Real-time RT-PCR was performed to detect the viral genome of enteroviruses. Positive specimens were submitted to semi-nested PCR. Physical examinations and demographic data were recorded on a standardized form. RESULTS: 48 patients with symptoms of HFMD were included in the study and collected all samples according to protocol. Enteroviruses were detected in 83 % of patients. An atypical form of HFMD with vesiculobullous exanthema was present in 70 % (28/40); desquamation of the palms and soles detected in 90 % (36/40) and onychomadesis in 30 % (12/40) of patients. The serotype was identified in 22 patients, CV- A6 occurred in 81.8 % of them. CONCLUSION: This is the first ambulatory surveillance and virologic investigation involving HFMD performed in outpatients from Amazon region, Brazil. The detection of CV-A6 was related to atypical forms HFMD. Desquamation of the palms and soles and nail changes occurred with frequency, such as a late sequel in the HFMD disease.
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Infecções por Enterovirus/epidemiologia , Enterovirus/isolamento & purificação , Doença de Mão, Pé e Boca/epidemiologia , Adolescente , Anticorpos Antivirais/sangue , Brasil/epidemiologia , Criança , Pré-Escolar , Surtos de Doenças , Enterovirus/classificação , Enterovirus/genética , Feminino , Genoma Viral , Genótipo , Humanos , Lactente , Recém-Nascido , Masculino , Filogenia , Estudos Prospectivos , Sorogrupo , Dermatopatias Vesiculobolhosas/diagnóstico , Dermatopatias Vesiculobolhosas/epidemiologia , Dermatopatias Vesiculobolhosas/virologiaRESUMO
La enfermedad mano-pie-boca (EMPB) típica es exantemática, con sintomatología clásica de fiebre, exantema papulovesicular en las manos y los pies, asociada o no a herpangina. Es causada, principalmente, por enterovirus 71 y virus Coxsackie A16, miembros del género Enterovirus. En los últimos años, se han descrito brotes mundiales de EMPB con manifestaciones atípicas causadas, sobre todo, por el virus Coxsackie A6. La EMPB atípica se considera emergente con características clínicas y epidemiológicas peculiares: la afección de adultos, el predominio en invierno y un amplio espectro de manifestaciones clínicas en la extensión y la distribución de las lesiones. Las características morfológicas de las lesiones son muy variables: pueden simular varicela, impétigo o vasculitis.Se describe el caso de un niño de 4 años con EMPB atípica. Se detalla su forma de presentación, evolución clínica, metodología diagnóstica y terapéutica empleada.
Typical hand-foot-mouth disease (HFMD) is an exanthematous viral disease with a classic symptomatology of fever, papulovesicular rash on the hands and feet with or without herpangina. It is usually caused by enterovirus 71 and Coxsackievirus A16, members of the genus Enterovirus. Recently, worldwide outbreaks of HFMD with atypical manifestations caused by Coxsackievirus A6 have been described. Atypical HFMD is considered an emerging disease due to its peculiar clinical and epidemiological characteristics: it affects adults, has a wide spectrum of clinical manifestations in the extension and distribution of the lesions and occurs in winter. The morphological characteristics of the lesions are very variable and can be misdiagnosed as chickenpox, impetigo or vasculitis. Here we describe the symptoms, clinical evolution, diagnostic methodology and treatment employed on a 4-year-old male patient with atypical HFMD.
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Humanos , Masculino , Pré-Escolar , Enterovirus Humano A/classificação , Doença de Mão, Pé e Boca/diagnóstico , Infecções por Coxsackievirus/epidemiologia , Diagnóstico Diferencial , Genótipo , Doença de Mão, Pé e Boca/terapiaRESUMO
Typical hand-foot-mouth disease (HFMD) is an exanthematous viral disease with a classic symptomatology of fever, papulovesicular rash on the hands and feet with or without herpangina. It is usually caused by enterovirus 71 and Coxsackievirus A16, members of the genus Enterovirus. Recently, worldwide outbreaks of HFMD with atypical manifestations caused by Coxsackievirus A6 have been described. Atypical HFMD is considered an emerging disease due to its peculiar clinical and epidemiological characteristics: it affects adults, has a wide spectrum of clinical manifestations in the extension and distribution of the lesions and occurs in winter. The morphological characteristics of the lesions are very variable and can be misdiagnosed as chickenpox, impetigo or vasculitis. Here we describe the symptoms, clinical evolution, diagnostic methodology and treatment employed on a 4-yearold male patient with atypical HFMD.
La enfermedad mano-pie-boca (EMPB) típica es exantemática, con sintomatología clásica de fiebre, exantema papulovesicular en las manos y los pies, asociada o no a herpangina. Es causada, principalmente, por enterovirus 71 y virus Coxsackie A16, miembros del género Enterovirus. En los últimos años, se han descrito brotes mundiales de EMPB con manifestaciones atípicas causadas, sobre todo, por el virus Coxsackie A6. La EMPB atípica se considera emergente con características clínicas y epidemiológicas peculiares: la afección de adultos, el predominio en invierno y un amplio espectro de manifestaciones clínicas en la extensión y la distribución de las lesiones. Las características morfológicas de las lesiones son muy variables: pueden simular varicela, impétigo o vasculitis. Se describe el caso de un niño de 4 años con EMPB atípica. Se detalla su forma de presentación, evolución clínica, metodología diagnóstica y terapéutica empleada.
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Enterovirus Humano A/genética , Genótipo , Doença de Mão, Pé e Boca/diagnóstico , Doença de Mão, Pé e Boca/virologia , Argentina , Pré-Escolar , Enterovirus Humano A/classificação , Enterovirus Humano A/isolamento & purificação , Genoma Viral , Técnicas de Genotipagem , Hospitais Pediátricos , Humanos , Masculino , Sorogrupo , SorotipagemRESUMO
We report for the first time in South America an HFMD case associated with Coxsackievirus A10. The viral strain belongs to a lineage involved in important European outbreaks and probably entered Uruguay after 2017 with a Greek origin. These findings call for strengthening the regional surveillance of HFMD.
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Infecções por Coxsackievirus/virologia , Enterovirus Humano A , Doença de Mão, Pé e Boca/virologia , Animais , Surtos de Doenças , Enterovirus Humano A/classificação , Feminino , Genótipo , Humanos , Lactente , Filogenia , Uruguai/epidemiologiaRESUMO
RESUMEN La llamada «boca-mano-pie¼ es una enfermedad infecto contagiosa, generalmente benigna, que afecta fundamentalmente a niños pequeños. Se realizó un estudio descriptivo prospectivo a niños atendidos en el cuerpo de guardia con el diagnóstico del síndrome manos, pies, boca en el periodo de octubre a diciembre del año 2017 y enero del 2018, con el objetivo de describir su comportamiento a través de las variables sociodemográficas edad y sexo; área de salud, mes de aparición; factores de riesgo y principales signos y síntomas que motivaron la consulta. El universo y la muestra: constituidos por 507 casos. Para realizar la caracterización de la muestra estudiada se utilizaron estadígrafos descriptivos (frecuencias absolutas y relativas), los datos se procesaron a través del programa profesional estadístico SPSS 22.0 para Windows. Resultados: el 79.3% correspondían al grupo de edad de 1 a 5 años, del sexo femenino; el 40.8% pertenecían al policlínico René Vallejo; el 63.5% asistían a guarderías o círculos infantiles y el 100% manifestó fiebre, erupciones mucocutáneas típicas y malestar general como cuadro clínico. Concluyendo que predominó el grupo de edad entre 1 a 5 años del sexo femenino. El policlínico René Vallejo aportó el mayor número de los casos, en el mes de noviembre. La asistencia a guarderías o círculos infantiles, el hacinamiento junto a la edad menor de 5 años, constituyeron factores de riesgo; la fiebre, la erupción mucocutánea típica y el malestar general fueron los síntomas primarios encontrados en todos los pacientes estudiados.
ABSTRACT The so-called "mouth-hand-foot" is a contagious, usually benign, infectious disease that primarily affects young children. A prospective descriptive study was carried out on children treated in the guard body with the diagnosis of the hands, feet, mouth syndrome in the period from October to December of the year 2017 and January 2018, with the aim of describing their behavior through the sociodemographic variables age and sex; health area, month of appearance; risk factors and main signs and symptoms that motivated the consultation. The universe and the sample: constituted by 507 cases. To perform the characterization of the sample studied, descriptive statisticians (absolute and relative frequencies) were used, the data were processed through the statistical professional program SPSS 22.0 for Windows. Results: 79.3% corresponded to the age group of 1 to 5 years, of the female sex; 40.8% belonged to the René Vallejo polyclinic; 63.5% attended daycare centers or children's circles and 100% manifested fever, typical mucocutaneous rashes and malaise as a clinical picture. Concluding that the age group prevailed between 1 to 5 years of the female sex. The polyclinic René Vallejo contributed the largest number of cases, in the month of November. Attendance at nurseries or children's circles, overcrowding at the age of less than 5 years, were risk factors; Fever, typical mucocutaneous rash and general malaise were the primary symptoms found in all the patients studied.
RESUMO A chamada "boca-mão-pé" é uma doença infecciosa contagiosa, geralmente benigna, que afeta principalmente crianças pequenas. Foi realizado um estudo prospectivo descritivo em crianças tratadas no corpo da guarda com diagnóstico de síndrome das mãos, pés, boca no período de outubro a dezembro do ano de 2017 e janeiro de 2018, com o objetivo de descrever seu comportamento através da variáveis sociodemográficas idade e sexo; área de saúde, mês de aparecimento; fatores de risco e principais sinais e sintomas que motivaram a consulta. O universo e a amostra: constituídos por 507 casos. Para realizar a caracterização da amostra estudada, foram utilizados estatísticos descritivos (frequências absolutas e relativas), os dados foram processados por meio do programa estatístico profissional SPSS 22.0 for Windows. Resultados: 79,3% corresponderam à faixa etária de 1 a 5 anos, do sexo feminino; 40,8% pertenciam à policlínica René Vallejo; 63,5% frequentavam creches ou círculos infantis e 100% manifestavam febre, erupções cutâneas mucocutâneas e mal-estar como quadro clínico. Concluindo que a faixa etária predominou entre 1 e 5 anos do sexo feminino. A policlínica René Vallejo contribuiu com o maior número de casos, no mês de novembro. A presença em creches ou círculos infantis, superlotação com menos de 5 anos, foram fatores de risco; Febre, erupção cutânea mucocutânea típica e mal-estar geral foram os principais sintomas encontrados em todos os pacientes estudados.
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To know the epidemiological context of hand-foot-and-mouth disease (HFMD) in a region of Uruguay and to identify the Enterovirus responsible for an outbreak in a rural childcare center in 2018. Swab samples from skin lesions and/or stools samples were collected from children suffering HFMD during an outbreak in a rural childcare center. Samples were subject to viral RNA extraction and reverse-transcription polymerase chain reaction towards VP1 coding segment, to identify the Enterovirus type by sequencing and phylogenetic analysis. Total of 149 cases of HFMD affecting 98 boys and 51 girls were reported in Salto Province-Uruguay in 2018. Total 60% of the cases were originated from outbreaks, which occurred in ten educative and childcare institutions from both urban and rural areas. Coxsackievirus-6 (CV-A6) was identified as responsible for one of the rural outbreaks. Uruguayan strains were more related to strains reported in Russia, Turkey, and Germany (2014-2017) than to strains reported in Brazil and Argentina from 2015 to 2016. This is the first report of CV-A6-associated HFMD in Uruguay, evidencing a wide geographic range of the virus in the Latin American region. Our report also warns about CV-A6-associated HFMD during winter, contrarily to most reports that register HFMD during summer and fall seasons.
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Enterovirus Humano A/classificação , Enterovirus Humano A/isolamento & purificação , Doença de Mão, Pé e Boca/epidemiologia , Doença de Mão, Pé e Boca/virologia , Criança , Creches , Pré-Escolar , Surtos de Doenças , Enterovirus Humano A/genética , Fezes/virologia , Feminino , Genótipo , Humanos , Lactente , Masculino , Epidemiologia Molecular , Filogenia , Reação em Cadeia da Polimerase , RNA Viral/genética , População Rural , Análise de Sequência de DNA , Pele/virologia , Uruguai/epidemiologiaRESUMO
We present two groups of cases of atypical hand, foot, and mouth disease (HFMD) caused by Coxsackievirus A6 (CV-A6) detected in Argentina in 2015. The first group involved 14 patients from Chubut province and the second group affected 12 patients from San Luis province. Molecular analysis of the complete VP1 protein gene revealed the circulation of E2 sublineage, the most predominant worldwide. To our knowledge, this is the first report of CV-A6 infections associated with atypical HFMD in Argentina and South America.
Se describen dos grupos de casos de enfermedad de mano-pie-boca (HFMD) atípica causada por el virus Coxsackie A6 (Coxsackievirus A6, CV-A6) detectados en Argentina en el año 2015. El primero de los grupos involucró a 14 pacientes de Chubut y el segundo a 12 pacientes de San Luis. El análisis molecular del gen de la proteína VP1 completa reveló la circulación del sublinaje E2, el predominante a nivel global. Hasta donde sabemos, este es el primer reporte de infecciones CV-A6 asociadas con HFMD atípica en Argentina y Sudamérica.
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Enterovirus/patogenicidade , Doença de Mão, Pé e Boca/etiologia , Doença de Mão, Pé e Boca/microbiologia , Doença de Mão, Pé e Boca/epidemiologiaRESUMO
We present two groups of cases of atypical hand, foot, and mouth disease (HFMD) caused by Coxsackievirus A6 (CV-A6) detected in Argentina in 2015. The first group involved 14 patients from Chubut province and the second group affected 12 patients from San Luis province. Molecular analysis of the complete VP1 protein gene revealed the circulation of E2 sublineage, the most predominant worldwide. To our knowledge, this is the first report of CV-A6 infections associated with atypical HFMD in Argentina and South America.
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Infecções por Coxsackievirus/complicações , Doença de Mão, Pé e Boca/virologia , Adolescente , Adulto , Argentina , Criança , Pré-Escolar , Humanos , Lactente , Pessoa de Meia-Idade , Adulto JovemRESUMO
Information about Human Enterovirus circulation in Uruguay is scarce. The aim of this study was to generate the first description about their circulation in the country through the study of sewage samples collected before and after the switch from Oral Poliovirus Vaccine to Inactivated Poliovirus Vaccine. Viruses were concentrated by an adsorption-elution to a negatively charged membrane, and real-time quantitative PCR and qualitative PCR methods were used to detect, quantify, and characterize enteroviruses. Positive samples were inoculated in RD cells and two passages were performed. Additionally, RD+ samples were subsequently passed onto L20B cells. Human Enteroviruses were detected in 67.6% of the samples, with concentrations between 4.9 and 6.6 Log10 genomic copies per liter. 10% of positive samples replicated in RD cells, of which none in L20B cells. Molecular characterization of Human Enterovirus strains directly detected from sewage sample concentrates allowed the identification of highly divergent members of species C such as Enterovirus C99 and Coxsackievirus A13, as well as the frequent detection of species A and B members (particularly Coxsackievirus A16 and Echovirus 6, respectively). Other detected types were Coxsackievirus A2, A22, B1, B5, Echovirus 5, and 9. The characterization of viruses isolated in cell culture revealed the presence of Echovirus 6 and Coxsackievirus B3. Despite the absence of poliovirus, a wide circulation of different enterovirus types was evidenced in Uruguayan sewage samples, highlighting that the local populations are exposed to different kinds of diseases originated by several human enterovirus.
Assuntos
Infecções por Enterovirus/virologia , Enterovirus/isolamento & purificação , Monitoramento Ambiental , Esgotos/virologia , Enterovirus/genética , Infecções por Enterovirus/epidemiologia , Humanos , Filogenia , Reação em Cadeia da Polimerase em Tempo Real , Estudos Retrospectivos , Análise Espaço-Temporal , Uruguai/epidemiologiaRESUMO
La enfermedad boca mano pie es una infección altamente contagiosa, causada por el virus Coxsackie A16 y el enterovirus 71. La transmisión ocurre por contacto directo con secreciones nasales, orales, materia fecal y gotas aerolizadas, en una ruta fecal-oral o ruta oral-oral, y a través de objetos contaminados. Se presenta el caso de un paciente de cuatro años de edad que acudió a la consulta de estomatología por la presencia de vesículas dolorosas en la mucosa bucal, las cuales dificultaban su alimentación. Además presentaba rash en manos y pies. Luego de indicársele tratamiento estomatológico, fue remitido al pediatra de su área de salud, quien concluyó el diagnostico de enfermedad boca mano pie. El componente bucal de esta entidad constituye, por lo general, el principal síntoma y el motivo de consulta, sin embargo, es poco conocida en el perfil estomatológico. En ello radica el interés de la presentación, ya que el conocimiento de la fisiopatología y el cuadro clínico de la afección, permite al estomatólogo realizar el diagnóstico diferencial y sospechar clínicamente la enfermedad.
Foot, hand and mouth disease is a highly contagious disease, caused by the A16 Coxsackie virus and 71 enterovirus. The transmission occurs by the direct contact with nasal and oral secretions or fecal material and sprayed drops, in an oral fecal or fecal oral route and through contaminated objects. A case of a 4 year old patient came to the dental office due to the presence of painful blisters in the oral mucosa which made his feeding difficult. In addition he had a rash in hands and feet. After prescribing dental treatment he was referred to the pediatrician of his health area who conclude the diagnosis of foot, hand and mouth disease. The oral component is generally the main symptom and the chief complaint, however, its almost unknown in its oral profile. That is the reason for the interest of this presentation because knowing its physiopathology and the clinical characteristics of the presentation allows differential diagnosis and clinically suspect the disease.
RESUMO
RESUMEN La enfermedad de mano, pie y boca (EMPB) es una enfermedad exantemática viral, causada principalmente por Coxsackie A16, con una sintomatología típica consistente en fiebre; exantema pápulo-vesicular en manos, pies y genitales; y un enantema ulceroso en boca. En el verano del 2016 se presentó una diversidad de casos en un hospital del Callao en niños y adultos, con una sintomatología compatible con EMPB; el diagnóstico fue clínico, se aplicó terapia de soporte con resolución final de síntomas. En la última década se han presentado reportes en algunos países con una afectación atípica causada por el Coxsackie A6, produciendo lesiones más extensas y en adultos. Sin embargo, el diagnóstico sigue siendo clínico, solo necesitando confirmación virológica en casos atípicos o cuando el diagnóstico no es claro. La importancia de este reporte radica en describir los casos del Callao ocurridos en el verano del 2016, para servir de apoyo a los profesionales de la salud en el diagnóstico y manejo de pacientes con similar sintomatología.
ABSTRACT Hand, foot, and mouth disease (HFMD) is an exanthematous viral disease caused mainly by Coxsackie A16 with a typical symptomatology of fever, papulovesicular rash on the hands, feet, and genitals, and an ulcerous enanthem in the mouth. In the summer of 2016, a variety of cases presented at a hospital in Callao in children and adults with a symptomatology consistent with HFMD. A clinical diagnosis was made, and support therapy was applied, resulting in the resolution of symptoms. In the last decade, reports have emerged in some countries of an atypical involvement caused by Coxsackie A6, producing lesions that are more widely distributed in adults. However, the diagnosis remains clinical, only requiring virological confirmation in atypical cases or when the diagnosis is unclear. The importance of this report stems from its description of the cases in Callao that occurred in the summer of 2016 and serve as an example for health professionals in the diagnosis and management of patients with similar symptomatology.