Pediatria pre prax 5/2015

A new form of hand-foot-and-mouth disease in children and adults caused by a virus Coxsackie A6

Hand-foot-and-mouth disease (HFMD) is a highly contagious, world-wide distributed viral illness that affects predominantly children. It is caused by several enteroviruses, mostly Coxsackie viruses. In most classic cases HFMD is caused by Coxsackie viruses A10 and A16 and follows a benign and self-limiting course. After an incubation period of 3 to 7 days, fever and sore throat, the first symptoms of the disease, appear. A few days later, maculopapular or vesicular eruptions form on the palms and soles as well as in the oral cavity. In some cases severe progressive HFMD forms with neurological complications caused by enteroviruses EV71 and EV68 were observed. Recently the atypical form of HFMD caused by the Coxsackie virus A6 is becoming more common worldwide. This illness affects both children and adults and is characterized by more severe symptoms than „classical“ HFMD, such as viral gingivostomatitis and herpangina, prolonged fevers, whole body spreading of vesicles and bullae and is frequently marked as Eczema coxsackium. In addition, outbreaks of Coxsackie virus-A6 associated HFMD are associated with onychomadesis after one or two months. Treatment of „classical“ HFMD is usually symptomatic, antiviral therapy is generally not recomended. In severe cases it is possible to treat the patients with antivirotics and intravenous immunoglobulins. A vaccine against Coxsackie viruses is not yet available.

Keywords: Coxsackie virus A6, Hand-foot-mouth disease, Eczema coxsackium, atypical form of Coxsackie infection, enterovirus, viral vesiculobullous exanthema.