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Abstract: Periodontal health is defined by absence of clinically detectable inflammation. There is a biological level of immune surveillance that is consistent with clinical gingival health and homeostasis. Clinical gingival health may be found in a periodontium that is intact, i.e. without clinical attachment loss or bone loss, and on a reduced periodontium in either a non‐periodontitis patient (e.g. in patients with some form of gingival recession or following crown lengthening surgery) or in a patient with a history of periodontitis who is currently periodontally stable. Clinical gingival health can be restored following treatment of gingivitis and periodontitis. However, the treated and stable periodontitis patient with current gingival health remains at increased risk of recurrent periodontitis, and accordingly, must be closely monitored. Two broad categories of gingival diseases include non‐dental plaque biofilm–induced gingival diseases and dental plaque‐induced gingivitis. Non‐dental plaque biofilm‐induced gingival diseases include a variety of conditions that are not caused by plaque and usually do not resolve following plaque removal. Such lesions may be manifestations of a systemic condition or may be localized to the oral cavity. Dental plaque‐induced gingivitis has a variety of clinical signs and symptoms, and both local predisposing factors and systemic modifying factors can affect its extent, severity, and progression. Dental plaque‐induced gingivitis may arise on an intact periodontium or on a reduced periodontium in either a non‐periodontitis patient or in a currently stable “periodontitis patient” i.e. successfully treated, in whom clinical inflammation has been eliminated (or substantially reduced). A periodontitis patient with gingival inflammation remains a periodontitis patient (Figure 1), and comprehensive risk assessment and management are imperative to ensure early prevention and/or treatment of recurrent/progressive periodontitis. Precision dental medicine defines a patient‐centered approach to care, and therefore, creates differences in the way in which a “case” of gingival health or gingivitis is defined for clinical practice as opposed to epidemiologically in population prevalence surveys. Thus, case definitions of gingival health and gingivitis are presented for both purposes. While gingival health and gingivitis have many clinical features, case definitions are primarily predicated on presence or absence of bleeding on probing. Here we classify gingival health and gingival diseases/conditions, along with a summary table of diagnostic features for defining health and gingivitis in various clinical situations. [ABSTRACT FROM AUTHOR]

Periodontal health is defined by absence of clinically detectable inflammation. There is a biological level of immune surveillance that is consistent with clinical gingival health and homeostasis. Clinical gingival health may be found in a periodontium that is intact, i.e. without clinical attachment loss or bone loss, and on a reduced periodontium in either a non‐periodontitis patient (e.g. in patients with some form of gingival recession or following crown lengthening surgery) or in a patient with a history of periodontitis who is currently periodontally stable. Clinical gingival health can be restored following treatment of gingivitis and periodontitis. However, the treated and stable periodontitis patient with current gingival health remains at increased risk of recurrent periodontitis, and accordingly, must be closely monitored. Two broad categories of gingival diseases include non‐dental plaque biofilm–induced gingival diseases and dental plaque‐induced gingivitis. Non‐dental plaque biofilm‐induced gingival diseases include a variety of conditions that are not caused by plaque and usually do not resolve following plaque removal. Such lesions may be manifestations of a systemic condition or may be localized to the oral cavity. Dental plaque‐induced gingivitis has a variety of clinical signs and symptoms, and both local predisposing factors and systemic modifying factors can affect its extent, severity, and progression. Dental plaque‐induced gingivitis may arise on an intact periodontium or on a reduced periodontium in either a non‐periodontitis patient or in a currently stable "periodontitis patient" i.e. successfully treated, in whom clinical inflammation has been eliminated (or substantially reduced). A periodontitis patient with gingival inflammation remains a periodontitis patient (Figure 1), and comprehensive risk assessment and management are imperative to ensure early prevention and/or treatment of recurrent/progressive periodontitis. Precision dental medicine defines a patient‐centered approach to care, and therefore, creates differences in the way in which a "case" of gingival health or gingivitis is defined for clinical practice as opposed to epidemiologically in population prevalence surveys. Thus, case definitions of gingival health and gingivitis are presented for both purposes. While gingival health and gingivitis have many clinical features, case definitions are primarily predicated on presence or absence of bleeding on probing. Here we classify gingival health and gingival diseases/conditions, along with a summary table of diagnostic features for defining health and gingivitis in various clinical situations. [ABSTRACT FROM AUTHOR]

Acute sensory neuronopathy (SNN) is a rapidly developing peripheral nervous system disease that primarily affects sensory neurons in the dorsal root ganglion or trigeminal ganglion, leading to the impairment of sensory axons. SNN is notably uncommon in childhood; only three cases of childhood or adolescent SNN have been reported to date. Moreover, SSN has never been reported in association with enterovirus infection. Here, we report the case of a 3-year-old girlwho was initially diagnosedwith enterovirus infection based on the presentation of fevers, rashes on all extremities, and ulceration over the posterior pharynx. Nine days later, she presented with ataxic and wide-based gait and dysmetria affecting the extremities, with an absence of sensory nerve action potentials in the upper and lower limbs. The patient was diagnosed with acute SNN based on the criteria developed by Camdessanché et al in 2009. To our knowledge, this is the youngest case of SNN reported to date. In addition, this case reveals that enterovirus infection can be associated with acute SNN in children in rare cases. Accurate diagnosis relies on clinical suspicion, comprehensive knowledge of the patient's history, and careful characterization of abnormal findings in electrodiagnostic studies. [ABSTRACT FROM AUTHOR]

Background: The high prevalence of oral pathology in children encourages to gain further understanding on their manifestations and urgent nature, objective of the present study Methodology. Cross-sectional study that included patients aged <14 years of age who attended an emergency department over a one-year period. The relationship between the variables collected and oral pathology was analyzed., Results: Fifty-five patients were included, 45.5% girls, mean age 4.11 years (10 days to 13 years). Overall, mucosal pathology (74.5%) prevailed over dental ones, and lesions of infectious origin (54.6%) over the traumatic ones (14.5%). Dental pathology (50% toothache and 35.7% infections) was significantly associated with being >6 years (66.7 vs 10%), pain (40.7 vs 10.7%) and absence of fever (37.9 vs 11.5%). Mucosal pathology (61% infections: 53.7% viral and 31.7% due to herpangina) was significantly associated with being =6 years (60 vs 6.7%) and having fever (76.9 vs 17.2%). Six traumatic lesions on the mucosa and two on the teeth were observed; significantly more patients attended the emergency room within 24 hours (median =1 hour) than in the case of infection (100 vs 51.7%). Being =6 years was significantly associated with fever, mucosal pathology, mucosal infection, and herpangina, and being >6 years was associated with pain, previous antibiotic treatment and at discharge, and previous NSAID regimen., Conclusions: The analyzed pediatric oral pathologies treated in the emergency department are of mucosal and infectious origin. Dental disease prevail in children >6 years of age and mucosal lesions in those =6 years; no sex differences are observed.

Objectives: Information on seasonal synchrony of influenza activity between neighbouring regions has been found useful for planning infection control measures. Seasonal synchrony of other infectious diseases is less known. We describe the seasonality and seasonal synchrony of three common childhood infectious diagnoses among three regions in Taiwan. Methods: A large, nationally representative sample of young children (N = 128 651, age 0–4 years) was used to estimate the monthly incidences of acute respiratory infection, acute intestinal infection, and herpangina and hand, foot, and mouth disease (HFMD) in three regions of Taiwan between 2000 and 2005. Seasonality of monthly incidences was indicated by year-on-year intra-class correlations (ICCs). Between-region ICCs were used to describe seasonal synchrony of incidences between regions. Results: We found evidence of seasonality in all three infectious diagnoses (p

Global temperatures continue to rise, reaching new records almost every year this decade. Although the causes are debated, climate change is a reality. Consequences of climate change include melting of the arctic ice cap, rising of sea levels, changes in precipitation patterns, and increased severe weather events. This article updates dermatologists about the effects of climate change on the epidemiology and geographic ranges of selected skin diseases in North America. Although globalization, travel, and trade are also important to changing disease and vector patterns, climate change creates favorable habitats and expanded access to immunologically naïve hosts. Endemic North American illnesses such as Lyme disease, leishmaniasis, and dimorphic fungal infections have recently expanded the geographic areas of risk. As temperatures increase, epidemic viral diseases such as hand-foot-and-mouth disease may develop transmission seasons that are longer and more intense. Chikungunya and dengue are now reported within the southern United States, with Zika on the horizon. Cutaneous injuries from aquatic and marine organisms that have expanding habitats and longer durations of peak activity include jellyfish envenomation, cercarial dermatitis, and seabather eruption, among others. Skin cancer rates may also be affected indirectly by changes in temperature and associated behaviors. [ABSTRACT FROM AUTHOR]

Vesiculobullous lesions are a type of mucocutaneous disease that is characterized by vesicles and bullae or blisters. Both vesicles and bullae are fluid-filled lesions, and they are distinguished by size, vesicles being less than 5-10 mm and bulla being larger than 5-10 mm, In the case of vesiculobullous diseases which are also immune disorders the term immunobullous is sometimes used. This review will provide an overview of vesiculobullous lesions involving oral cavity, their characteristic features and recent developments in the diagnosis of these lesions. Sridhar Reddy Erugula, Dilip Kumar Singaraju, Jesudass Govada, K.T.S.S. Rajajee, M.V.S. Sudheer, A. Sudharshan Kumar, Brijesh Krishna Bandaru, Kandukuri Mahesh Kumar. Vesiculobullous lesions of the oral cavity. [ABSTRACT FROM AUTHOR]

Background: Enterovirus (EV)-related hand, foot, and mouth disease/herpangina (HFMD/HA) has been prevalent in Guangdong Province, China, since 2010.Methods: Clinical data for EV-related HFMD/HA inpatients admitted to the Department of Paediatrics of Zhujiang Hospital from 2010 to 2013 were retrospectively reviewed. The corresponding EV serotypes were also determined by reverse transcription-polymerase chain reaction or BLAST analysis of the sequenced partial lengths of the viral protein1/5'-untranslated region.Results: A total of 867 eligible inpatients admitted during 2010-2013 were included in the study. Of these, the serotype of the responsible EV was successfully identified in 824 cases. The incidence of enterovirus 71 (EV71) infection amongst pediatric HFMD/HA inpatients decreased dramatically from 55.5 % in 2010 to 8.1 % in 2013, with a similar decrease recorded for coxsackievirus A16 (CVA16). However, the incidence of non-EV71/CVA16 infection increased from 30.0 % in 2010 to 83.8 % in 2013. We noted that the types of infection caused by different EV serotypes varied: EV71 was responsible for 100 % of the paralysis cases (26/26), 84.6 % of the deaths (11/13), and 84.1 % of cases with severe central nervous system involvement (SCNSI) (74/88); echovirus contributed to 16.4 % of the deaths (2/13) and 4.4 % of the SCNSI cases; and coxsackievirus accounted for only 2.2 % of the SCNSI cases (2/90). The clinical features of HFMD/HA cases varied greatly during the time period examined, with drastic changes in the hospitalization rates (45.1, 63.7, 36.4, and 19.1 % for 2010, 2011, 2012, and 21013, respectively), mortality rates (2.3, 0.9, 2.5, and 0.0 %, respectively), paralysis (5.1, 1.2, 5.4, and 0.0 %, respectively), SCNSI (16.8, 7.1, 12.7, and 2.2 %, respectively), and acute respiratory infection (21.1, 22.0, 45.9, and 59.0 %, respectively).Conclusions: The incidences of infection caused by different EV serotypes, along with the clinical features of HFMD/HA cases, changed drastically in Guangdong Province, China, from 2010 to 2013, with the biggest changes observed in 2013. The changed constituent ratios of the different EV serotypes might therefore be responsible for the differences in the observed clinical features of HFMD/HA during this period. [ABSTRACT FROM AUTHOR]

The community burden of enterovirus is often monitored through syndromic monitoring systems based on reported cases of enterovirus-related infection (EVI) diagnoses. The extent to which this is affected by under- and over-diagnosis has not been reported. In Taiwan, children often make more than one healthcare visit during an episode of infection. We used change of diagnosis within an episode of infection as a guide of diagnostic uncertainty in a nationally representative cohort of Taiwanese children (n = 13 284) followed from birth to the 9th birthday through electronic health records. We conducted a nested case-control analysis and estimated cross-diagnosis ratios (CDRs) as the observed proportion of acute respiratory infection (ARI) diagnoses following an EVI diagnosis in excess of background ARI burdens. With 19 357 EVI diagnoses in this cohort, the CDR within 7 days was 1·51 (95% confidence interval 1·45-1·57), confirming a significant excess of ARI diagnoses within the week following an EVI diagnosis. We used age-specific CDRs to calibrate the weekly EVI burden in children aged 3-5 years in 2008, and the difference between observed and calibrated weekly EVI burdens was small. Therefore, there was evidence suggesting a small uncertainty in EVI diagnosis, but the observed EVI burdens through syndromic monitoring were not substantially affected by the small uncertainty. [ABSTRACT FROM AUTHOR]

Aim: To study the genomic factors of coxsackievirus A6 (CVA6) correlated with herpangina and hand, foot and mouth disease (HFMD). Materials & methods: Complete genome of CVA6 strains and HFMD causing enteroviruses were enrolled for genomic comparisons. Results: Recombinations in the nonstructural P2-P3 region appeared to correlate with HFMD causing pathogenicity. Among nonrecombinant CVA6 strains, a markedly nucleotide diversity in 3C-3UTR was observed between herpangina and HFMD causing CVA6. Synonymous mutations take an important role in the evolution of CVA6 3C-3UTR region, as limited amino acid variations were resulted from the high nucleotide diversity. Key amino acid mutations at positions 168-170 of 3D protein were correlated with the differences in viral pathogenicities. Conclusion: These findings provide insights into viral genomic features correlated with CVA6 pathogenicities. [ABSTRACT FROM AUTHOR]

Background: A series of complications caused by enteroviruses, including meningitis, encephalitis, acute flaccid paralysis, acute cardiopulmonary failure, respiratory infection, and myocardial injury have been reported in hand, foot and mouth disease/herpangina (HFMD/HA). However, the complication of diarrhoea caused by enteroviruses has been neglected, and a summary of its clinical features and impact on HFMD/HA is unavailable.Methods: We included inpatients with HFMD/HA admitted to the Paediatric Department of Zhujiang Hospital during 2009-2012. We summarised and compared clinical data for cases with and without diarrhoea, and determined enterovirus serotypes by reverse transcriptase polymerase chain reaction and genotyping based on a partial-length fragment of viral protein 1 or the 5'-untranslated region.Results: There were 804 inpatients with HFMD/HA and 28 (3.5%) presented with diarrhoea. Gastrointestinal symptoms were mild in most cases of diarrhoea (82.1%), with high prevalence of no dehydration (82.1%), short duration of diarrhoea (78.6%) and watery stools (75.0%). The prevalence of multi-organ dysfunction syndrome (10.7 vs 0.40%) (p = 0.001), hepatic injury (14.3 vs 3.4%) (p = 0.019), myocardial injury (21.4 vs 6.1%) (p = 0.002) and convulsion (21.4 vs 7.2%) (p = 0.016) was significantly higher in the diarrhoea than no diarrhoea group. There was no significant difference between the two groups regarding prevalence of death, altered consciousness, paralysis, central nervous system involvement, or acute respiratory infection.Conclusions: Most patients with diarrhoea caused by enteroviruses circulating in Guangdong Province in 2009-2012 had mild or moderate gastrointestinal symptoms. Although enterovirus-related diarrhoea caused additional multi-organ dysfunction syndrome, hepatic injury and myocardial injury in children with HFMD/HA, timely intervention efficiently reduced disease severity and improved outcome. [ABSTRACT FROM AUTHOR]

In Thailand, hand, foot, and mouth disease (HFMD) is usually caused by enterovirus 71 or coxsackievirus A16. To determine the cause of a large outbreak of HFMD in Thailand during June–August 2012, we examined patient specimens. Coxsackievirus A6 was the causative agent. To improve prevention and control, causes of HFMD should be monitored.

Highlights • Hospital-based studies consistently suggest boys are more affected by infections than girls. • Age trajectories of common infections were compared between boys and girls in Taiwan. • With regard to urinary tract infections, boys and girls followed very different age trajectories. • During early childhood, boys were more likely than girls to have most other types of infections. • After 6 years of age, sex difference varied by type of infection. Abstract Sex differences in childhood infections are commonly reported in case-only studies. In this population-based study of 278 000 Taiwanese children followed from 3 months to 18 years of age during the period 2000–2012, age-trajectories of monthly numbers of all-cause healthcare visits and monthly rates of infection-specific healthcare visits were compared between boys and girls. For all-cause healthcare visits and for healthcare visits related to conjunctivitis, respiratory tract infections, enteritis, hand, foot, and mouth disease, and herpangina, there was good resemblance of age trajectories between boys and girls. Despite this resemblance, there was evidence of a slightly higher rate in boys than in girls under age 6 years (i.e., a male tendency, or male-to-female ratio >1.0) across all diagnoses except herpangina. For urinary tract infection, where an age-specific sex difference is well reported in case-only studies, this population-based study confirmed that there was a much higher rate of kidney infection among boys than among girls during infancy, and a higher rate of kidney and bladder infection among girls than among boys after this period. The age-specific sex difference in urinary tract infections was so strong that the age trajectories in boys and girls were qualitatively different. This report confirms previously reported sex differences in other countries, whilst placing this in the context of age dynamics in childhood infection. [ABSTRACT FROM AUTHOR]

배경: Human enteroviruses (EVs) are associated with a broad spectrum of diseases, from mild symptoms to neurological ones. To develop effective preventive measures for EV infection, including vaccines, monitoring circulating EVs is very important. Therefore, this study aimed to evaluate the long-term pattern changes in the prevalence, seasonality, and genotype distribution in Korea for 10 years (2011–2020). 방법: Totally, 7,160 specimens (stool, throat swab, skin swab, and cerebrospinal fluid) were collected from patients with suspected EV infections in 10 local hospitals between 2011–2020 in Gwangju, Korea. RNA extraction and real-time reverse transcription polymerase chain reaction using EV-specific probes and primers were performed for EV detection. EV genotyping and phylogenetic analysis were performed using BLAST and the Enterovirus Genotyping Tool. 결과: Among the 7,160 specimens collected, EVs were detected in 3,076 (43.0%). The annual EV detection rate varied. No difference in EV infection by sex was observed, and children aged ≤4 years were susceptible to EV infection; this trend has not changed over time. Overall, 35 different EV types belonging to four different species and rhinoviruses were identified. Although the serotype distribution changed frequently every year, the eight most frequently observed EVs were EV71 (accounting for 13.1% of the cases), CA6 (8.3%), CB5 (7.6%), CA16 (7.6%), CA10 (7.5%), E18 (7.5%), E30 (7.0%), and E11 (5.0%) for 10 years (2011–2020). Predominant EV genotypes by clinical manifestation were CB5 for aseptic meningitis; EV71 for hand, foot, and mouth disease (HFMD) cases; and CA10 for herpangina signs. 결론: Our study provides valuable data that aid the development of vaccines against EV infection and comprehensive disease control in South Korea. Consequently, continuous laboratory surveillance of EVs should be improved to detect the emergence of new EV variants and types. [ABSTRACT FROM AUTHOR]

Coxsackievirus A8 (CV-A8), a member of the genus Enterovirus of the family Picornaviridae, can cause a variety of infectious diseases, such as hand, foot and mouth disease (HFMD), herpangina (HA), encephalitis, paralysis, myelitis, and meningitis. This is a first report of complete genome sequences of CV-A8 strains associated with HFMD/HA since the prototype strain Donovan was identified in 1949. The complete genome sequences of eight new CV-A8 strains showed 19.2 %-20.6 % nucleotide differences when compared to the prototype strain Donovan, and 81.5 %-99.9 % similarity to each other. The topology of a polyphyletic tree based on complete capsid protein gene sequences indicated that the new CV-A8 strains and Donovan are monophyletic. However, seven CV-A8 strains clustered with CV-A10 and CV-A2 in the 5'UTR and P2 region, respectively. In the P3 region, three and four CV-A8 strains grouped with CV-A6 and CV-A2, respectively. Seven CV-A8 strains segregated from Donovan and grouped in a separate lineage in the 3'UTR. The strain CVA8/SZ266/CHN/2014 was most similar to EV71 in the nonstructural proteins regions. Phylogenetic analysis classified worldwide CV-A8 isolates into four distinct clusters, and almost all Chinese and Thai CV-A8 strains evolved independently in their respective lineages, which indicated geographical evolution of CV-A8. [ABSTRACT FROM AUTHOR]

Enterovirus A71 ( EV- A71) belongs to the species group A in the E nterovirus genus within the P icornaviridae family. EV- A71 usually causes self-limiting hand, foot and mouth disease or herpangina but rarely causes severe neurological complications such as acute flaccid paralysis and encephalomyelitis. The pathology and neuropathogenesis of these neurological syndromes is beginning to be understood. EV- A71 neurotropism for motor neurons in the spinal cord and brainstem, and other neurons, is mainly responsible for central nervous system damage. This review on the general aspects, recent developments and advances of EV- A71 infection will focus on neuropathogenesis and its implications on other neurotropic enteroviruses, such as poliovirus and the newly emergent Enterovirus D68. With the imminent eradication of poliovirus, EV- A71 is likely to replace it as an important neurotropic enterovirus of worldwide importance. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To probe into the clinical efficacy and safety of antibiotics in treatment of herpangina with the increase of C-reactive protein ( CRP ) in children. METHODS: 204 child patients with herpangina of CRP increasing admitted into the Affiliated Hospital of Xinyang Vocational and Technical College during 2014-2016 were selected and divided into control group and observation group via random number table, with 102 cases in each group. The control group was treated with Pudilan Xiaoyan oral liquid, while the observation group was given amoxicillin and clavulanate potassium particles combined with Pudilan Xiaoyan oral liquid, both groups received 5-day treatment . Disappearance times of fever, total courses of disease, clinical efficacy and incidences of adverse drug reactions of two groups were compared. RESULTS: The disappearance time of fever, total courses of disease and total effective rate of observation group were respectively (2.91 ±0.59) d, (6.32 ±1.24) d and 96.08%(98/102), those of the control group were respectively (2.86 ±0.54) d, (6.25 ±1.12) d and 97.06%(99/102), the differences had no statistical significances ( P >0.05 ); the incidence of adverse drug reactions of observation group ( 13.75%, 14/102 ) was significantly higher than that of the control group ( 4.90%, 5/102 ) , with statistically significant difference ( P <0.05 ). CONCLUSIONS: The efficacy of antibiotics in treatment of children herpangina with CRP increasing is basically the same as the therapeutic regimen without antibiotics, therefore, antibiotics therapy is not recommended because it will increase adverse drug reactions, [ABSTRACT FROM AUTHOR]

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Background Enteroviruses are seasonally prevalent each year in Southeast Asia. Elevated C-reactive protein (CRP) levels have been noted in minor populations of patients, and antibiotics may be prescribed under the impression of a suspected bacterial infection. This prescription might be inappropriate, resulting in further bacterial resistance and medical expense. The aim of this study was to delineate how effective antibiotics are for children suffering from enterovirus infection complicated with a high CRP level. Methods The medical records of children hospitalized between January 2008 and December 2012 with herpangina or hand, foot and mouth disease were reviewed retrospectively. The children enrolled were divided into three groups, A, B, and C, by CRP level, which were <40, 40-80, and ≥80mg/l, respectively. A case-control study of group C divided into subgroups according to the prescription of antibiotics for at least 24h during the admission was conducted for further analysis. Results A total 3566 cases were identified; 214 were in group C and 71.0% of them received a prescription for antibiotics. There was a linear trend between a relatively higher CRP level and a higher proportion of antibiotics prescribed in the three groups (p=0.001). In the case-control study, there were no significant differences in age, sex, mean CRP, or febrile days. However, a relatively longer stay of hospitalization was recorded in the subgroup with an antibiotic prescription (p=0.020). Conclusions The present study indicated that antibiotics might not be beneficial in treating these patients, even those with a high CRP level. Clinicians should be more prudent in antibiotic use when no obvious evidence of bacterial infection is found. [ABSTRACT FROM AUTHOR]

Context: Glinus oppositifolius (L.) Aug. DC. (Molluginaceae), a perennial subshrubs herb, grows at low altitudes in the southern part of Taiwan, and is used in traditional Chinese medicine for herpes zoster and herpangina. Objective: This study describes nutritional and therapeutic potential of Glinus oppositifolius and summarizes scientific evidence that supports traditional claims; recent progress in research for this plant is reviewed herein. Materials and methods: The literature has been retrieved from the web-based online systems including PubMed, Medline, and Google Scholar. The articles related to phytochemistry, pharmaceutical biology and ethnopharmacology have been excluded. Results and discussion: In clinical practice, the plant has been extensively investigated in a broad range of studies to provide scientific evidence for folklore claims or to find new therapeutic uses. The present review may arouse related research and make a more valid display for Taiwanese native medicinal plants. [ABSTRACT FROM AUTHOR]

Hand, foot, and mouth disease (HFMD) and herpangina are common infectious diseases caused by several genotypes of human enterovirus species A and frequently occurring in young children. This study was aimed at analyzing enteroviruses from patients with these diseases in Thailand in 2012. Detection and genotype determination of enteroviruses were accomplished by reverse transcription-polymerase chain reaction and sequencing of the VP1 region. Enterovirus-positive samples were differentiated into 17 genotypes (coxsackievirus A4 (CAV4), A5, A6, A8, A9, A10, A12, A16, A21, B1, B2, B4, B5, echovirus 7, 16, 25 and Enterovirus 71). The result showed CAV6 (33.5%), followed by CAV16 (9.4%) and EV71 (8.8%) as the most frequent genotypes in HFMD, CAV8 (19.3%) in herpangina and CAV6 (1.5%) in influenza like illness. Enterovirus infections were most prevalent during July with 34.4% in HFMD, 39.8% in herpangina and 1.6% in ILI. The higher enterovirus infection associated with HFMD and herpangina occurred in infants over one year-old. This represents the first report describing the circulation of multiple enteroviruses in Thailand. [ABSTRACT FROM AUTHOR]

Background Clinical manifestations of enterovirus 71 (EV71) range from herpangina, hand-foot-andmouth disease (HFMD), to severe neurological complications. Unlike the situation of switching genotypes seen in EV71 outbreaks during 1998-2008 in Taiwan, genotype B5 was responsible for two large outbreaks in 2008 and 2012, respectively. In China, by contrast, EV71 often persists as a single genotype in the population and causes frequent outbreaks. To investigate genetic changes in viral evolution, complete EV71 genome sequences were used to analyze the intra-genotypic evolution pattern in Taiwan, China, and the Netherlands. Results Genotype B5 was predominant in Taiwan's 2008 outbreak and was re-emergent in 2012. EV71 strains from both outbreaks were phylogenetically segregated into two lineages containing fourteen non-synonymous substitutions predominantly in the non-structural protein coding region. In China, genotype C4 was first seen in 1998 and caused the latest large outbreak in 2008. Unlike shifting genotypes in Taiwan, genotype C4 persisted with progressive drift through time. A majority of non-synonymous mutations occurred in residues located in the non-structural coding region, showing annual increases. Interestingly, genotype B1/B2 in the Netherlands showed another stepwise evolution with dramatic EV71 activity increase in 1986. Phylogeny of the VP1 coding region in 1971-1986 exhibited similar lineage turnover with genotype C4 in China; however, phylogeny of the 3D-encoding region indicated separate lineage appearing after 1983, suggesting that the 3D-encoding region of genotype B2 was derived from an unidentified ancestor that contributed to intra-genotypic evolution in the Netherlands. Conclusions Unlike VP1 coding sequences long used for phylogenetic study of enteroviruses due to expected host immune escape, our study emphasizes a dominant role of non-synonymous mutations in non-structural protein regions that contribute to (re-)emergent genotypes in continuous stepwise evolution. Dozens of amino acid substitutions, especially in nonstructural proteins, were identified via genetic changes driven through intra-genotypic evolution worldwide. These identified substitutions appeared to increase viral fitness in the population, affording valuable insights not only for viral evolution but also for prevention, control, and vaccine against EV71 infection. [ABSTRACT FROM AUTHOR]

Since 1998 in Taiwan, enterovirus (EV) 71 epidemics have caused encephalomyelitis and placed a significant burden on parents and physicians. In this study, we present clinical manifestations, magnetic resonance (MR) imaging findings, and neurological sequelae on epidemic EV-infected patients with encephalomyelitis. Of the 46 patients, 14 patients presented with neurological sequelae; of them, 3 patients suffered from complications of mental regression. Predictors of unfavorable neurological sequelae were myoclonic jerks (> 4 times/night) and pleocytosis (167/μL) of the cerebrospinal fluid (CSF). Results from viral culture and MR imaging indicated that positive identification of EV71 infection was associated significantly with lesions on MR imaging. Our results show that hand-foot-mouth disease carries a higher risk of encephalomyelitis and that frequent myoclonic jerks and pleocytosis of the CSF are risk factors for subsequent neurological sequelae. Positive identification of EV71 might be useful as a predictor of lesions in MR imaging. [ABSTRACT FROM AUTHOR]