Background: Coxsackievirus A9 (CA9) was one of the most prevalent serotype of enteroviral infections in Taiwan in\r\n2011. After several patient series were reported in the 1960s and 1970s, few studies have focused on the clinical\r\nmanifestations of CA9 infections. Our study explores and deepens the current understanding of CA9.\r\nMethods: We analyzed the clinical presentations of 100 culture-proven CA9-infected patients in 2011 by reviewing\r\ntheir medical records and depicted the CA9 phylogenetic tree.\r\nResults: Of the 100 patients with culture-proven CA9 infections, the mean (SD) age was 4.6 (3.4) years and the\r\nmale to female ratio was 1.9. For clinical manifestations, 96 patients (96%) had fever and the mean (SD) duration of\r\nfever was 5.9 (3.4) days. Sixty one patients (61%) developed a skin rash, and the predominant pattern was a\r\ngeneralized non-itchy maculopapular rash without vesicular changes. While most patients showed injected throat,\r\noral ulcers were found in only 19 cases (19%), among whom, 6 were diagnosed as herpangina. Complicated cases\r\nincluded: aseptic meningitis (n=8), bronchopneumonia (n=6), acute cerebellitis (n=1), and polio-like syndrome\r\n(n=1). Phylogenetic analysis for current CA9 strains is closest to the CA9 isolate 27-YN-2008 from the border area of\r\nmainland China and Myanmar.\r\nConclusions: The most common feature of CA9 during the 2011 epidemic in Taiwan is generalized febrile\r\nexanthema rather than herpangina or hand, foot, and mouth disease. Given that prolonged fever and some\r\ncomplications are possible, caution should be advised in assessing patients as well as in predicting the clinical\r\ncourse.
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