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