BRIEF RESEARCH REPORT article
Front. Pediatr.
Sec. Pediatric Infectious Diseases
This article is part of the Research TopicNew Discoveries and Challenges in Pediatric Infectious Diseases: Epidemiological, Clinical, and Pathogenic AdvancesView all 13 articles
Clinical features of poorly distinguishable HFMD and chickenpox in children: A retrospective analysis
Provisionally accepted
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
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Atypical HFMD, which is caused predominantly by enteroviruses (EVs) shares overlapping cutaneous manifestations with varicella, a condition triggered by varicella-zoster virus (VZV) and further complicates diagnosis. This study systematically characterized the clinical features, hematological profiles, and infection patterns (single, mixed and sequential infection) of pediatric patients with poorly distinguishable EV and VZV infection to improve diagnostic accuracy and optimize clinical management strategies. A retrospective analysis was conducted on the cases that were difficult to distinguish and were confirmed by PCR, including demographics, symptoms, hematological profiles, and infection patterns. Among the 85 patients, 33 had a single EV infection and 46 had a single VZV infection, with 4 mixed infections and 2 sequential infections. Compared with patients in VZV group, those in EV group were more often associated with local rashes on the limbs and around the mouth, often accompanied by oral vesicles. In contrast, patients with VZV infection usually exhibited pruritic, widespread skin rashes across the body. Virological testing identified CV-A6 as the dominant EV serotype (51.52%). Hematological profiles revealed increased atypical lymphocytes in patients with VZV infection compared with those with EV infection. Patients with mixed infection maybe correlated with more extensive skin lesions. The clinical differentiation of poorly distinguishable EV and VZV infection presents significant challenges, especially in children with mixed infection or atypical features. In the absence of early virological testing, it is hoped that this study can provide some guidance for the diagnosis of HFMD and chickenpox that are difficult to distinguish or have mixed infection.
Keywords: Hand, Foot and mouth disease, Chickenpox, clinical diagnosis, Children, Coinfection
Received: 16 Sep 2025; Accepted: 25 Nov 2025.
Copyright: © 2025 Duan, Zhang and Yang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Qiuxia Yang
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