Coxsackievirus A6 Polymorphic Exanthem in Israeli Children

Area of Science:

• Pediatrics
• Virology
• Dermatology

Background:

• Hand, foot, and mouth disease (HFMD) is a common childhood illness, typically caused by Coxsackievirus A16 or Enterovirus 71.
• Atypical presentations of HFMD have emerged, with recent reports linking Coxsackievirus A6 to unusual manifestations.

Purpose of the Study:

• To describe the clinical and virological features of atypical HFMD associated with Coxsackievirus A6 in a cohort of toddlers.
• To characterize the diverse eruption patterns and outcomes in these patients.

Main Methods:

• Case series of 8 toddlers with idiopathic extensive eruptions.
• Demographic and clinical data collection.
• Enterovirus detection using Reverse transcriptase-real-time PCR (RT-PCR).
• Phylogenetic analysis of confirmed Coxsackievirus A6 strains.

Main Results:

• All patients tested positive for enterovirus.
• Coxsackievirus A6 was identified in 6 out of 8 patients.
• Eruptions were morphologically polymorphous, including vesicular, erosive, papular, desquamative, and purpuric forms.
• One patient experienced delayed nail shedding.
• Phylogenetic analysis was performed on 5 Coxsackievirus A6 sequences.

Conclusions:

• Coxsackievirus A6-associated atypical HFMD represents a distinct childhood viral exanthem.
• The term "coxsackievirus A6 polymorphic exanthem" is proposed due to the extensive and variable nature of the eruption.
• This is the first report of this condition in Israeli children, emphasizing its potential emergence.