Virological Investigation of Hand, Foot, and Mouth Disease in a Tertiary Care Center in South India

Overview

Journal J Glob Infect Dis

Date 2012 Oct 12

PMID 23055646

Citations 6

Authors

Pavithra M Vijayaraghavan

Sara Chandy

Kavitha Selvaraj

Susanne Pulimood

Asha M Abraham

Affiliations

Soon will be listed here.

Abstract

Context: Hand, foot, and mouth disease (HFMD) remains a common problem in India, yet its etiology is largely unknown as diagnosis is based on clinical characteristics. There are very few laboratory-based molecular studies on HFMD outbreaks.

Aim: The aim of this study was to characterize HFMD-related isolates by molecular techniques.

Settings And Design: Between 2005 and 2008, during two documented HFMD outbreaks, 30 suspected HFMD cases presented at the Outpatient Unit of the Department of Dermatology, Christian Medical College (CMC), Vellore. Seventy-eight clinical specimens (swabs from throat, mouth, rectum, anus, buttocks, tongue, forearm, sole, and foot) were received from these patients at the Department of Clinical Virology, CMC, for routine diagnosis of hand, foot, and mouth disease.

Materials And Methods: Samples from these patients were cultured in Vero and rhabdomyosarcoma (RD) cell lines. Isolates producing enterovirus-like cytopathogenic effect (CPE) in cell culture were identified by a nested reverse transcription-based polymerase chain reaction (RT-PCR) and sequenced. The nucleotide sequences were analyzed using the BioEdit sequence program. Homology searches were performed using the Basic Local Alignment Search Tool (BLAST) algorithm.

Statistical Analysis Used: The statistical analysis was performed using Epi Info version 6.04b and Microsoft Excel 2002 (Microsoft Office XP).

Results: Of the 30 suspected HFMD cases, only 17 (57%) were laboratory confirmed and Coxsackievirus A16 (CVA16) was identified as the etiological agent in all these cases.

Conclusions: Coxsackievirus A16 (CVA16) was identified as the virus that caused the HFMD outbreaks in Vellore between 2005 and 2008. Early confirmation of HFMD helps to initiate control measures to interrupt virus transmission. In the laboratory, classical diagnostic methods, culture and serological tests are being replaced by molecular techniques. Routine surveillance systems will help understand the epidemiology of HFMD in India.

Citing Articles

Whole-genome sequencing and phylogenetic analysis of coxsackievirus-A16 strains causing hand, foot and mouth disease (HFMD) in India.

Tikute S, Sonawane S, Shete A, Kumar A, Yadav S, Yadav P Microb Genom. 2023; 9(10).

PMID: 37905988 PMC: 10634451. DOI: 10.1099/mgen.0.001130.

Hand, Foot, and Mouth Disease (HFMD) in India: A Review on Clinical Manifestations, Molecular Epidemiology, Pathogenesis, and Prevention.

Tikute S, Lavania M Indian Dermatol Online J. 2023; 14(4):475-481.

PMID: 37521225 PMC: 10373810. DOI: 10.4103/idoj.idoj_423_22.

Clinico Virological Characterization of Hand, Foot and Mouth Disease in a Tertiary Care Hospital, South India.

Rajaseker C, Sharmila P, Munisamy M, Kandhasamy V, Sundaramurthy R, Dhodapkar R J Glob Infect Dis. 2023; 15(1):13-18.

PMID: 37090140 PMC: 10118210. DOI: 10.4103/jgid.jgid_145_22.

Hand, Foot and Mouth Disease: A Single Centre Retrospective Study of 403 New Cases and Brief Review of Relevant Indian Literature to Understand Clinical, Epidemiological, and Virological Attributes of a Long-Lasting Indian Epidemic.

Sharma A, Mahajan V, Mehta K, Chauhan P, Manvi S, Chauhan A Indian Dermatol Online J. 2022; 13(3):310-320.

PMID: 36226004 PMC: 9549533. DOI: 10.4103/idoj.idoj_701_21.

Circulating HFMD-associated coxsackievirus A16 is genetically and phenotypically distinct from the prototype CV-A16.

Wei W, Guo H, Li J, Ren S, Wei Z, Bao W PLoS One. 2014; 9(4):e94746.

PMID: 24736564 PMC: 3988102. DOI: 10.1371/journal.pone.0094746.

References

Ooi M, Solomon T, Podin Y, Mohan A, Akin W, Yusuf M . Evaluation of different clinical sample types in diagnosis of human enterovirus 71-associated hand-foot-and-mouth disease. J Clin Microbiol. 2007; 45(6):1858-66. PMC: 1933032. DOI: 10.1128/JCM.01394-06. View

Wang J, Tuan Y, Tsai H, Yan J, Liu C, Su I . Change of major genotype of enterovirus 71 in outbreaks of hand-foot-and-mouth disease in Taiwan between 1998 and 2000. J Clin Microbiol. 2002; 40(1):10-5. PMC: 120096. DOI: 10.1128/JCM.40.1.10-15.2002. View

Saoji V . Hand, foot and mouth disease in Nagpur. Indian J Dermatol Venereol Leprol. 2008; 74(2):133-5. DOI: 10.4103/0378-6323.39697. View

Nijhuis M, van Maarseveen N, Schuurman R, Verkuijlen S, de Vos M, Hendriksen K . Rapid and sensitive routine detection of all members of the genus enterovirus in different clinical specimens by real-time PCR. J Clin Microbiol. 2002; 40(10):3666-70. PMC: 130891. DOI: 10.1128/JCM.40.10.3666-3670.2002. View

Chan L, Parashar U, Lye M, Ong F, Zaki S, Alexander J . Deaths of children during an outbreak of hand, foot, and mouth disease in sarawak, malaysia: clinical and pathological characteristics of the disease. For the Outbreak Study Group. Clin Infect Dis. 2000; 31(3):678-83. DOI: 10.1086/314032. View

Chan K, Goh K, Chong C, Teo E, Lau G, Ling A . Epidemic hand, foot and mouth disease caused by human enterovirus 71, Singapore. Emerg Infect Dis. 2003; 9(1):78-85. PMC: 2873753. DOI: 10.3201/eid0901.020112. View

Singh S, Poh C, Chow V . Complete sequence analyses of enterovirus 71 strains from fatal and non-fatal cases of the hand, foot and mouth disease outbreak in Singapore (2000). Microbiol Immunol. 2003; 46(11):801-8. DOI: 10.1111/j.1348-0421.2002.tb02767.x. View

Mori J, Clewley J . Polymerase chain reaction and sequencing for typing rhinovirus RNA. J Med Virol. 1994; 44(4):323-9. PMC: 7166759. DOI: 10.1002/jmv.1890440403. View

Russo D, Luchs A, Machado B, Carmona R, Timenetsky M . Echovirus 4 associated to hand, foot and mouth disease. Rev Inst Med Trop Sao Paulo. 2006; 48(4):197-9. DOI: 10.1590/s0036-46652006000400004. View

10.

Chen S, Chang H, Yan T, Cheng Y, Chen K . An eight-year study of epidemiologic features of enterovirus 71 infection in Taiwan. Am J Trop Med Hyg. 2007; 77(1):188-91. View

11.

Oberste M, Maher K, Kilpatrick D, Flemister M, Brown B, Pallansch M . Typing of human enteroviruses by partial sequencing of VP1. J Clin Microbiol. 1999; 37(5):1288-93. PMC: 84754. DOI: 10.1128/JCM.37.5.1288-1293.1999. View

12.

Manayani D, Cherian T, Murali N, Finny G, Green J, Brown D . Evaluation of a one-tube RT-PCR system for detection of enteroviruses. J Clin Virol. 2001; 24(1-2):25-30. DOI: 10.1016/s1386-6532(01)00234-7. View

13.

Sasidharan C, Sugathan P, Agarwal R, Khare S, Lal S, Jayaram Paniker C . Hand-foot-and-mouth disease in Calicut. Indian J Pediatr. 2005; 72(1):17-21. DOI: 10.1007/BF02760573. View

14.

Chang L, Lin T, Hsu K, Huang Y, Lin K, Hsueh C . Clinical features and risk factors of pulmonary oedema after enterovirus-71-related hand, foot, and mouth disease. Lancet. 1999; 354(9191):1682-6. DOI: 10.1016/S0140-6736(99)04434-7. View

15.

Ang L, Koh B, Chan K, Chua L, James L, Goh K . Epidemiology and control of hand, foot and mouth disease in Singapore, 2001-2007. Ann Acad Med Singap. 2009; 38(2):106-12. View

16.

Hosoya M, Kawasaki Y, Sato M, Honzumi K, Hayashi A, Hiroshima T . Genetic diversity of coxsackievirus A16 associated with hand, foot, and mouth disease epidemics in Japan from 1983 to 2003. J Clin Microbiol. 2006; 45(1):112-20. PMC: 1828949. DOI: 10.1128/JCM.00718-06. View