Clinical profile and virology analysis of hand, foot and mouth disease cases from North Kerala, India in 2015-2016: A tertiary care hospital-based cross-sectional study

{Table 2}{Table 3}{Figure 1} Thirty eight patients (63.3%) had features of atypical hand, foot and mouth disease [Table 1], [Table 2], [Table 3] and [Figure 2]a and [Figure 2]b.{Figure 2} Detailed workup including polymerase chain reaction-based study of cerebrospinal fluid for viral infection was within normal limits in two patients who developed seizures, and febrile seizure was diagnosed in the above cases. [1],[4],[12],[13],[14],[15] Though recurrence of hand, foot and mouth disease in the same season is reported earlier (attributed to infection with a different strain formed by genetic recombination), we cannot comment whether the three patients who gave history of previous hand, foot and mouth disease in our study suffered from same virus infection or not because the earlier diagnosis in these cases was not confirmed by virology workup. [17] Nearly one-third of the clinically suspected cases testing polymerase chain reaction negative for pan enterovirus could be due to delay in sample collection, inadequate material for virology workup, the failure to maintain the cold chain during viral transport and inability to detect a new or uncommon enterovirus RNA by the assay. [...]absence of rash in hands, feet and mouth at the time of presentation does not rule out hand, foot and mouth disease.