Causative agents of hand, foot and mouth disease in University Malaya Medical Centre, Kuala Lumpur, Malaysia in 2012-2013
- Author:
Aw-Yong, K.L.
;
Sam, I.C.
;
Chan, Y.F.
- Publication Type:Journal Article
- From:Tropical Biomedicine
2017;34(1):240-248
- CountryMalaysia
- Language:English
-
Abstract:
Hand, foot and mouth disease (HFMD) is a childhood illness, commonly caused by
enterovirus A71 (EV-A71) and coxsackievirus A16 (CV-A16). In recent years, unusual HFMD
outbreaks caused by coxsackievirus A6 (CV-A6) have been reported. From May 2012 to
September 2013, enteroviruses were detected in 25 HFMD patients in University Malaya
Medical Centre, Kuala Lumpur, Malaysia. The predominant serotypes were EV-A71 (48%) and
CV-A6 (48%), followed by CV-A16 (4%). CV-A6 patients (mean age, 2.1) were significantly
younger than EV-A71 patients (mean age, 3.3). There were no significant differences observed
in clinical features between EV-A71 and CV-A6 patients. Since enteroviruses are difficult to
differentiate clinically, the conserved 5’ untranslated region (5’ UTR) was used to identify
enterovirus serotypes. Phylogenetic analysis of 5’ UTR showed distinct clustering of viruses
as EV-A71, CV-A16 and CV-A6. Further genotyping with capsid genes showed that all the EVA71
sequences belonged to subgenotype B5, while the CV-A16 sequence belonged to
subgenotype B2b. CV-A6 sequences were clustered into genotypes D1 and D2, with recent
isolates from Seri Kembangan, Malaysia and China. In summary, 59.5% of HFMD cases in our
centre in 2012-2013 were caused by EV-A71, CV-A16 and the newly emerging CV-A6. This
study also demonstrated that 5’ UTR is suitable for preliminary identification of enteroviruses
during HFMD outbreaks, but specific capsid genes such as VP1 and VP4/VP2 are required for
further genotyping. Apart from measures to control the spread of the virus during an outbreak
of HFMD, identification of EV-A71 as the etiological agent is important as EV-A71 is a major
cause of severe neurological complications and potentially fatal.
- Full text:P020170530366783245490.pdf
