Clinical characteristics and managements of severe hand, foot and mouth disease caused by enterovirus A71 and coxsackievirus A16 in Shanghai, China

Abstract

Background Hand, foot and mouth disease (HFMD) is a transmissible infectious disease caused by human enteroviruses (EV). Here, we described features of children with severe HFMD caused by EV-A71 or coxsackievirus A16 (CV-A16) in Shanghai, China. Methods Severe EV-A71 or CV-A16 caused HFMD children admitted to the Xinhua Hospital from January 2014 and December 2016, were recruited retrospectively to the study. Symptoms and findings at the time of hospitalization, laboratory tests, treatments, length of stay and residual findings at discharge were systematically recorded and analyzed. Results Of 19,995 children visited clinic service with probable HFMD, 574 children (2.87%) were admitted, 234 children (40.76%) were confirmed with EV-A71 (90/574) or CV-A16 (144/574) disease. Most (91.02%) of the patients were under 5 years. Initial clinical symptoms of EV-A71 and CV-A16 cases were: fever > 39 °C in 81 (90%) and 119 (82.63%), vomiting in 31 (34.44%) and 28 (19.44%), myoclonic twitching in 19 (21.11%) and 11(7.64%), startle in 21 (23.33%) and 20 (13.69%), respectively. Serum levels of interleukin-1β (IL-1β), IL-2, IL-6, IL-8, interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α) were significantly upregulated in severe HFMD subjects. Forty-seven children (20.08%) treated with intravenous gamma globulin (IVIG) showed decreased duration of illness episodes. All children were discharged without complications. Conclusions EV-A71 and CV-A16 accounted 40.76% of admitted HFMD during 2014 to 2016 in Xinhua Hospital. IVIG appeared to be beneficial in shortening the duration of illness episodes of severe HFMD.

Analysis of Clinical Related Factors of Neonatal Hand-Foot-Mouth Disease Complicated With Encephalitis

“…Among the newborns with HFMD complicated with encephalitis in our hospital, most of them were infected with HFMD common virus, a few were infected with CA16 and no EV71 infection, and most of them developed into severe cases because of EV71 infection, which may be one of the reasons for the good prognosis of most of the newborns with HFMD in our hospital. In our hospital, the vast majority of newborns have fever, which is consistent with foreign reports ( 11 ). The rash is not specific and atypical, usually manifesting as punctate rash or macular papule.…”

Association of gene polymorphisms of CD55 with susceptibility to and severity of hand, foot, and mouth disease caused by enterovirus 71 in the Han Chinese population

“…This result suggests that CD55 suppresses T cell immunity in vivo. The downregulation of sCD55 in the patients with EV71 infection in our study, especially severe cases, may also be associated with hyperactive T cell immunity, as previous studies have reported that EV71 infection causes increases in IFN‐γ and IL‐2 36,37 …”

Clinical characterization of benign enterovirus infection in neonates

“…Previous studies had found out that aseptic meningitis could be caused by EV in children or infants and emphasized the importance of CSF virus nucleic acid detection for diagnosis. [ 15 , 23 ] Meanwhile data on neonates were still limited. Only a few studies involved neonates, which had also shown that EV was an important pathogen in neonatal viral meningitis.…”