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Hand, Foot, and Mouth Disease (Coxsackievirus A16) in Atlanta

James E. Froeschle, MD; Andre J. Nahmias, MD; Paul M. Feorino, PhD; George McCord, MD; Z. Naib, MD
Am J Dis Child. 1967;114(3):278-283. doi:10.1001/archpedi.1967.02090240092006.
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IN 19581 Robinson and his co-workers reported an outbreak of epidemic disease in Toronto characterized by stomatitis, a maculopapular rash, and vesicles on the hands and feet associated with coxsackievirus A16 infection. Since that time, there have been additional reports of similar cases in England, Australia, and the United States.2-11 This disease has been termed hand, foot, and mouth syndrome (HFM) and primarily affects children.

During the summer of 1964, over 40 children with a similar syndrome were observed in Atlanta. This report presents clinical, virologic, serologic, and epidemiologic features on 30 of these patients and cytological studies on five. The occasional difficulty of clinically differentiating HFM from herpes simplex virus infection is emphasized. The new finding of intracytoplasmic inclusions in vesicular scrapings is described. Finally, evidence for asymptomatic infection with coxsackievirus A16 in contacts of the patients is presented and the association of this virus with other


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