Hand, Foot, and Mouth Disease Neurologic Complications: Clinical Features and Parameters / 대한소아신경학회지

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.