NAIL CHANGES IN CASE OF ENTEROVIRAL INFECTIONS IN WESTERN UKRAINE: A REPORT OF 34 CASES

O. R. Boyarchuk, L. A. Volyanska, O. M. Dyvonyak

Abstract


Background. Enteroviral infections are common infections, mostly affect children. Nail changes of enteroviral infection including transverse ridging (Beau's lines) and nail shedding (onychomadesis) were described in many countries worldwide.

Objective. The aim of the research was to investigate the clinical features of the infection that was followed by nail changes during its outbreak in summer-autumn 2016 in Ternopil region, Ukraine.

Methods. A case report of 34 children with nail changes that were observed in October 2016 in Ternopil region, Ukraine is presented. All patients were from one kindergarten. Nail trauma, periungual dermatitis, significant medication intake history, systemic diseases were excluded. The survey and clinical examination of cases was performed. Faecal samples were obtained from 13 children with onychomadesis.

Results. The median age of the exemined children was 3.97±0.78 years. Interval between onsets of enteroviral infection to nail changes varied from 4 to 12 weeks. Clinical signs that preceded nail changes are fever (64.7%), herpangina (32.6%), pharyngitis (17.6%), gastrointestinal symptoms (44.1%), cutaneous lesions (82.4%) as maculopapular, vesicular rash (44.2%) or/and skin desquamation (41.2%). These clinical data indicate preceded enterovirus infection. In 21 (61.8%) patients hand-foot-mouth disease was suggested.

Nail changes were presented by Beau's lines and onychomadesis (nail shedding). The number of affected nails varied from 1 to 16, the median number was 4.88±4.09.

Conclusions. Our study proved association between the outbreak of onychomadesis (nail shedding) and enteroviral infection, mainly hand-foot-mouth disease, during summer-autumn 2016 in Western Ukraine (Ternopil region). Enteroviral infection was followed by onychomadesis in 4-12 weeks. Clinical features of enteroviral infection were very variable, with prevalence of cutaneous lesions.

More studies are necessary to determine the serotype of the virus that causes onychomadesis.


Keywords


enteroviral infections; hand-foot-mouth disease; onychomadesis; children; Ukraine.

Full Text:

PDF

References


de Crom SCM. Rossen, JWA, van Furth AM, Obihara CC. Enterovirus and parechovirus infection in children: a brief overview. Eur J Pediatr 2016; 175: 1023–1029.

Shin JY, Cho BK, Park HJ. A Clinical study of nail changes occurring secondary to hand-foot-mouth disease: onychomadesis and Beau's lines. Ann Dermatol 2014; Apr; 26(2): 280–283.

Stock I. Hand, foot and mouth disease — more than a harmless "childhood disease". Med Monatsschr Pharm 2014; Jan; 37(1): 4–10; quiz 11–2.

Clementz GC, Mancini AJ. Nail matrix arrest following hand-foot-mouth disease: a report of five children. Pediatr Dermatol 2000;17: 7–11.

Bernier V, Labrèze C, Bury F, Taïeb A. Nail matrix arrest in the course of hand, foot and mouth disease. Eur J Pediatr 2001; 160: 649–651.

Apalla Z, Sotiriou E, Pikou O, Lefaki I, Lallas A, Lazaridou E, Ioannides D. Onychomadesis after hand-foot-and-mouth disease outbreak in northern Greece: case series and brief review of the literature. Int J Dermatol 2015; 54: 1039–1044.

Haneke E. Onychomadesis and hand, foot and mouth disease — is there a connection? Euro Surveill 2010; 15: pil: 19664.

Bettoli V, Zauli S, Toni G, Virgili A. Onychomadesis following hand, foot, and mouth disease: a case report from Italy and review of the literature. Int J Dermatol 2013; 52: 728–730.

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.

Osterback R, Vuorinen T, Linna M, Susi P, Hyypiä T, Waris M. Coxsackievirus A6 and hand, foot, and mouth disease, Finland. Emerg Infect Dis 2009; 15: 1485–1488.

Wei SH, Huang YP, Liu MC, Tsou TP, Lin HC, Lin TL, et al. An outbreak of coxsackievirus A6 hand, foot, and mouth disease associated with onychomadesis in Taiwan, 2010. BMC Infect Dis 2011; 11: 346.

Bracho MA, González-Candelas F, Valero A, Córdoba J, Salazar A. Enterovirus co-infections and onychomadesis after hand, foot, and mouth disease, Spain, 2008. Emerg Infect Dis 2011; 17: 2223–2231.




DOI: http://dx.doi.org/10.11603/ijmmr.2413-6077.2016.2.7033

Refbacks

  • There are currently no refbacks.