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CORRESPONDENCE
Hand, Foot and Mouth Disease and Echovirus 3: A Comment to Høgsberg & Bygum
Pascal DEL GIUDICE and Thomas HUBICHE
Dermatology and Infectious Diseases Unit, Centre Hospitalier de Fréjus-Saint-Raphël, 240 avenue Saint Lambert, FR-83600 Fréjus, France.
E-mail: [email protected]
We read with great interest the case report by Høgsberg
& Bygum (1) of atypical hand, foot and mouth (HFM)
disease caused by echovirus 3; however, we do not share
their conclusion. The finding of an enterovirus, such as
echovirus 3, in stools can be incidental. Indeed, enterovi-
ruses can be excreted in stools for 10 weeks or more after
an infection (2). Therefore the finding of an enterovirus
in stools is not sufficiently specific to draw a definitive
conclusion of causality in HFM. This is even more the
case if the enterovirus isolated is not considered a usual
pathogen associated with HFM. The virus is present in
skin vesicle fluid (3), therefore the most specific virologi-
cal test in HFM is the sampling of the contents of skin
vesicles using enterovirus PCR to confirm the causal link.
Reply to the Comment by Del Giudice & Hubiche
Trine HØGSBERG and Anette BYGUM
Department of Dermatology, Odense University Hospital, Søndre Blvd 29, DK-5000 Odense C, Denmark. E-mail: [email protected].
We appreciate the comment from Del Giudice & Hubi-
che. We share the point that the detection of echovirus 3
may be purely incidental. However, the patient presented
a clinical picture compatible with atypical hand, foot,
and mouth disease, and no other differential diagnoses
fitted appropriately. A skin swab was negative for herpes-
virus, varicella zoster virus, enterovirus and pathogenic
bacteria. Echovirus 3 was detected in stool. The finding
of echovirus 3 has been reported previously in a patient
with hand, foot, and mouth associated onychomadesis
(4), but could also be seen in controls. We must conclude
that we found a temporal relationship of echovirus 3 and
atypical hand, foot, and mouth disease, but cannot prove
a causal relationship.
REFERENCES (for both papers)
1. Høgsberg T, Bygum A. Disseminated vesicular rash in an im-
munocompetent adult woman: a quiz. atypical hand, foot,
and mouth disease caused by echovirus 3. Acta Derm Ve-
nereol 2018; 98: 163–164.
2. Chung PW, Huang YC, Chang LY, Lin TY, Ning HC. Duration
of enterovirus shedding in stool. I Microbiol Immune Infect
2001; 34: 167–170.
3. Hubiche T, Schuffenecker I, Boralevi F, Léauté-Labrèze C,
doi: 10.2340/00015555-2943
Acta Derm Venereol 2018; 98: 718
Bornebusch L, Chiaverini C, et al. Dermatological spectrum
of hand, foot and mouth disease from classical to generalized
exanthema. Pediatr Infect Dis J 2014; 33: e92–e98.
4. Davia JL, Bel PH, Ninet VZ, Bracho MA, González-Candelas F,
Salazar A, et al. Onychomadesis outbreak in Valencia, Spain
associated with hand, foot, and mouth disease caused by
enteroviruses. Pediatr Dermatol 2011; 28: 1–5.
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Journal Compilation © 2018 Acta Dermato-Venereologica.