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Journal of Clinical Microbiology, June 2007, p. 1858-1866, Vol. 45, No. 6
0095-1137/07/$08.00+0     doi:10.1128/JCM.01394-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Evaluation of Different Clinical Sample Types in Diagnosis of Human Enterovirus 71-Associated Hand-Foot-and-Mouth Disease{triangledown}

Mong How Ooi,1,2* Tom Solomon,2,4 Yuwana Podin,3 Anand Mohan,1 Winnie Akin,3 Mohd Apandi Yusuf,3 Syvia del Sel,2 Kamsiah Mohd Kontol,1 Boon Fu Lai,1 Daniela Clear,2 Chae Hee Chieng,1 Emma Blake,2 David Perera,3 See Chang Wong,1 and Jane Cardosa3

Department of Paediatrics, Sibu Hospital, Sibu, Sarawak, Malaysia,1 Division of Neurological Science, University of Liverpool, Walton Centre for Neurology and Neurosurgery, Liverpool L9 7LJ, United Kingdom,2 Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Kota, Samarahan, Sarawak, Malaysia,3 Division of Medical Microbiology and Genitourinary Medicine, University of Liverpool, Duncan Building, Liverpool L69 3GA, United Kingdom4

Received 6 July 2006/ Returned for modification 28 August 2006/ Accepted 5 April 2007

Human enterovirus 71 and coxsackievirus A16 are important causes of hand-foot-and-mouth disease (HFMD). Like other enteroviruses, they can be isolated from a range of sterile and nonsterile sites, but which clinical sample, or combination of samples, is the most useful for laboratory diagnosis of HFMD is not clear. We attempted virus culture for 2,916 samples from 628 of 725 children with HFMD studied over a 3 1/2-year period, which included two large outbreaks. Overall, throat swabs were the single most useful specimen, being positive for any enterovirus for 288 (49%) of 592 patients with a full set of samples. Vesicle swabs were positive for 169 (48%) of 333 patients with vesicles, the yield being greater if two or more vesicles were swabbed. The combination of throat plus vesicle swabs enabled the identification of virus for 224 (67%) of the 333 patients with vesicles; for this patient group, just 27 (8%) extra patients were diagnosed when rectal and ulcer swabs were added. Of 259 patients without vesicles, use of the combination of throat plus rectal swab identified virus for 138 (53%). For 60 patients, virus was isolated from both vesicle and rectal swabs, but for 12 (20%) of these, the isolates differed. Such discordance occurred for just 11 (10%) of 112 patients with virus isolated from vesicle and throat swabs. During large HFMD outbreaks, we suggest collecting swabs from the throat plus one other site: vesicles, if these are present (at least two should be swabbed), or the rectum if there are no vesicles. Vesicle swabs give a high diagnostic yield, with the added advantage of being from a sterile site.

* Corresponding author. Mailing address: Department of Paediatrics, Sibu Hospital, Ulu Oya Road, 96000 Sibu, Sarawak, Malaysia. Phone: 6 084 343333. Fax: 6 084 337 354. E-mail: monghow{at}pd.jaring.my

{triangledown} Published ahead of print on 19 April 2007.

Journal of Clinical Microbiology, June 2007, p. 1858-1866, Vol. 45, No. 6
0095-1137/07/$08.00+0     doi:10.1128/JCM.01394-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.



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  • Solomon, T., Hart, I. J, Beeching, N. J (2007). Viral encephalitis: a clinician's guide. PN 7: 288-305 [Abstract] [Full Text]  


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