ABSTRACT
Objective ToexploretheclinicalmanifestationsandMRIfeaturesofnervoussystemdiseasecomplicationsinpediatric EV71relatedhand-foot-mouthdisease(HFMD).Methods Theclinicaldataof17EV71relatedHFMDpatientswithnervoussystemdisease wereanalyzedretrospectively.Results 4patientswerediagnosedwith meningitisandthebrain MRIshowedasymmetricunilateral ventricularenlargement.9patientswerediagnosedwithbrainstemencephalitis,amongwhich8patientsshowedthecraniocerebral MRIfeaturesthatthelesionswerelocatedonthedorsalsideofthepontomedullaryjunction,andtheT2imageshowedahighsignal withasymmetrycharacteristic.1caseofbrain MRIdisplayedthatthelesionwaslocatedinthemidbrain,andT2imagewasahigh signalwithsymmetricalfeatures.4patientswerediagnosed withacuteflaccidparalysis.1casehadbrainstem encephalitis,andthe brain MRIshowedthatthelesion waslocatedonthedorsalsideofthepontomedullaryjunction,andthe MRIofthespinalcord showedthelesionintheC1-C7segment.1caseofspinalcordMRIshowedthatthelesionwaslocatedatT2-L1segment,1caseof spinalMRIshowedthelesionlocatedinT8-T12segment;1caseofspinalcord MRIshowedthatthelesionwaslocatedatT9-L1 segment,andsagittalT2 wasahighsignal,andthelesionconcentratedintheanteriorhornofthespinalcordand (or)theanterior rootofthespinalnerve.Byfollow-up,patientswithmeningitishadagoodprognosisandwithoutneurologicalsequelae.Thelesionsof brainstemencephalitiswerebasicallyabsorbedanddisappeared,theprognosiswasgood.Fortheacuteparalysis,theaffectedlimbs recoveredtovaryingdegrees,andthelesionswereabsorbedpartially.Conclusion HFMDpatientsclinicalmanifestationsand MRI characteristicsofconcurrentnervoussystemdiseasewerediversity.Whenthenervoussystemsymptomshappened,weshouldactively performtheMRIexaminationtoidentifytheinflammatoryinvasionarea.Onceinvolvingthebrainstemandspinalcord,highalert, earlyrecognitionandtimelyinterventionarekeytoreducethemorbidityandmortalityofacuteHFMD,toenableHFMDtobeoptimizedand comprehensivelytreated.
ABSTRACT
Objective To investigate the clinical efficacy and safety of Ganciclovir combined with interferon-α1 b inhalation for children with infectious mononucleosis(IM).Methods A total of 177 childhood cases of IM were selected,and they were divided into 3 groups,59 cases in each group according to the random number table.Three therapeutic methods were applied in different groups for 5-7 days in different groups:Ganciclovir (group A),Ganciclovir + interferon-α1 b inhalation (group B) and Ganciclovir + interferon-α1b intramuscularly (group C).The time of post-drug recovery from isthmitis,less than 0.05 of heterotypic lymphocytes,shrink of cervical lymph nodes shrink,liver retraction,spleen retraction among groups were compared.The Epstein-Barr virus (EBV)-DNA copy number and T lymphocyte subsets were compared before and after treatment.Adverse reactions were observed in each group.Results Compared with group A,the time to defervescence [(3.20 ± 1.81) d,(3.17 ± 1.76) d vs.(4.01 ± 2.34) d],duration of isthmitis was [(3.15 ± 1.33) d,(3.09 ± 1.37) d vs.(3.98 ± 1.31) d],and the time of heterotypic lymphocytes less than 0.05 [(3.12 ± 1.55) d,(3.10 ± 1.33) d vs.(3.95 ± 1.26) d] in group B and group C,were obvious shorter,and there were significant differences(F =4.150,4.580,4.060,all P ＜ 0.05).EBV-DNA negative conversion rate of group B and group C were higher than that of group A [53 cases(89.8％),52 cases (88.1％) vs.41 cases (69.5％),x2 =10.403,P ＜ 0.05],and the cellular immune function was improved significantly than that of group A after treatment for 7 days [CD3 +:(63.00 ±4.39)％,(62.75 ±4.84)％ vs.(68.70 ± 7.70)％;CD4+:34.08(30.21,41.70)％,33.94(29.17,45.17)％ vs.32.34(28.16,43.53)％;CD8+:30.59 (27.14,40.22)％,30.09(27.54,40.48)％ vs.32.57(28.68,41.17)％;CD4+/CD8+:1.12(1.03,1.31),1.11 (0.99,1.64) vs.0.94 (0.87,1.59),F/x2 =11.020,1.217,1.121,6.728,all P ＜ 0.05].The differences in indexes between B group and C group were not significant,and there was no statistical significance (all P ＞ 0.05).There were 2 cases with fever in the group C,and 2 cases of granulocytopenia in all group.Conclusions Ganciclovir combined with interferon-α1 b inhalation or intramuscular injection is effective and safe in treating children with IM.It can improve clinical symptoms,cellular immune function and EBV-DNA negative conversion rate.Since inhalation is of less side effects and no pain,it can be accepted by children and their parents easily.Therefore,it is recommended that Ganciclovir be used together with interferon-α1 b inhalation in the treatment of children with IM.