Molecular epidemiology of enteroviruses associated with severe hand, foot and mouth disease in Shenzhen, China, 2014-201
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ORIGINAL ARTICLE
Molecular epidemiology of enteroviruses associated with severe hand, foot and mouth disease in Shenzhen, China, 2014‑2018 Long Chen1 · Shao‑Jian Xu2 · Xiang‑Jie Yao1 · Hong Yang1 · Hai‑Long Zhang1 · Jun Meng1 · Han‑Ri Zeng3 · Xu‑He Huang3 · Ren‑Li Zhang1 · Ya‑Qing He1 Received: 13 February 2020 / Accepted: 13 June 2020 © Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract In this study, we investigated the epidemiology and molecular characteristics of enteroviruses associated with severe hand, foot and mouth disease (HFMD) in Shenzhen, China, during 2014-2018. A total of 137 fecal specimens from patients with severe HFMD were collected. Enterovirus (EV) types were determined using real-time reverse transcription polymerase chain reaction (RT-PCR), RT nested PCR, and sequencing. Sequences were analyzed using bioinformatics programs. Of 137 specimens tested, 97 (70.8%), 12 (8.8%), and 10 (7.3%) were positive for EV-A71, coxsackievirus A6 (CVA6), and CVA16, respectively. Other pathogens detected included CVA2 (2.9%, 4/137), CVA10 (2.9%, 4/137), CVA5 (0.7%, 1/137), echovirus 6 (E6) (0.7%, 1/137) and E18 (0.7%, 1/137). The most frequent complication in patients with proven EV infections was myoclonic jerk, followed by aseptic encephalitis, tachypnea, and vomiting. The frequencies of vomiting and abnormal eye movements were higher in EV-A71-infected patients than that in CVA6-infected or CVA16-infected patients. Molecular phylogeny based on the complete VP1 gene revealed no association between the subgenotype of the virus and disease severity. Nevertheless, 12 significant mutations that were likely to be associated with virulence or the clinical phenotype were observed in the 5’UTR, 2 Apro, 2C, 3A, 3 Dpol and 3’UTR of CVA6. Eight significant mutations were observed in the 5’UTR, 2B, 3A, 3Dpol and 3’UTR of CVA16, and 10 significant mutations were observed in the 5’UTR, VP1, 3A and 3 Cpro of CVA10. In conclusion, EV-A71 is still the main pathogen causing severe HFMD, although other EV types can also cause severe complications. Potential virulence or phenotype-associated sites were identified in the genomes of CVA6, CVA16, and CVA10.
Introduction Hand, foot and mouth disease (HFMD), which is mainly caused by some members of the species Enterovirus A, is a common childhood infectious disease [1, 2]. Enterovirus A is one of 15 species of the genus Enterovirus in the family
Handling Editor: Akbar Dastjerdi. Shao-Jian Xu and Xiang-Jie Yao have contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00705-020-04734-z) contains supplementary material, which is available to authorized users. * Long Chen [email protected] * Ya‑Qing He [email protected] Extended author information available on the last page of the article
Picornaviridae (http://www.picornaviridae.com/enteroviru s/entero virus .htm). This species includes viruses of 25 types, of which coxsackievirus A2 (CVA2), CVA3, CVA4, CVA5, CVA6, CVA
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