The diagnosis is a clinical one. Look for features of hand, foot, and mouth disease with severe rash, and do bacterial and viral cultures to rule out other infections. "We did have some patients who had a superinfection with Staph in addition to their viral infection," she said. Coxsackievirus will not grow in culture; if you want to confirm the diagnosis, use PCR. If you see a severe case in a patient hospitalized with neurologic or cardiac complications, send specimens for diagnostic confirmation to your local health department or the CDC, she advised.
The international reports of severe hand, foot, and mouth disease from CVA6 infection began in 2012 in Finland, and then came from Singapore and Japan. The international reports noted a severe rash, onychomadesis and desquamation, rare neurologic complications, and a high prevalence of infection in school-age children or adults, probably because of low herd immunity. The international investigators were able to obtain the virus for analysis from nail clippings from the patients who had onychomadesis, Dr. Mathes noted.
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