Justino Maria Cleonice A, da S Mesquita Deisiane, Souza Maurício F, Farias Francisco P, Dos S Alves Jainara Cristina, Ferreira James L, Lopes Daniela P, Tavares Fernando N
Instituto Evandro Chagas, Health Surveillance Secretariat, Brazilian Ministry of Health, Belém, Brazil.
J Clin Virol. 2020 May;126:104307. doi: 10.1016/j.jcv.2020.104307. Epub 2020 Mar 6.
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.
Identify the clinical spectrum for atypical HFMD and enterovirus serotypes in Belém, Pará, Amazon region of northern Brazil.
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.
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.
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.
肠道病毒A71型（EV-A71）和柯萨奇病毒A16型（CV-A16）是亚洲各地手足口病（HFMD）疫情中最常见的血清型。然而，在过去5年中，CV-A6已成为全球一种新的重要病原体，并且有更严重和广泛的皮肤表现的报道。
确定巴西北部亚马逊地区帕拉州贝伦市非典型手足口病和肠道病毒血清型的临床谱。
2019年1月至6月进行了一项基于门诊诊所的前瞻性监测，纳入15岁以下有手足口病症状的患者。分析粪便、血清、口咽和皮肤拭子样本。进行实时逆转录聚合酶链反应（RT-PCR）以检测肠道病毒的病毒基因组。阳性标本进行半巢式PCR。体格检查和人口统计学数据记录在标准化表格上。
48例有手足口病症状的患者纳入研究并按方案采集了所有样本。83%的患者检测到肠道病毒。70%（28/40）的患者出现伴有水疱大疱性皮疹的非典型手足口病形式；90%（36/40）的患者检测到手掌和脚底脱皮，30%（12/40）的患者检测到甲脱落。在22例患者中鉴定出血清型，其中81.8%为CV-A6。
这是巴西亚马逊地区门诊患者中首次进行的涉及手足口病的门诊监测和病毒学调查。CV-A6的检测与非典型手足口病形式有关。手掌和脚底脱皮以及指甲变化频繁发生，如手足口病疾病的后期后遗症。
