Clinical characteristics of 16 fatality cases of hand foot and mouth disease caused by enterovirus 71 / 中国小儿急救医学

ABSTRACT

ObjectiveTo explore clinical characteristics of fatality cases of hand foot and mouth disease caused by enterovirus 71 (EV71),and to improve the diagnosis and treatment of the disease.Methods Sixteen children infected with EV71 were retrospectively reviewed.Clinical manifestation,laboratory data and death causes were analyzed.ResultsAll cases were younger than four years,and the mean age was 18.9 months.Seasonal variations in incidence were observed,with a peak in incidence during the summer season.These cases typically presented with a brief duration of febrile illness,nonspecific neurological signs including headache,vomiting,limb tremor and convulsions.After two to four days,they all got sudden deterioration,manifested with tachycardia,poor peripheral perfusion,tachypnea and transient hypertension.After intubation,they all had pink frothy or blood from the endotracheal.Tweleve of them died from pulmonary edema or pulmonary hemorrhage,and acute refractory cardiac dysfunction.The other four of cases died from brain stem encephalitis.Atypical presentation such as absence of skin rash should alert the physician.Total white cell count,blood glucose and cardiac troponin I were raised significantly.The protein raised in cerebrospinal fluid.ConclusionHand foot and mouth disease caused by EV71 progresses rapidly.The primary site of attack is the central nervous system,particularly the brainstem,and the cause of death are neurogenic pulmonary edema and/or hemorrhage,acute refractory cardiac dysfunction.