Prevalence of Coxsackievirus A6 and Enterovirus 71 in Hand, Foot and Mouth Disease in Nanjing, China in 2013
Prevalence of Coxsackievirus A6 and Enterovirus 71 in Hand, Foot and Mouth Disease in Nanjing, China in 2013
复制标题
DOI：
10.1097/inf.0000000000000794
复制
发表时间：
2015-09-01
影响因子：
3.6
通讯作者：
Duan, Zhao-Jun
中科院分区：
文献类型：
--
作者：
Hu, Ya-Qian;Xie, Guang-Cheng;Duan, Zhao-Jun
背景：尽管手足口病（HFMD）与肠道病毒71（EV71）、柯萨奇病毒A16（CVA16）和其他肠道病毒密切相关，但有关手足口病的柯萨奇病毒A6（CVA6）感染的研究有限。本研究旨在明确2013年南京市手足口病的主要病原菌，探讨手足口病流行的肠道病毒（EV）类型的临床和遗传特征。方法：收集2013年4月至7月住院确诊的手足口病患儿咽拭子394份，采用5'UTR序列逆转录聚合酶链反应检测EV。基因分型和系统发育分析基于 VP4 序列。获得了人口统计学和临床数据。结果：在标本中，68.5% (270/394) 的 EV 呈阳性。基因型和检出率为CVA6，30.00%（81/270）； EV71，17.41%（47/270）；心率变异性，11.11% (30/270)； CVA10，3.33%（9/270）； CVA2，1.11%（3/270）； CVA16，0.74%（2/270）； EV68，0.37%（1/270）；艾可病毒 6, 0.37% (1/270);艾可病毒 9 分别为 0.37% (1/270)。感染CVA6的患者表现出非手足口病的典型症状，包括四肢和臀部出现较大的水疱。系统发育分析揭示了 2 个遗传上不同的 CVA6 菌株，它们在该地区独立传播。从临床表现和脑脊液白细胞分析来看，CVA6感染者外周血白细胞和C反应蛋白水平更容易出现异常，而EV71感染者更容易感染中枢神经系统。结论：2013年南京市手足口病由多种EV基因型引起，其中CVA6为优势基因型。手足口病中 CVA6 感染的临床表现与 EV71 感染的临床表现不同。
Background:Although hand, foot and mouth disease (HFMD) has been strongly associated with enterovirus 71 (EV71), coxsackievirus A16 (CVA16) and other enteroviruses, studies regarding coxsackievirus A6 (CVA6) infection in HFMD are limited. The aim of this study was to identify the major etiological agents causing HFMD in Nanjing in 2013 and explore the clinical and genetic characteristics of the prevalent enterovirus (EV) types in HFMD.Methods:A total of 394 throat swabs were collected from hospitalized children diagnosed with HFMD from April to July 2013. EVs were detected by reverse transcription polymerase chain reaction of 5 ' UTR sequences. Genotyping and phylogenetic analysis were based on VP4 sequences. Demographic and clinical data were obtained.Results:Of the specimens, 68.5% (270/394) were positive for EVs. The genotypes and detection rates were CVA6, 30.00% (81/270); EV71, 17.41% (47/270); HRV, 11.11% (30/270); CVA10, 3.33% (9/270); CVA2, 1.11% (3/270); CVA16, 0.74% (2/270); EV68, 0.37% (1/270); echovirus 6, 0.37% (1/270); echovirus 9, 0.37% (1/270), respectively. Patients infected with CVA6 displayed symptoms atypical of HFMD, including larger vesicles on their limbs and buttocks. Phylogenetic analysis revealed 2 genetically distinct CVA6 strains that circulated independently within the region. Patients infected with CVA6 were more likely to have abnormal periphery blood white blood cell and C-reactive protein levels, while EV71 was more likely to infect the central nervous system, as indicated by clinical manifestations and white blood cell analysis of cerebrospinal fluid.Conclusions:Multiple EV genotypes contributed to HFMD in Nanjing in 2013, and CVA6 was the dominant genotype. The clinical presentation of CVA6 infection differs from that of EV71 infection in HFMD.