Coxsackievirus A6 and hand, foot, and mouth disease, Finland.
Bottom Line: During fall 2008, an outbreak of hand, foot, and mouth disease (HFMD) with onychomadesis (nail shedding) as a common feature occurred in Finland.We identified an unusual enterovirus type, coxsackievirus A6 (CVA6), as the causative agent.CVA6 infections may be emerging as a new and major cause of epidemic HFMD.
Affiliation: University of Turku, Turku, Finland.
During fall 2008, an outbreak of hand, foot, and mouth disease (HFMD) with onychomadesis (nail shedding) as a common feature occurred in Finland. We identified an unusual enterovirus type, coxsackievirus A6 (CVA6), as the causative agent. CVA6 infections may be emerging as a new and major cause of epidemic HFMD.
Related in: MedlinePlus
Mentions: To identify the enterovirus type in the specimens, RT-PCR, specific for a partial sequence of the viral protein 1 (VP1) region, was performed by using the COnsensus-DEgenerate Hybrid Oligonucleotide (CODEHOP) Primers (bioinformatics.weizmann.ac.il/blocks/codehop.html) (5). The amplicons were separated by agarose gel electrophoresis, purified with the QIAquick PCR Purification Kit (QIAGEN, Hilden, Germany), and sequenced in the DNA Sequencing Service Laboratory of the Turku Centre for Biotechnology. The virus type in the 3 index specimens, 3 samples of vesicular fluids, and 1 throat swab was successfully identified with sequencing and BLAST (www.ncbi.nlm.gov/BLAST) analysis as CVA6. Phylogenetic relationships of the sequences were examined by using CVA6 (Gdula strain), CVA16 (G10), and enterovirus 71 (BrCr) prototype strains as well as selected clinical CVA6 isolates obtained from GenBank. Sequence alignments were generated with the ClustalW program (www.ebi.ac.uk/clustalw), and the phylogenetic tree was computed by using the Jukes-Cantor algorithm and the neighbor-joining method. Phylogenetic analyses were conducted by using MEGA4 software (www.megasoftware.net) and the bootstrap consensus tree inferred from 1,000 replicates (6) (Figure 2).