Seroprevalence and B1 gene Phylogeny of Toxoplasma gondii of Dogs and Cats in Republic of Korea

The outbreak of human toxoplasmosis can be attributed to ingestion of food contaminated with Toxoplasma gondii. Toxoplasmosis recently increased in domestic and stray dogs and cats. It prompted studies on the zoonotic infectious diseases transmitted via these animals. Sero- and antigen prevalences of T. gondii in dogs and cats were surveyed using ELISA and PCR, and B1 gene phylogeny was analyzed in this study. Toxoplasmosis antibodies were measured on sera of 403 stray cats, 947 stray dogs, 909 domestic cats, and 2,412 domestic dogs collected at nationwide regions, Korea from 2017 to 2019. In addition, whole blood, feces, and tissue samples were also collected from stray cats (1,392), stray dogs (686), domestic cats (3,040), and domestic dogs (1,974), and T. gondii-specific B1 gene PCR was performed. Antibody prevalence of stray cats, stray dogs, domestic cats, and domestic dogs were 14.1%, 5.6%, 2.3%, and 0.04%, respectively. Antigen prevalence of these animals was 0.5%, 0.2%, 0.1%, and 0.4%, respectively. Stray cats revealed the highest infection rate of toxoplasmosis, followed by stray dogs, domestic cats, and domestic dogs. B1 gene positives were 5 of stray cats, and identified to high/moderate pathogenic Type I/III group. These findings enforce that preventive hygienic measure should be strengthened at One Health level in dogs and cats, domestic and stray, to minimize human toxoplasmosis infections.

Identification of Cystoisospora ohioensis in a Diarrheal Dog in Korea

A 3-month-old female Maltese puppy was hospitalized with persistent diarrhea in a local veterinary clinic. Blood chemistry and hematology profile were analyzed and fecal smear was examined. Diarrheal stools were examined in a diagnostic laboratory, using multiplex real-time polymerase chain reaction (PCR) against 23 diarrheal pathogens. Sequence analysis was performed using nested PCR amplicon of 18S ribosomal RNA. Coccidian oocysts were identified in the fecal smear. Although multiplex real-time PCR was positive for Cyclospora cayetanensis, the final diagnosis was Cystoisospora ohioensis infection, confirmed by phylogenetic analysis of 18S rRNA. To our knowledge, this the first case report of C. ohioensis in Korea, using microscopic examination and phylogenetic analysis.

Detection of Rotavirus Genotypes in Korea 5 Years after the Introduction of Rotavirus Vaccines

Rotavirus (RV) is one of the most important viral etiologic agents of acute gastroenteritis (AGE) in children. Although effective RV vaccines (RVVs) are now used worldwide, novel genotypes and outbreaks resulting from rare genotype combinations have emerged. This study documented RV genotypes in a Korean population of children with AGE 5 yr after the introduction of RVV and assessed potential genotype differences based on vaccination status or vaccine type. Children less than 5-yr-old diagnosed with AGE between October 2012 and September 2013 admitted to 9 medical institutions from 8 provinces in Korea were prospectively enrolled. Stool samples were tested for RV by enzyme immunoassay and genotyped by multiplex reverse-transcription polymerase chain reaction. In 346 patients, 114 (32.9%) were RV-positive. Among them, 87 (76.3%) patients were infected with RV alone. Eighty-six of 114 RV-positive stool samples were successfully genotyped, and their combinations of genotypes were G1P[8] (36, 41.9%), G2P[4] (12, 14.0%), and G3P[8] (6, 7.0%). RV was detected in 27.8% of patients in the vaccinated group and 39.8% in the unvaccinated group (P=0.035). Vaccination history was available for 67 of 86 cases with successfully genotyped RV-positive stool samples; RotaTeq (20, 29.9%), Rotarix (7, 10.4%), unvaccinated (40, 59.7%). The incidence of RV AGE is lower in the RV-vaccinated group compared to the unvaccinated group with no evidence of substitution with unusual genotype combinations.

Comparison among Known Severity Scoring Scales in the Evaluation of Acute Gastroenteritis in Children / 소아감염

PURPOSE: This study aimed to evaluate the disease severity of children suffering from gastroenteritis using different scales. The results are compared and subsequently classified on the basis of the type of virus causing the disease in order to investigate the differences in clinical characteristics and disease severity according to pathogen. METHOD: This study was conducted prospectively with patients under 5 years of age diagnosed with acute gastroenteritis and hospitalized at 9 medical institutions in 8 regions across the Republic of Korea. Disease severity was evaluated using the Vesikari Scale, the Clark Scale, and the modified Flores Scale. Fecal samples collected from patients were used to detect rotavirus and enteric adenovirus by enzyme immunoassay, and for RT-PCR of norovirus, astrovirus, and sapovirus. RESULTS: There were a total of 214 patients with a male : female ratio of 1.58 : 1, of which 35 were under the age of 6 months (16.4%), 105 were aged 6-23 months (49.1%), and 74 were aged 24-59 months (34.5%). The rate of concordance between the Vesikari and Clark Scales was 0.521 (P<0.001) and, in severe cases, the Vesikari Scale was 60.7% and Clark Scale was 2.3%, indicating that the Clark Scale was stricter in the evaluation of severe cases. CONCLUSIONS: In children with gastroenteritis, there were differences in disease severity based on the scale used. Therefore, to achieve consistent results among researchers, either only a single scale or a measure of all scales should be used to determine disease severity.

Epidemiology and Clinical Characteristics of Enterovirus Infections in Children: A Single Center Analysis from 2006 to 2010 / 소아감염

PURPOSE: This study was performed to investigate the epidemiology of enterovirus (EV) infections in children at a secondary hospital during recent 5 years. METHODS: We collected the cerebrospinal fluid, stool and throat swab samples from the pediatric patients with suspected EV infections in KEPCO Medical Center, Seoul, Korea from July 2006 to September 2010. EV detection and genotype identification were performed by RT-PCR at Korea Centers for Disease Control and Prevention. RESULTS: A total of 386 samples were collected from 277 patients during study period. Ninety-eight patients (35.4%) were diagnosed with EV infections. The RT-PCR positive rate was the highest in throat swab samples (48.3%). The median age of patient was 4.7 years (range, 0.1-12.5 years). Aseptic meningitis (50, 51.0%) was the most common clinical manifestation; herpangina (22, 22.4%) and hand-foot-mouth disease (18, 18.4%). One hundred EVs were isolated from 98 patients and 20 genotypes of EV were identified; Echovirus 30 (28 cases, 28%), Enterovirus 71 (12 cases, 12%), Echovirus 25 (10 cases, 10%), Echovirus 9 (9 cases, 9%) and Coxsackievirus A6 (8 cases, 8%). Aseptic meningitis caused by Echovirus 30 was the most common manifestation in 2008. There was no complicated case caused by Enterovirus 71. CONCLUSION: This study showed the epidemiology of confirmed EV infection in children from 2006 to 2010. There is a need for continuous surveillance of EV infections and its clinical manifestations.

Risk Factors for Neurologic Complications of Hand, Foot and Mouth Disease in the Republic of Korea, 2009

In 2009, the first outbreak of hand, foot and mouth disease (HFMD) or herpangina (HP) caused by enterovirus 71 occurred in the Republic of Korea. This study inquired into risk factors associated with complications of HFMD or HP. A retrospective medical records review was conducted on HFMD or HP patients for whom etiologic viruses had been verified in 2009. One hundred sixty-eight patients were examined for this investigation. Eighty patients were without complications while 88 were accompanied by complications, and 2 had expired. Enterovirus 71 subgenotype C4a was the most prevalent in number with 67 cases (54.9%). In the univariate analysis, the disease patterns of HFMD rather than HP, fever longer than 4 days, peak body temperature over 39degrees C, vomiting, headache, neurologic signs, serum glucose over 100 mg/dL, and having an enterovirus 71 as a causative virus were significant risk factors of the complications. After multiple logistic analysis, headache (Odds ratio [OR], 10.75; P < 0.001) and neurologic signs (OR, 42.76; P < 0.001) were found to be the most significant factors. Early detection and proper management of patients with aforementioned risk factors would be necessary in order to attain a better clinical outcome.

Epidemiology of astrovirus infection in children / 소아과

Human astrovirus (HAstV) is a major cause of acute diarrhea among children, resulting in outbreaks of diarrhea and occasionally hospitalization. Improved surveillance and application of sensitive molecular diagnostics have further defined the impact of HAstV infections in children. These studies have shown that HAstV infections are clinically milder (diarrhea, vomiting, fever) than infections with other enteric agents. Among the 8 serotypes of HAstV identified, serotype 1 is the predominant strain worldwide. In addition to serotype 1, the detection rate of HAstV types 2 to 8 has increased by using newly developed assays. HAstV is less common compared with other major gastroenteritis viruses, including norovirus and rotavirus; however, it is a potentially important viral etiological agent with a significant role in acute gastroenteritis. A better understanding of the molecular epidemiology and characteristics of HAstV strains may be valuable to develop specific prevention strategies.

Epidemiology of astrovirus infection in children / 소아과

Human astrovirus (HAstV) is a major cause of acute diarrhea among children, resulting in outbreaks of diarrhea and occasionally hospitalization. Improved surveillance and application of sensitive molecular diagnostics have further defined the impact of HAstV infections in children. These studies have shown that HAstV infections are clinically milder (diarrhea, vomiting, fever) than infections with other enteric agents. Among the 8 serotypes of HAstV identified, serotype 1 is the predominant strain worldwide. In addition to serotype 1, the detection rate of HAstV types 2 to 8 has increased by using newly developed assays. HAstV is less common compared with other major gastroenteritis viruses, including norovirus and rotavirus; however, it is a potentially important viral etiological agent with a significant role in acute gastroenteritis. A better understanding of the molecular epidemiology and characteristics of HAstV strains may be valuable to develop specific prevention strategies.

Clinical Manifestations of Norovirus Infection in Korean Pediatric Cancer Patients / 소아감염

PURPOSE: Norovirus infection, a common cause of community-acquired gastroenteritis, can also lead to severe illness in immunocompromised patients. We investigated clinical manifestations of norovirus infection in pediatric cancer patients. METHODS: Stool specimens were collected from pediatric patients with gastrointestinal symptoms between November 2008 and September 2009 at Samsung Medical Center, Seoul, Korea. Norovirus infection was identified by reverse-transcription polymerase chain reaction (RT-PCR). A retrospective chart review was performed in pediatric cancer patients who were diagnosed with norovirus infection. RESULTS: Ten patients were diagnosed with norovirus infection by RT-PCR in stool samples. The median age was 0.83 years (range 0.25-5.5 years) and the male to female ratio was 1.5:1 (6 males and 4 females). Underlying diseases were hematologic malignancies (4/10, 40%), neuroblastoma (4/10, 40%), and brain tumors (2/10, 20%). Three patients were infected before hematopoietic cell transplantation (HCT) and four patients after HCT. All patients had diarrhea (10/10, 100%), with a median frequency of diarrhea of 8.5 times/day (range 4-22 times/day). Median virus shedding duration was 72.5 days (range 19-299 days). Four patients with pneumatosis intestinalis were conservatively treated with bowel rest and total parenteral nutrition. One patient with severe diarrhea and bloody stool had concomitant chronic gut graft-versus-host disease (GVHD). Norovirus infection-related mortality was not observed. CONCLUSION: Norovirus infection can cause significant clinical manifestations with prolonged viral shedding in immunocom-promised patients. Norovirus should be considered in pediatric cancer patients with severe gastrointestinal symptoms.

Antibody Production of Baculovirus-expressed VP6 from Porcine Group C Rotavirus

The emerging pathogen, group C rotavirus (RVC) has been reported to cause acute diarrhea. But there was the limitation on the detection and monitoring for the absence of rapid sensitive diagnosis system. For the molecular biology study and diagnostic system development, we could detect porcine RVC by reverse transcriptase PCR (RT-PCR) analyses from 60 diarrheal disease porcine stool samples. VP6 full length RT-PCR product (CA-2 RVC, 1352 bp) was cloned and compared the nucleotide and deduced amino acid sequences with those of previously reported other porcine, human, and bovine rotavirus group A, B and C strains. Analyses data showed >82% homology on the nucleotide sequences and >90% homology on the deduced amino acid sequences with other RVCs. Recombinant baculovirus was prepared with cloned PCR product corresponding to VP6 coding sequence (CDS) (position 22~1206) into BaculoDirect(TM) C-term linear DNA, and used for the transfection of insect cells. The polyclonal antibody was produced from mice with purified recombinant VP6 and confirmed with western blot. Both of VP6 antigen and antibody, are useful for the development of rapid diagnostic system against RVC.

Enterovirus 71-associated hand, foot and mouth diseases with neurologic symptoms, a university hospital experience in Korea, 2009 / 소아과

PURPOSE: Hand-foot-mouth disease (HFMD) is a common viral illness in children, which is usually mild and self-limiting. However, in recent epidemics of HFMD in Asia, enterovirus 71 (EV71) has been recognized as a causative agent with severe neurological symptoms with or without cardiopulmonary involvement. HFMD was epidemic in Korea in the spring of 2009. Severe cases with complications including death have been reported. The clinical characteristics in children with neurologic manifestations of EV71 were studied in Ewha Womans University Mokdong Hospital. METHODS: Examinations for EV71 were performed from the stools, respiratory secretion or CSF of children who presented neurologic symptoms associated with HFMD by realtime PCR. Clinical and radiologic data of the patients were collected and analyzed. RESULTS: EV71 was isolated from the stool of 16 patients but not from respiratory secretion or CSF. Among the 16 patients, meningitis (n=10) was the most common manifestation, followed by Guillain-Barre syndrome (n=3), meningoencephalitis (n=2), poliomyelitis-like paralytic disease (n=1), and myoclonus (n=1). Gene analysis showed that most of them were caused by EV71 subgenotype C4a, which was prevalent in China in 2008. CONCLUSION: Because EV71 causes severe complications and death in children, a surveillance system to predict upcoming outbreaks should be established and maintained and adequate public health measures are needed to control disease.

Genetic Diversity of Echovirus 6 Strains Circulating in Korea

Echovirus 6 (ECV6) is the prevalent serotype detected in aseptic meningitis cases in Korea. To analyze the genetic variation of ECV6 isolates recently circulating in Korea, we determined the partial sequence of the VP1 capsid gene from 22 Korean ECV6 isolates and performed pairwise analysis against 42 reference strains from the GenBank database using MegAlign. The 22 Korean ECV6 isolates formed 3 distinct genetic clusters: Kor-lineage I, II, and III. The Korean ECV6 strains showed significant genetic diversity with 14.8~22.8% nucleotide divergence among the 3 different lineages. These ECV6 Kor-lineages were demonstrated to belong to different genetic clusters using VP1 sequence-based phylogenetic analysis, implying that the recently circulating Korean ECV6 strains have potential antigenic variation.

Application of a Diagnostic Method Using Reverse Transcription-PCR ELISA for the Diagnosis of Enteroviral Infections / 대한진단검사의학회지

BACKGROUND: Enteroviruses are known as major pathogen for aseptic meningitis. Although rapid diagnosis for enteroviruses is very essential to exclude bacterial infections in patients with meningitis, classical diagnostic method based on virus isolation is not practicable for timely treatment of patients due to its laborious and time-consuming procedure. Recently molecular methodologies as alternatives are routinely used for rapid and sensitive diagnosis for enteroviruses infections. METHODS: Reverse transcription (RT)-PCR ELISA kit for targeting 5'non-coding region (NCR) with highly conserved genetic identity among all genotypes of enteroviruses was introduced in this investigation. RT-PCR ELISA was evaluated about sensitivity and specificity through virus isolation using clinical specimens from patients suspected of enteroviral infections and enteroviral isolates comparing with conventional RT-PCR identifying them. RESULTS: The detection limit of the RT-PCR ELISA was up to 10-100 folds higher than virus isolation using cell culture and conventional RT-PCR. On comparison between above two methods, the detection rate of RT-PCR ELISA for clinical specimens from patients with aseptic meningitis was 7% higher than that of conventional RT-PCR targeting 5'NCR (P=0.016). CONCLUSIONS: Our results suggest that RT-PCR ELISA developed in this study could be an alternative diagnostic method for the detection of enteroviral genome with high sensitivity and specificity.

Distribution of Group A Rotavirus Genotypes Circulating in Gwangju, Korea

To determine the distribution of rotavirus strain genotypes in Gwangju, Korea, we performed reverse-transcription polymerase chain reaction and nucleotide sequencing analysis using the 115 rotavirus EIA positive stool specimens collected from December 2006 through April 2007. The most predominant genotype was confirmed as G1P[8] (53.9%), followed by G3P[8] (29.6%), G4P[6] (8.7%), G2P[4] (4.3%) and G9P[8] (1.7%). A special attention is drawn to the unusual findings of the genotypes G11P[25] and G12P[9] during this study period. In order to investigate the phylogenetic relationships among the same or different genotypes, the nucleotide sequences of rotavirus circulating in Korea and the foreign countries were analyzed using MegAlign and Clustal X programme. The G11P[25] strain identified in this study showed the highest nucleic acid similarity with G11 /CUK1 /2006 /Korea (99.2%) and P[25] /Dhaka /2001 /BGD (98.7%). Meanwhile, the G12P[9] strain detected in this study shared 99.4~99.5% nucleotide homology with the reference strain G12P[9] /CP1030 /2004 /Japan. This incidence of new rotavirus genotypes in our area illustrates the large diversity of rotavirus strains found worldwide. Therefore, the epidemiological surveillance of rotavirus may need to be continued in a wide geographic area.

Hand-Foot-Mouth Disease Related to Enterovirus 71

Hand-foot-mouth disease (HFMD), one of the more distinctive rash syndromes, is most frequently caused by coxsackievirus A16, but can also be caused by enterovirus 71 (EV71) and other coxsackieviruses. Recently, there have been large outbreaks of simple, neurologically complicated and even fatal HFMD caused by EV71 in Western Pacific Area. However, in the Republic of Korea, despite its location in EV71 endemic Western Pacific Area, published reports on HFMD with EV71 are rare and there are no published reports on fatal cases. After the first fatal case of HFMD caused by EV71 announced in May 2009, much more cases of neurologically complicated HFMD have been announced. Even now, physician's increased awareness about the seriousness of HFMD, viral surveillance and early warning system of HFMD, and early detection and proper management of potentially life threatening HFMD caused by EV71 are required in the Republic of Korea, as in the neighboring countries.

Molecular Epidemiologic Investigation of Norovirus Infections in Incheon City, Korea, from 2005 to 2007

Noroviruses (NoVs) cause major epidemic gastroenteritis in humans. To obtain the molecular epidemiological information on gastroenteritis sporadic cases in Incheon city, Korea, we analyzed the nucleotide sequences of NoV strains detected during 2005~2007. We performed one step RT-PCR amplifying the open reading frame (ORF) 2 (capsid region) followed by semi-nested PCR from the stool samples from acute gastroenteritis patients from 2005 to 2007. Amplicons of the capsid region of norovirus strains were sequenced and analyzed using MegAlign in DNAstar software. Faecal samples were collected from 6,618 acute gastroenteritis patients during the study period. The incidence of NoV infection was about 10.7% (n=708) among patients with acute gastroenteritis and genotypes of the 320 positive samples were determined by sequence analysis. Sequence comparison of NoV strains revealed that 16 genotypes of GII NoV strains were circulated in Incheon city, from 2005 to 2007. Among norovirus strains, the most prevalent genotype GII/4 was most common 69.7% (223 strains), followed by GII/3 17.2% (55 strains), GII/12 4.4% (14 strains), GII/1 2.2% (7 strains), GII/5 1.6% (5 strains), GII/15 1.3% (4 strains) and 0.6% (2 strains) each of GII/9 and GII/16. The GII-3 strains were most frequently detected in Incheon, 2005. From the phylogenetic analysis of NoV strains, we detected 16 genotypes of GII NoV strains during 2005~2007 in Incheon. Our results suggest that various genotypes of human NoV strains in sporadic case of AGE were circulated in Incheon, Korea.

Isolation and Characterization of G9 Human Rotaviruses

Group A rotaviruses are the most common causes of gastroenteritis among infants and young children. The outer capsid layer of the virus is composed of two structural proteins, VP4 and VP7, and they play important roles in protection by eliciting neutralization antibodies. Group A rotaviruses are subdivided into distinct G and P serotypes according to the antigenic differences of the VP7 and VP4, respectively. Rotavirus G9 serotype was thought to be the fifth most common serotype circulating among the population worldwide. In this study, G9 human rotaviruses (HRV) were isolated from fecal samples using MA104 cells and characterized. Characteristic cytopathic effects of rotavirus were observed and rotaviral antigens were confirmed by indirect immunofluorescence antibody test in MA104 cells inoculated with isolated HRV strains. The nucleotide sequences of the VP7 gene of Korean G9 HRV isolated in this study were determined and compared with those of other recent and prototype G9 rotavirus strains from other parts of the world. Also, the nucleotide sequences of VP4 and NSP4 gene of Korean G9 HRV were determined and compared with those of other rotavirus strains from other countries. The results showed that the Korean HRV isolates belong to a G9, P[8] and NSP4 B genotype. The Korean G9 HRV isolates and their nucleotide sequence data would be usefully applied for the vaccine development of HRV in the near future.

Epidemiological Surveillance of P and G Genotypes of Group A Rotavirus Detected from Diarrheic Patients in Daejeon Region

During 3 years surveillance (January 2001 through December 2003) for acute gastroenteritis in human in Daejeon region, 432 out of 4,869 stool samples were selected as rotavirus-positive specimens by means of antigen-capture enzyme-linked immunosorbent assay (ELISA). The P (VP4) and G (VP7) genotypes for 432 stool samples were investigated by reverse transcription polymerase chain reaction (RT-PCR) and nested multiplex PCR. The most prevalent P subtype was P[8] (44.9%), followed by P[4] (25.7%) and P[6] (17.1%). No cases for P[10] and P[9] subtypes were found through the study. In G subtyping, G1 (53.2%) was the most frequently found G type, followed by G2 (23.1%), G3 (9.5%), G4 (6.7%), and G9 (0.9%). The order of detection rates for G2, G3 and G4 was variable by years. The most common G- and P- type combination found in this study was G1P[8] (33.1%), followed by G2P[4] (20.4%), G1P[6] (10.0%), G3P[8] (7.2%) and G4P[6] (4.2%). The mixed types of G and P were observed most frequently in P[8] (1.4%) and G1 (3.2%), respectively. This is the first molecular epidemiological study for Group A rotavirus in Daejeon region. The results might be useful data for evaluating the epidemiological status of rotaviral diarrhea in the region.

The Prevalence and Genotypic Distribution of Group A Rotavirus Detected from Patients with Acute Gastroenteritis Patients in Incheon

This study has focused on genetical patterns of rotavirus positives on diarrhea patients in Incheon. Fecal specimens collected from January 2002 to December 2004 from patients with diarrhea in seven localities in Incheon were screened for group A rotavirus by RT-PCR. To survey the prevalence of group A rotavirus infection and distribution of P (VP4) and G (VP7) genotypes of rotaviruses in Incheon, we performed the nested RT-PCR using rotavirus ELISA positive samples. Among a total of 4,865 samples investigated, 1,100 samples (22.6%) were positive. The predominant genotypes of 293 RT-PCR positive samples were confirmed as G4P[6] (101 samples, 34.5%) followed by G2P[4] (73 samples, 24.9%), G1P[8] (38 samples, 13.0%), G3P[8] (28 samples, 9.6%), G3P[10] (14 samples, 4.8%), G4P[8] (6 samples, 2.0%) and G9P[8] (6 samples, 2.0%). Mixed types and untypable types were 3.8% and 5.1%, respectively. The most prevalent types in 2002, 2003 and 2004 were G4P[6] (71 samples, 40.3%), G4P[6] (22 samples, 40.7%) and G2P[4] (15 samples, 22.2%) respectively. This is the first nationwide genoepidemiological study for determining the prevailing of genotypes of rotaviruses in Incheon. The genetic analysis for investigating sequence variations among group A rotavirus strains in this study would provide the useful information to establish the preventing strategy of human rotaviruses and of developing vaccines which will be used in Korea.

A Case of Polio-like Encephalomyelitis Associated with Enterovirus 71 Infection

Enterovirus 71(EV71), like polioviruses, invades the central nervous system to give rise to aseptic meningitis, encephalitis or myelitis. EV71 was first isolated in California in 1969 from a 9-month- old infant with encephalitis. Since then it has been isolated from the brain of children who died of encephalitis and from feces of patients with meningitis, encephalitis or paralysis. Related strains have been isolated from outbreaks of similar diseases in Australia, Sweden, Bulgaria and Hungary. We have experienced polio-like encephalomyelitis in a 3-month-old girl. Initial brain MR imaging showed tissue destruction in the bilateral posterior portions of the medulla oblongata and the bilateral anterior horns of cervical spinal cord from C3 to C6 level. Follow-up MR imaging was performed 3 months later, which showed minimal residual change on the anterior horn of the cervical spinal cord at C4 level only. This report deals with rare polio-like encephalomyelitis associated with EV71 and discusses its diagnosis and management. Brain stem and cervical spinal cord involvement are characteristic findings of EV encephalomyelitis.