Diagnosis and treatment of herpangina: Chinese expert consensus.

BACKGROUND: Herpangina is a common infectious disease in childhood caused by an enterovirus. This consensus is aiming to standardize and improve herpangina prevention and clinical diagnosis. METHODS: The Subspecialty Group of Infectious Diseases, the Society of Pediatric, Chinese Medical Association and Nation Medical Quality Control Center for Infectious Diseases gathered 20 experts to develop the consensus, who are specialized in diagnosis and treatment of herpangina. RESULTS: The main pathogenic serotypes of herpangina include Coxsackievirus-A, Enterovirus-A and Echovirus. Its diagnosis can be rendered on the basis of history of epidemiology, typical symptoms, characteristic pharyngeal damage and virological tests. The treatment is mainly symptomatic, and incorporates topical oral spray with antiviral drugs. The course of herpangina generally lasts 4-6 days with a good prognosis. CONCLUSION: The consensus could provide advices and references for the diagnosis, treatment and management of herpangina in children.

Nationwide Survey of Pediatric Inpatients With Hand, Foot, and Mouth Disease, Herpangina, and Associated Complications During an Epidemic Period in Japan: Estimated Number of Hospitalized Patients and Factors Associated With Severe Cases.

BACKGROUND: Severe pediatric cases of hand, foot, and mouth disease (HFMD), herpangina (HA), and associated complications caused by enterovirus 71 (EV71) infection have brought substantial public health impact in Asia. This study aimed to elucidate the epidemiology of these pediatric cases in Japan. METHODS: A nationwide survey was conducted using stratified random sampling of hospital pediatric departments. We estimated the number of inpatients with HFMD, HA, and associated complications between April 1 and September 30, 2010, during which EV71 was circulating predominantly. Factors associated with severe cases with ≥7 days of admission, sequelae, or outcome of death were analyzed using multivariate logistic regression. RESULTS: During the 6-month epidemic period, the number of pediatric inpatients aged <15 years was about 2,900 (estimated cumulative incidence of hospitalized cases: 17.0 per 100,000 population). Severe cases were significantly associated with younger age. Compared to patients ≥5 years of age, the odds ratios (ORs) for <1 year of age and 1 to <3 years of age were 5.74 (95% confidence interval [CI], 2.14-15.4) and 2.94 (95% CI, 1.02-8.51), respectively. Elevated ORs for hyperglycemia (plasma glucose level of ≥8.3 mmol/L) on admission (OR 3.60; 95% CI, 0.94-13.8) were also observed. CONCLUSIONS: Disease burden of pediatric inpatients with HFMD, HA, and associated complications in Japan was described for the first time. During an EV71 epidemic, younger age and, suggestively, hyperglycemia may have been critical factors requiring more careful treatment.

[Clinical observation of infantile herpetic angina treated with acupuncture:a randomized controlled trial].

OBJECTIVE: To observe the difference in the therapeutic effects on infantile herpetic angina among the treatments with western medication, acupuncture and the combined therapy of acupuncture and western medication. METHODS: One hundred and twenty children of herpetic angina were randomized into a western medication group, an acupuncture group and a combined therapy group, 40 cases in each one. Besides the basic treatment with symptomatic support, in the western medication group, ribavirin granules were prescribed for oral administration, 10 mg/kga day, three times a day, for 3 days. In the acupuncture group, acupuncture was applied at Fengchi (GB 20), Hegu (LI 4), Quchi (LI 11), Xiaguan (ST 7), Jiache (ST 6), Dicang (ST 4), Shaoshang (LU 11) and Shangyang (LI 1), once a day, for 3 days. In the combined therapy group, the treatments as the western medication group and the acupuncture group were used, in which, the oral administration with ribavirin granules and acupuncture were adopted for 3 days. The clinical therapeutic effects were compared after treatment and the follow-up visit was conducted since the 4th day at the end of treatment to compare the antifebrile time, herpes relieving time and the use frequency of ibuprofen oral liquid in the children among the three groups. RESULTS: After treatment, the total effective rate was 95.0% (39/40) in the combined therapy group, was 62.5% (25/40) in the western medication group and was 80.0% (32/40) in the acupuncture group. The result in the combined therapy group was better than those in the acupuncture group and the western medication group, indicating the significant differences (both P<0.05). The antifebrile time and the herpetic relief time in the combined therapy group were earlier than those in the acupuncture group and the western medication group, indicating the significant differences (both P<0.05). The use frequency of ibuprofen oral liquid in the combined therapy group was lower than those in the acupuncture group and the western medication group, indicating the significant difference (both P<0.05). CONCLUSIONS: The combined therapy with acupuncture and western medication relieve fever and herpes much more quickly and reduces the use frequency of ibuprofen oral liquid as compared with the simple use of acupuncture or western medication in the treatment of infantile herpetic angina, which achieve the much better therapeutic effects.

Diseases caused by enterovirus 71 infection.

The purpose of this review was to explore the epidemiology, pathogenesis, virology, and management of enterovirus 71 (EV71) infection. Published literature was surveyed by Medline using the keyword "EV71." The reported incidence of cases of hand-foot-mouth disease/herpangina varied from year to year; seasonal variations in incidence were observed, with a peak in incidence during the summer season. Most cases of hand-foot-mouth disease/herpangina hospitalized for complications occurred in children less than 5 years old. The brainstem was the most likely major target of EV71 infection. Different enteroviruses cocirculate in the community annually. The emergence of the EV71 epidemic in the Asia Pacific region has been associated with the circulation of 5 genetic lineages (genotypes B3, B4, C1, C2, C4) that appear to be undergoing rapid evolutionary changes. The relationship between the gene structure of the EV71 virus and the factors that ensure its survival, ease of transmission, and evasion of immunity is still unclear. EV71 central nervous system involvement causes serious clinical illness, death, and long-term neurologic and psychiatric disorders in young children. EV71 infection has emerged as an important public health problem. Vaccine development is recommended for the prevention of EV71 infection in the future.

Outcome of enterovirus 71 infections with or without stage-based management: 1998 to 2002.

BACKGROUND: Enterovirus 71 (EV71) infection may progress through four stages, one of which is cardiopulmonary failure. In Taiwan in 1998 almost all the EV71 patients with cardiopulmonary failure died. To improve clinical outcome of EV71 patients, we developed a stage-based management program in 2000. METHODS: The medical records of 196 EV71 patients who did not have stage-based management (1998 to 1999) and of 331 EV71 patients who did (2000 to 2002) at Chang Gung Children's Hospital were reviewed for demographic characteristics, clinical syndromes, case-fatality rates and sequelae. We compared and analyzed the results for the 2 groups. RESULTS: Of the patients who did not receive stage-based management, 83% (15 of 18) of cases with both central nervous system (CNS) involvement and cardiopulmonary failure died during the acute stage of the infection. Two patients died at convalescence, and 1 had sequelae of dysphagia and limb weakness. By contrast of the patients who received stage-based management, 33% (12 of 36) of patients with CNS and cardiopulmonary failure died during the acute stage, 8% (3 of 36) died at convalescence, 14% (5 of 36) recovered and 43% (16 of 36) had severe sequelae of central hypoventilation, dysphagia and limb weakness (P < 0.001). For cases with CNS and cardiopulmonary failure, multivariate analysis showed that age older than 2 years and cerebro-spinal fluid white blood cell count >100/microl were associated with a increase in acute mortality [95% confidence interval (CI) 1.9 to 105.3, P = 0.001; 95% CI 1.1 to 66.6, P = 0.04, respectively], but stage-based management was significantly associated with a reduction in acute mortality (95% CI 0.007 to 0.24; P = 0.0004). Stage-based management did not affect the outcome of cases with CNS involvement alone. CONCLUSIONS: Stage-based management reduced the case fatality rate of EV71-related cardiopulmonary failure, but two-thirds of the survivors had severe sequelae.

Enfermedad mano pie boca y herpangina: enterovirus 71: actualización / Hand-foot and mouth disease and herpangina: enterovirus 71: an update

La enfermedad mano-pie-boca y la herpangina causadas por los virus Coxsakie se considern autolimitadas. Recientes epidemias de estas patologías pero por enterovirus 71 en Malasia, Japón y taiwán, causaron complicaciones neurológicas y pulmonares, fatales en muchos casos. En este trabajo nos referimos al pleconaril, un nuevo antiviral en ensayos clínicos para el tratamiento de meningitis e infecciones respiratorias por enterovirus

Enfermedad mano pie boca y herpangina: enterovirus 71: actualización / Hand-foot and mouth disease and herpangina: enterovirus 71: an update

La enfermedad mano-pie-boca y la herpangina causadas por los virus Coxsakie se considern autolimitadas. Recientes epidemias de estas patologías pero por enterovirus 71 en Malasia, Japón y taiwán, causaron complicaciones neurológicas y pulmonares, fatales en muchos casos. En este trabajo nos referimos al pleconaril, un nuevo antiviral en ensayos clínicos para el tratamiento de meningitis e infecciones respiratorias por enterovirus(AU)