Clinical and epidemiologic features of Coxsackievirus A6 infection in children in northern Taiwan between 2004 and 2009

Shih Hsuan Lo, Yhu Chering Huang, Chung Guei Huang, Kuo Chien Tsao, Wen Chen Li, Yu Chia Hsieh, Cheng Hsun Chiu, Tzou Yien Lin

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Abstract

Background: Isolates of Coxsackievirus A6 (Cox A6) is increasing clinically in 2009 in Taiwan but detailed clinical features of Cox A6 infections in children have not been reported. This study is to define clinical manifestations and laboratory findings of Cox A6 infection in children. Methods: From January 2004 to December 2009, a total of 4,664 children with enterovirus infections, based on throat virus culture, were treated in Chang Gung Children's hospital. Two hundred and ninety-six (6.3%) patients positive for Cox A6 infection were included in this study. One hundred and forty-one (47.6%) inpatients were further analyzed for clinical presentations, laboratory findings, and clinical diagnoses. Results: There were two peaks of Cox A6 infection in 2007 and 2009 during the study period, especially during the warm season. The proportion of Cox A6 among total enterovirus isolates was 15.5% in 2007 and up to 22.2% in 2009. The mean age of inpatients was 2.42±0.14 years. The mean hospitalization duration was 4.21±0.11 days. The most common symptoms were fever (100%), oral ulcers (90.8%), and decreased oral intake (89.4%). The mean duration of fever was 2.78±1 days (range, 1-7 days). Seventy-seven (54.6%) patients had fever more than 3 days. The mean leukocyte count was 14,850/mm3, and 63 (45%) patients had leukocytosis (>15,000/mm3). The mean serum C-reactive protein (CRP) level was 44.1±3.3mg/L (normal, <10mg/L) and 62 (44%) had a CRP level >40mg/L. One hundred and eight (76.6%) inpatients were diagnosed as herpangina and 18 (12.8%) hand-foot-mouth disease. Three patients had complications, including aseptic meningitis in one and encephalitis in two. All 141 inpatients recovered uneventfully. Conclusions: Cox A6 is among the major serotypes of enteroviruses in Taiwan and most cases presented as herpangina and hand-foot-mouth disease. Nearly half of the cases may have leukocytosis and elevated CRP levels. Outcomes are usually good.

Original languageEnglish
Pages (from-to)252-257
Number of pages6
JournalJournal of Microbiology, Immunology and Infection
Volume44
Issue number4
DOIs
Publication statusPublished - Aug 2011
Externally publishedYes

Fingerprint

Coxsackievirus Infections
Enterovirus
Taiwan
Herpangina
Inpatients
Hand, Foot and Mouth Disease
Fever
Leukocytosis
C-Reactive Protein
Enterovirus Infections
Oral Ulcer
Aseptic Meningitis
Encephalitis
Pharynx
Leukocyte Count
Blood Proteins
Hospitalization
Viruses

Keywords

  • Coxsackievirus A6
  • Hand-foot-mouth disease
  • Herpangina

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology and Microbiology(all)
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Clinical and epidemiologic features of Coxsackievirus A6 infection in children in northern Taiwan between 2004 and 2009. / Lo, Shih Hsuan; Huang, Yhu Chering; Huang, Chung Guei; Tsao, Kuo Chien; Li, Wen Chen; Hsieh, Yu Chia; Chiu, Cheng Hsun; Lin, Tzou Yien.

In: Journal of Microbiology, Immunology and Infection, Vol. 44, No. 4, 08.2011, p. 252-257.

Research output: Contribution to journalArticle

Lo, Shih Hsuan ; Huang, Yhu Chering ; Huang, Chung Guei ; Tsao, Kuo Chien ; Li, Wen Chen ; Hsieh, Yu Chia ; Chiu, Cheng Hsun ; Lin, Tzou Yien. / Clinical and epidemiologic features of Coxsackievirus A6 infection in children in northern Taiwan between 2004 and 2009. In: Journal of Microbiology, Immunology and Infection. 2011 ; Vol. 44, No. 4. pp. 252-257.
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title = "Clinical and epidemiologic features of Coxsackievirus A6 infection in children in northern Taiwan between 2004 and 2009",
abstract = "Background: Isolates of Coxsackievirus A6 (Cox A6) is increasing clinically in 2009 in Taiwan but detailed clinical features of Cox A6 infections in children have not been reported. This study is to define clinical manifestations and laboratory findings of Cox A6 infection in children. Methods: From January 2004 to December 2009, a total of 4,664 children with enterovirus infections, based on throat virus culture, were treated in Chang Gung Children's hospital. Two hundred and ninety-six (6.3{\%}) patients positive for Cox A6 infection were included in this study. One hundred and forty-one (47.6{\%}) inpatients were further analyzed for clinical presentations, laboratory findings, and clinical diagnoses. Results: There were two peaks of Cox A6 infection in 2007 and 2009 during the study period, especially during the warm season. The proportion of Cox A6 among total enterovirus isolates was 15.5{\%} in 2007 and up to 22.2{\%} in 2009. The mean age of inpatients was 2.42±0.14 years. The mean hospitalization duration was 4.21±0.11 days. The most common symptoms were fever (100{\%}), oral ulcers (90.8{\%}), and decreased oral intake (89.4{\%}). The mean duration of fever was 2.78±1 days (range, 1-7 days). Seventy-seven (54.6{\%}) patients had fever more than 3 days. The mean leukocyte count was 14,850/mm3, and 63 (45{\%}) patients had leukocytosis (>15,000/mm3). The mean serum C-reactive protein (CRP) level was 44.1±3.3mg/L (normal, <10mg/L) and 62 (44{\%}) had a CRP level >40mg/L. One hundred and eight (76.6{\%}) inpatients were diagnosed as herpangina and 18 (12.8{\%}) hand-foot-mouth disease. Three patients had complications, including aseptic meningitis in one and encephalitis in two. All 141 inpatients recovered uneventfully. Conclusions: Cox A6 is among the major serotypes of enteroviruses in Taiwan and most cases presented as herpangina and hand-foot-mouth disease. Nearly half of the cases may have leukocytosis and elevated CRP levels. Outcomes are usually good.",
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AU - Lo, Shih Hsuan

AU - Huang, Yhu Chering

AU - Huang, Chung Guei

AU - Tsao, Kuo Chien

AU - Li, Wen Chen

AU - Hsieh, Yu Chia

AU - Chiu, Cheng Hsun

AU - Lin, Tzou Yien

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N2 - Background: Isolates of Coxsackievirus A6 (Cox A6) is increasing clinically in 2009 in Taiwan but detailed clinical features of Cox A6 infections in children have not been reported. This study is to define clinical manifestations and laboratory findings of Cox A6 infection in children. Methods: From January 2004 to December 2009, a total of 4,664 children with enterovirus infections, based on throat virus culture, were treated in Chang Gung Children's hospital. Two hundred and ninety-six (6.3%) patients positive for Cox A6 infection were included in this study. One hundred and forty-one (47.6%) inpatients were further analyzed for clinical presentations, laboratory findings, and clinical diagnoses. Results: There were two peaks of Cox A6 infection in 2007 and 2009 during the study period, especially during the warm season. The proportion of Cox A6 among total enterovirus isolates was 15.5% in 2007 and up to 22.2% in 2009. The mean age of inpatients was 2.42±0.14 years. The mean hospitalization duration was 4.21±0.11 days. The most common symptoms were fever (100%), oral ulcers (90.8%), and decreased oral intake (89.4%). The mean duration of fever was 2.78±1 days (range, 1-7 days). Seventy-seven (54.6%) patients had fever more than 3 days. The mean leukocyte count was 14,850/mm3, and 63 (45%) patients had leukocytosis (>15,000/mm3). The mean serum C-reactive protein (CRP) level was 44.1±3.3mg/L (normal, <10mg/L) and 62 (44%) had a CRP level >40mg/L. One hundred and eight (76.6%) inpatients were diagnosed as herpangina and 18 (12.8%) hand-foot-mouth disease. Three patients had complications, including aseptic meningitis in one and encephalitis in two. All 141 inpatients recovered uneventfully. Conclusions: Cox A6 is among the major serotypes of enteroviruses in Taiwan and most cases presented as herpangina and hand-foot-mouth disease. Nearly half of the cases may have leukocytosis and elevated CRP levels. Outcomes are usually good.

AB - Background: Isolates of Coxsackievirus A6 (Cox A6) is increasing clinically in 2009 in Taiwan but detailed clinical features of Cox A6 infections in children have not been reported. This study is to define clinical manifestations and laboratory findings of Cox A6 infection in children. Methods: From January 2004 to December 2009, a total of 4,664 children with enterovirus infections, based on throat virus culture, were treated in Chang Gung Children's hospital. Two hundred and ninety-six (6.3%) patients positive for Cox A6 infection were included in this study. One hundred and forty-one (47.6%) inpatients were further analyzed for clinical presentations, laboratory findings, and clinical diagnoses. Results: There were two peaks of Cox A6 infection in 2007 and 2009 during the study period, especially during the warm season. The proportion of Cox A6 among total enterovirus isolates was 15.5% in 2007 and up to 22.2% in 2009. The mean age of inpatients was 2.42±0.14 years. The mean hospitalization duration was 4.21±0.11 days. The most common symptoms were fever (100%), oral ulcers (90.8%), and decreased oral intake (89.4%). The mean duration of fever was 2.78±1 days (range, 1-7 days). Seventy-seven (54.6%) patients had fever more than 3 days. The mean leukocyte count was 14,850/mm3, and 63 (45%) patients had leukocytosis (>15,000/mm3). The mean serum C-reactive protein (CRP) level was 44.1±3.3mg/L (normal, <10mg/L) and 62 (44%) had a CRP level >40mg/L. One hundred and eight (76.6%) inpatients were diagnosed as herpangina and 18 (12.8%) hand-foot-mouth disease. Three patients had complications, including aseptic meningitis in one and encephalitis in two. All 141 inpatients recovered uneventfully. Conclusions: Cox A6 is among the major serotypes of enteroviruses in Taiwan and most cases presented as herpangina and hand-foot-mouth disease. Nearly half of the cases may have leukocytosis and elevated CRP levels. Outcomes are usually good.

KW - Coxsackievirus A6

KW - Hand-foot-mouth disease

KW - Herpangina

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