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Clinicopathologic analysis of coxsackievirus a6 new variant induced widespread mucocutaneous bullous reactions mimicking severe cutaneous adverse reactions
- Source :
- The Journal of infectious diseases. 208(12)
- Publication Year :
- 2013
-
Abstract
- Background. The cutaneous manifestations of human enterovirus (HEV) infection are usually limited, such as hand-foot-mouth disease. By comparison, Stevens-Johnson syndrome (SJS) is a life-threatening severe cutaneous adverse reaction (SCAR), mainly caused by drugs. During the HEV outbreaks in 2010–2012 in Taiwan, we identified 21 patients who developed widespread blistering mucocutaneous reactions without any suspected drug causality. Methods. We screened possible pathogen(s) for detecting human herpes virus (HHV1–HHV7), HEV, or Mycoplasma pneumoniae infections using throat swab virus cultures, real-time PCR, DNA sequencing, immunochemistry and electron microscopy analyses. Results. Coxsackievirus A6 (CVA6) DNA was identified in the blistering skin lesions in 6 of 21 patients. Cytotoxic T lymphocytes and natural killer cells expressing granulysin predominantly infiltrated into the skin lesions, sharing the histopathological features with SJS. Intact CVA6 viral particles were identified in the blister fluids and skin lesions by electron microscopy. The phylogenetic analysis of the viral genome showed the CVA6 DNA sequence sharing higher similarity (97.6%–98.1%) to CVA6 strains reported from Finland at 2008. Conclusions. This study identifies a new variant of CVA6 as the causative agent for severe mucocutaneous blistering reactions mimicking SCAR. An awareness of this unusual presentation of HEV infection is needed in the epidemic area.
- Subjects :
- Antigens, Differentiation, T-Lymphocyte
Male
Biopsy
Mucocutaneous zone
Biology
Coxsackievirus
medicine.disease_cause
Herpesviridae
Virus
law.invention
Blister
law
medicine
Immunology and Allergy
Humans
Granulysin
Child
Polymerase chain reaction
Phylogeny
Enterovirus
Skin
Virion
Hepatitis E
medicine.disease
biology.organism_classification
Virology
Body Fluids
Killer Cells, Natural
Infectious Diseases
Child, Preschool
Immunology
DNA, Viral
Female
Hand, Foot and Mouth Disease
T-Lymphocytes, Cytotoxic
Subjects
Details
- ISSN :
- 15376613
- Volume :
- 208
- Issue :
- 12
- Database :
- OpenAIRE
- Journal :
- The Journal of infectious diseases
- Accession number :
- edsair.doi.dedup.....94265356e3146c6809a4a61b59f69075