In a previous article on a recent outbreak of the mysterious “tomato flu” or “tomato fever” in Kerala, India, we explored how this strange disease might have come about. In September 2022, an article in The Conversation suggested that the mystery was “solved”.  

“Nothing to do with tomatoes” 

An earlier article in The Lancet stated that “tomato flu” was causing alarm in certain regions of India. Tomato flu is so-called because of the tomato-sized blisters appearing on patients’ bodies. The authors acknowledged that it might be a variant of the viral hand, foot, and mouth disease (HFMD), and recent evidence suggests this is true. 

An article published in September indicates that two children returned from a family holiday in Kerala and developed “suspected tomato flu symptoms”. Lab results from swab samples revealed that they were infected with “an enterovirus named coxsackie A16″. 

Coxsackie A16 

Coxsackie A16 causes HFMD, which is not in any way related to the foot and mouth disease suffered by cattle. Occasionally patients present with sores in their mouths, causing difficulty swallowing, causing dehydration in young children. In rare cases the patient can develop viral meningitis. However, the article suggests that symptoms tend to be mild and, as reported in The Lancet it usually passes after time, although pain relief is recommended.  

The article also recommends that parents should keep infected children away from school or nursery because, “like many common childhood infections, it is very contagious”. However, this does not seem to be a cause for concern for Dr Sarah Pitt, author of the report in The Conversation, as she suggests that “viruses have been doing strange things since” the start of the COVID-19 pandemic. She is interested to understand why “the spots looked different enough for the disease to be given a new name”. Her conclusion is that, as fewer than 100 cases have been reported since May, the outbreak is “probably under control”.