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Indian Pediatr 2013;50: 250 |
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Hand, Foot and Mouth Disease in Odisha
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Girish Chandra Bhatt and *Tanya Sharma
Departments of Pediatrics, All India Institute of
Medical Sciences and *Department of Pathology, UCMS and associated
GTB Hospital, New Delhi, India.
Email: [email protected]
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The recent article on Hand, Foot, and Mouth disease by Kar,
et al. [1] found laboratory confirmation of the
suspected viral etiology in about 10% of the cases of Hand
foot and mouth disease (HFMD) in serum samples. Studies have
shown that the viral yield from sterile sites such as CSF
(0-5%), in patients with neurological complications, and
serum is low [2] and yield can be increased by taking
samples from other sites such as throat, rectum, ulcer swab
and fluid from vesicles. The sensitivity, specificity, as
well as usefulness of findings vary according to the sample
[3]. Studies, particularly from south East Asia, have shown
that viral isolation from vesicular fluid is more useful, if
a proper method of collection is used. One study showed the
most efficient approach was to examine throat swabs for all
patients, plus swabs from at least two vesicles or from the
rectum for patients with no vesicles [3]. Another report of
175 patients with HFMD during the 2000 outbreak in Singapore
found that rectal swabs most often yielded virus, followed
by stool samples, vesicle swabs, and then throat swabs [4].
They found about 50% positive vesicles in 62 patients with
HFMD.
As viral shedding from the
gastrointestinal tract may continue even after complete
resolution of the symptoms, the isolates from the sterile
and non sterile sites may differ. One report have shown that
when an enterovirus is detected in non sterile site it
differs from that isolated in sterile sites in 10% of throat
swabs and 20% of rectal swabs [2]. Vesicle swab which was
earlier neglected is now being widely used, as the viral
yield is almost comparable to throat swab with extra
advantage of being sterile.
References
1. Kar BR, Dwibedi B, Kar SK. Outbreak of
hand, foot and mouth disease in Bhubaneswar, Odisha:
Epidemiology and clinical features. Indian Pediatr. 2012. [Epub
ahead of print].
2. Ooi MH, Wong SC, Podin Y, Akin W, del
Sel S, Mohan A, et al. Human enterovirus 71 disease
in Sarawak, Malaysia: a prospective clinical, virological,
and molecular epidemiological study. Clin Infect Dis.
2007;44:646–56.
3. Ooi MH, Solomon T, Podin Y, Mohan A,
Akin W, Yusuf MA, et al. Evaluation of different
clinical sample types in diagnosis of human enterovirus
71-associated hand-foot-and-mouth disease. J Clin Microbiol.
2007;45:1858–66.
4. Chan, KP, Goh KT, Chong CY, Teo ES, Lau G, Ling AE.
Epidemic hand, foot and mouth disease caused by human
enterovirus 71, Singapore. Emerg Infect Dis. 2003;9: 78-85.
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