Hand, Foot, and Mouth Disease Neurologic Complications: Clinical Features and Parameters
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Purpose: Hand, foot, and mouth disease (HFMD) is a common childhood illness. Enterovirus 71 (EV71) epidemics have recently been associated with HFMD-based neurologic complications in the Asia-Pacific region. This study described HFMD clinical features, and investigated clinical parameters in patients presenting with acute neurologic complications associated with HFMD. Methods: We retrospectively reviewed medical records from 235 hospitalized patients who developed HFMD with or without neurologic complications (22 and 213 cases, respectively) in Uijengbu, Korea between 2010 and 2013. Clinical manifestations, radiologic findings, cerebrospinal fluid (CSF) analyses, virological analyses, and treatment regimens were summarized. Additionally, routinely collected baseline data from 235 patients were retrospectively analyzed to identify clinical parameters associated with neurologic complications. Results: Brainstem encephalitis was the most frequent neurologic complication (11 cases), followed by aseptic meningitis (seven cases). We also found acute disseminated encephalomyelitis and meningitis retention syndrome. Both have rarely been reported in EV71-associated HFMD. Virological analyses were performed for 15 cases, and 14 demonstrated EV71 infection, while one patient demonstrated Coxsackievirus B3 infection. Multivariate logistic regression analysis indicated patients were more likely to develop neurologic complications if they experienced nausea/vomiting (OR= 13.65, P<0.001) and lethargy (OR=10.68, P=0.003). Males were more likely to develop neurologic complications compared to females (OR=2.12, P=0.005). In addition, neurologic complications were associated with a higher peak heart rate (OR=1.13, P=0.001). Conclusion: This study revealed usual and unusual findings of HFMD-associated neurologic complications. Male gender, nausea/vomiting, lethargy, and peak heart rate parameters predicted HFMD-associated neurologic complications. However, laboratory findings did not reliably predict HFMD-associated neurologic complications.
Abstract
Purpose: Hand, foot, and mouth disease (HFMD) is a common childhood illness. Enterovirus 71 (EV71) epidemics have recently been associated with HFMD-based neurologic complications in the Asia-Pacific region. This study described HFMD clinical features, and investigated clinical parameters in patients presenting with acute neurologic complications associated with HFMD. Methods: We retrospectively reviewed medical records from 235 hospitalized patients who developed HFMD with or without neurologic complications (22 and 213 cases, respectively) in Uijengbu, Korea between 2010 and 2013. Clinical manifestations, radiologic findings, cerebrospinal fluid (CSF) analyses, virological analyses, and treatment regimens were summarized. Additionally, routinely collected baseline data from 235 patients were retrospectively analyzed to identify clinical parameters associated with neurologic complications. Results: Brainstem encephalitis was the most frequent neurologic complication (11 cases), followed by aseptic meningitis (seven cases). We also found acute disseminated encephalomyelitis and meningitis retention syndrome. Both have rarely been reported in EV71-associated HFMD. Virological analyses were performed for 15 cases, and 14 demonstrated EV71 infection, while one patient demonstrated Coxsackievirus B3 infection. Multivariate logistic regression analysis indicated patients were more likely to develop neurologic complications if they experienced nausea/vomiting (OR= 13.65, P<0.001) and lethargy (OR=10.68, P=0.003). Males were more likely to develop neurologic complications compared to females (OR=2.12, P=0.005). In addition, neurologic complications were associated with a higher peak heart rate (OR=1.13, P=0.001). Conclusion: This study revealed usual and unusual findings of HFMD-associated neurologic complications. Male gender, nausea/vomiting, lethargy, and peak heart rate parameters predicted HFMD-associated neurologic complications. However, laboratory findings did not reliably predict HFMD-associated neurologic complications.
참고문헌 (22)
- Ooi MH, "Clinical features, diagnosis, and management of Enterovirus 71", Lancet Neurol, 9, pp.1097~1105 (2010)
- Sabanathan S, "Enterovirus 71 related severe hand, foot and mouth disease outbreaks in South-East Asia : current situation and ongoing challenges", J Epidemiol Community Health, 68, pp.500~502 (2014)
- Ishimaru Y, "Outbreaks of hand, foot, and mouth disease by Enterovirus 71. High incidence of complication disorders of central nervous system", Arch Dis Child, 55, pp.583~588 (1980)
- Ooi MH, "Human Enterovirus 71 disease in Sarawak, Malaysia : a prospective clinical, virological, and molecular epidemiological study", Clin Infect Dis, 44, pp.646~656 (2007)
- Ho M, "An epidemic of Enterovirus 71 infection in Taiwan. Taiwan Entererovirus Epidemic Working Group", N Engl J Med, 341, pp.929~935 (1999)
- Yang F, "Enterovirus 71outbreak in the People’s Republic of China in 2008", J Clin Microbiol, 47, pp.2351~2352 (2009)
- Xu J, "EV71 : an emerging infectious disease vaccine target in the Far East?", Vaccine, 28, pp.3516~3521 (2010)
- Lee KY, "Clinico-radiological spectrum in Enterovirus 71 infection involving the central nervous system in children", J Clin Neurosci, 21, pp.416~420 (2014)
- Ryu WS, "Clinical and etiological characteristics of Enterovirus 71-related diseases during a recent 2-year period in Korea", J Clin Microbiol, 48, pp.2490~2494 (2010)
- McMinn P, "Neurological manifestations of Enterovirus 71 infection in children during an outbreak of hand, foot, and mouth disease in Western Australia", Clin Infect Dis, 32, pp.236~242 (2001)
- Ooi MH, "Identification and validation of clinical predictors for the risk of neurological involvement in children with hand, foot, and mouth disease in Sarawak", BMC Infect Dis, 9, pp.3~ (2009)
- Lu HK, "Prognostic implications of myoclonic jerk in children with Enterovirus infection", J Microbiol Immunol Infect, 37, pp.82~87 (2004)
- Huang CC, "Neurologic complications in children with Enterovirus 71 infection", N Engl J Med, 341, pp.936~942 (1999)
- Lian ZY, "Diffusion-weighted imaging in the diagnosis of Enterovirus 71 encephalitis", Acta Radiol, 53, pp.208~213 (2012)
- Tascilar N, "Unusual combination of reversible splenial lesion and meningitisretention syndrome in aseptic meningomyelitis", Clinics, 64, pp.932~937 (2009)
- Sakakibara R, "Meningitis-retention syndrome : a review", Neurourol Urodyn, 32, pp.19~23 (2013)
- Ooi MH, "Evaluation of different clinical sample types in diagnosis of human Enterovirus 71-associated hand-foot-and-mouth disease", J Clin Microbiol, 45, pp.1858~1866 (2007)
- Chung PW, "Duration of Enterovirus shedding in stool", J Microbiol Immunol Infect, 34, pp.167~170 (2001)
- Goto K, "Rhombencephalitis and coxsackievirus A16", Emerg Infect Dis, 15, pp.1689~1691 (2009)
- Yoke-Fun C, "Phylogenetic evidence for inter-typic recombination in the emergence of human Enterovirus 71 subgenotypes", BMC Microbiol, 6, pp.74~ (2006)
- Chang LY, "Clinical features and risk factors of pulmonary oedema after Enterovirus-71-related hand, foot, and mouth disease", Lancet, 354, pp.1682~1686 (1999)
- Chakraborty R, "An epidemic of Enterovirus 71 infection among HIV-1-infected orphans in Nairobi", AIDS, 18, pp.1968~1970 (2004)