Etiological and clinical characteristics of severe hand,foot and mouth disease in Xi'an in 2018 / 中华实用儿科临床杂志

ABSTRACT

Objective To understand the etiological and clinical characteristics of children with severe hand,foot and mouth disease (HFMD) in Xi'an in 2018,and to provide the evidence for clinical diagnosis and treatment.Methods The children with severe HFMD admitted at Xi'an Children's Hospital from January to December 2018 were selected as the research objects.Clinical data were collected,and the anal swab were detected by adopting real time (RT)-polymerase chain reaction(PCR).Results Ninety-five cases of HFMD were treated in Xi'an Children's Hospital in 2018,of which 92 cases were severe and 3 cases were critical.Eighty-seven cases were positive for enterovirus nucleic acid,30 cases were enterovirus 71 (EV71) (31.6％),39 cases were coxsackievirus A6 (CA6) (41.0％),3 cases were CA16 (3.2 ％),2 cases were CA 10 (2.1％) and 13 cases were other enteroviruses (13.7 ％).Among 95 patients,the ratio of male to female was 1.1 ∶ 1.0;the peak period of incidence of HFMD was from May to July,and the main age of onset of severe HFMD was under 3 years old.The main clinical manifestations were mental retardation,vomiting,irritability,lethargy and convulsion.Severe cases of CA6 are prone to convulsion.The main form of rash in CA6 cases was bullous rash,and demethylation may occur in recovery period.The rash in EV71 cases was small,thick,hard and few.After active treatment,only one child with EV71 infection died because of severe cerebral dysfunction,frequent convulsions and neurogenic pulmonary edema.The other child was discharged with hemiplegia and language dysfunction.The other severe children were cured and discharged from hospital.Conclusions In 2018,CA6 was the main pathogen of severe HFMD in Xi'an,with bullae was the main manifestation of skin rash,and nail removal could occur during convalescence.Critical and death cases were still caused by EV71.