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The last of these is hand-foot-and-mouth syndrome, and this is the most distinctive enanthem/exanthem complex. The main etiology is coxsackie A-16 but this has been seen with other enteroviruses but in outbreak circumstances it has mainly been A-16. Or when it’s described to other viruses, they don’t usually have the complete syndrome. Most recently in Hong Kong and Taiwan they had an outbreak with enterovirus 71 and they described cases of hand-foot-and-mouth. The lesions most common on hands and then the feet and buttocks. The peripheral distribution is distinct and occasionally they will go away and then come back. So you will have recurring lesions and sometimes they’ll be chronic with immune defects and sometimes with no apparent immune defects. Chronic reoccurring lesions. This is a classic case of the lesions on the heel of this child and also the buttock. The buttock lesions are usually just maculopapular and not vesicles. This is the tongue of this child’s aunt, which looks like aphthous stomatitis and this is the grandmother of that child with typical lesions on the hands. This is just to show the size of the lesions. The other day I showed you Herpes simplex lesions on the soft palate, and this is almost a 2 cm lesion in the mouth of this particular child.
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Now I’m going to move on to roseola. Roseola and phantom exanthem subitum is a classic pediatric exanthem and about somewhere between 10-30% of children have roseola.It usually will occur in the first two years of life and the illness is fever for 3-5 days. The fever usually falls rapidly and then you have the appearance of the rash. But a lot of physicians just call the first rash they see in a child roseola, which you shouldn’t do. The illness is not seasonal but there have been occasional outbreaks. It has been associated with many different viruses, but recently, relatively recently, herpes virus 6 has been found to be the major cause of this but it’s not the only cause. The Japanese papers on this, the way they did their studies, it was destined to prove this was the cause. So the actual fact is there are multiple etiologies. It seems that this complex of fever and then fever dropping and rash occurring is a host phenomenon relating to multiple different virus antigens, of which the most important is probably herpesvirus 6.
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This is just an example of an outbreak of roseola that occurred in Rochester New York in 1974. This is the outbreak and from a number of these they isolated echovirus 16. So showing you that, at least in outbreak circumstances, enteroviruses may play a role.