Vesicular stomatitis and exanthem. A syndrome associated with Coxsackie virus, type A16

Siji Antiviral Mixture Protects against CA16 Induced Brain Injury through Inhibiting PERK/STAT3/NF-κB Pathway

Coxsackievirus 16 (CA16) causes hand, foot, and mouth disease (HFMD) in young children and infants, and it can lead to fatal neurological complications. This study investigated antiviral effects of Siji Antiviral Mixture (SAM) on CA16 in neonatal mice and the protective effects of SAM on CA16 induced brain injuries. Neonatal BALB/c mice and SH-SY5Y cells were used and injected with CA16 stains to study the efficacy. ELISA and Western blotting were used to measure the cytokines levels and proteins expression. Genes transduction was also used to verify interaction mechanism. As the results shown, SAM could reduce the clinical scores at the beginning and delay disease development in vivo. Treatment with SAM decreased the levels of LDH, CK-MB, caspase 3 and Bax, ER stress, and inflammatory reaction induced by CA16 infection. Further siRNA transfection results showed that CA16 induced ER stress and inflammatory reaction through PERK/STAT3/NF-κB signaling and the protective effects of SAM might be through inhibiting PERK/STAT3/NF-κB signaling. HPLC analysis showed fingerprint profiles of SAM had 42 chromatographic peaks. Collectively, our study highlighted distinct roles of SAM in inhibiting CA16 infection and brain injury. The molecular mechanism of SAM might be through inhibiting PERK/STAT3/NF-κB signaling.

Clinical Features for Mild Hand, Foot and Mouth Disease in China

Background

Mild hand, foot and mouth disease (HFMD) is at a critical stage owing to its ease of communicability and a higher risk of developing severe complications and death. Clinical diagnosis of mild HFMD was made by the presenting symptoms and signs (symptoms in brief) alone. We aim to evaluate the frequencies of symptoms in a retrospective case series study.

Methods

We collected epidemiological, demographic, clinical, and laboratory data from outpatient and inpatient settings on the clinical data warehouse system. We principally described the frequencies of symptoms of mild HFMD. Correlations between symptoms with laboratory-confirmed cases were then analyzed.

Results

The clinical data warehouse system included 3649 probable cases, between 2010 and 2012, of which 956 (26.20%) were laboratory confirmed. The peak incidence was identified in children 2 years of age. A total of 370 of the 956 laboratory confirmed cases (38.70%) were associated with enterovirus 71 (EV71). Logistic regression analysis adjusted for geographical variables, age, sex, month of onset, and time from onset to diagnosis showed that the clinical features constipation (P<0.0001; adjusted OR, 95%CI (2.99, 2.28–3.91)), and blisters (P<0.0001; adjusted OR, 95%CI (2.16, 1.82–2.56)) were positively correlated with the confirmed cases.

Conclusions

This is the largest case series study, including all the guideline-mentioned symptoms of mild HFMD. Our findings suggest that blisters and constipation should be considered as potential warning signs while front-line clinicians manage surges of children diagnosed with mild HFMD during a pandemic.

Challenges to licensure of enterovirus 71 vaccines

Human enteroviruses usually cause self-limited infections except polioviruses and enterovirus 71 (EV71), which frequently involve neurological complications. EV71 vaccines are being evaluated in humans. However, several challenges to licensure of EV71 vaccines need to be addressed. Firstly, EV71 and coxsackievirus A (CA) are frequently found to co-circulate and cause hand-foot-mouth disease (HFMD). A polyvalent vaccine that can provide protection against EV71 and prevalent CA are desirable. Secondly, infants are the target population of HFMD vaccines and it would need multi-national efficacy trials to prove clinical protection and speed up the licensure and usage of HFMD vaccines in children. An international network for enterovirus surveillance and clinical trials is urgently needed. Thirdly, EV71 is found to evolve quickly in the past 15 years. Prospective cohort studies are warranted to clarify clinical and epidemiological significances of the antigenic and genetic variations between different EV71 genogroups, which is critical for vaccine design.

'Hand, foot, and mouth disease' associated with Coxsackie A5 virus

Seven cases are described of highly infectious disease characterized by vesicular eruptions in the mouth and on the hands and feet. In previous outbreaks described in the literature Coxsackie type A16 virus was isolated but from these cases, similar clinically, Coxsackie type A5 virus was isolated.

A clustering outbreak of hand, foot, and mouth disease caused by Coxsackie virus A10

A clustering outbreak of hand, foot, and mouth disease (HFMD) occurred from July, 1981 to January, 1982 in Matsue City and Gotsu City, Shimane Prefecture. Thirty-seven patients with clinical HFMD were virologically and serologically examined, and Coxsackie virus A10 (CA10) was isolated in 18 patients from vesicles (7/16), throat-swabs (9/31) and feces (6/7). During the period, no CA16 or enterovirus 71 were isolated from HFMD patients or from other diseases such as pharyngitis, febrile diseases, and aseptic meningitis. Serological diagnosis was performed employing an African green monkey kidney cell (AG-1)-adapted CA10 which demonstrated cytopathogenic effects on the cells. Paired sera from seven patients including three cases in which isolation failed showed a significant increase of neutralizing antibody titer against CA10. Finally, an etiological diagnosis was made in 21 out of 37 patients with clinical HFMD. This is the first report of a clustering outbreak of HFMD caused by CA10 in Japan.

Hand, foot and mouth disease associated with coxsackievirus group B

This study from Frankfurt, although similar to other reports with respect to clinical findings, presents further evidence of a varied etiology for hand, foot and mouth disease (HFMD). Of the 6 patients with HFMD, 5 ahd virologic evidence of coxsackievirus B5 infection, and 1 had definite evidence of coxsackievirus B2 infection. Our data suggest an etiologic association of coxsackievirus group B with HFMD.

Hand, foot, and mouth disease: a viral disease of importance to dentists

Hand, foot, and mouth disease is a disease of viral origin that produces characteristic lesions in the mouth and on the hands and feet. Knowledge of the disease is important to dentists since the oral vesicular and ulcerative lesions are usually the first clinical signs of the disease, and the epidemiclike patterns of the disease make it likely that the dentist will contract the disease himself or possibly become a carrier of the virus. The lesions of hand, foot, and mouth disease usually regress in two to three weeks, and complications are rare. Treatment is basically palliative to reduce the pain and irritation. Differential diagnosis of the disease must include consideration of herpes simplex, herpangina, recurrent aphthae, erythema multiforme, and animal foot and mouth disease. A case involving a dentist and his family is reported.

Fluorescent antibody responses of cases and contacts of hand, foot, and mouth disease

Paired sera from clinical cases, familial contacts, and school contacts of hand, foot, and mouth disease were tested by indirect immunofluorescence against a strain of coxsackie A16 virus which had been adapted to human fibroblast tissue-cultured cells. All of the 22 clinical cases developed immunoglobulin (Ig) G antibodies, and 11 responded with IgM and 10 with IgA antibodies. Seventeen of 21 familial contacts of cases showed subclinical infection as determined by development of IgG antibodies. Only seven and nine, respectively, of these had demonstrable IgM and IgA antibodies. Thirteen of 16 school classmates of three clinical cases were shown to have experienced subclinical infection by the development of IgG antibodies. Only five had antibodies in the IgM fraction, and three had antibodies in the IgA fraction. A comparison of IgG titers with those obtained by neutralization tests provides further evidence that the indirect fluorescent antibody technique represents a rapid diagnostic procedure for this disease.

Hand, foot, and mouth diseases

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