Etiology and clinical characteristics of 26 critically ill children with severe hand foot and mouth disease in Shanxi province / 中国小儿急救医学

ABSTRACT

Objective To analyse the etiology and clinical characteristics of 26 critically ill children with severe hand foot and mouth disease (HFMD) of Shanxi province in 2010.Methods We retrospectively analysed the clinical data of 26 children with severe HFMD from Mar to Sep 2010.Nucleic acid of enterovirus 71 ( EV71 ) and Coxsackie virus A 16 ( CoxA16) were detected in 20 out of 26 children with HFMD by reversed real time polymerase chain reaction (rRT-PCR),and the whole VP1 gene of EV71 deriving from 6 different areas of Shanxi province was amplified,sequenced,and compared with strains from other areas in china.Results EV71 nucleic acid were positive in 18 out of 20 children,while the other two were negative for EV71 and CoxAl6.Among all the critical cases,20 cases (76.9％) occurred in Weinan area,four in Xianyang area,and two in Xi'an urban area.Compared with those of Fuyang Anhui,Hong Kong China,Guangzhou,Shenzhen,Shandong,Beijing,the homology of the whole VP1 gene sequence from 6 strains of Shanxi area was 96％ ～ 100％.Most of the critical children were under 3-year-old,and the incidence rate of male children was higher than that of female children.All affected children had persisted fever,poor energy,hyperarousal,hypersomnia,and limb shaking.Meanwhile their peripheral blood leukocytes,C-reactive protein and blood glucose were markedly increased,but renal injuries were rare.Eighteen children clinically recovered on discharge,among which 2 cases had sequelae of limb activity obstacle,and 8 cases died.Conclusion Weinan is the area with the highest incidence rate of critical HFMD cases in Shanxi Province,and the major etiological organism is EV71,which is highly homologous to EV71 found in other regions of mainland China.As many cases are in dangerous condition,thus early identification and intervention could inhibit the disease progression,and play a key role in reducing the mortality.