Clinical Features and Management Outcomes of Severe Hand, Foot and Mouth Disease

Abstract

Objective: This study was designed to describe the clinical features and management outcomes of severe hand, foot and mouth disease (HFMD). Subjects and Methods: Data on 147 severe HFMD patients during an outbreak in 2009 were analyzed. Results: Most patients were under 3 years of age; 102 (69.4%) were boys. All had skin rashes and fever of ≥38°C. All (n = 147, 100%) showed signs of central nervous system involvement, such as lethargy (n = 124, 84.4%), myoclonic jerks (n = 76, 51.7%), or drowsiness (n = 34, 23.1%). Respiratory symptoms were mainly tachypnea (n = 112, 76.2%) or bradypnea (n = 21, 14.3%). Common cardiovascular symptoms included tachycardia (n = 134, 91.2%) and hypertension (n = 23, 15.5%). Chest X-ray showed increased markings in 76 (51.7%) or consolidation in 44 (29.9%). Hyperglycemia and elevated blood lactic acid levels were found in 127 (86.4%) and 130 (88.4%), respectively. Positive enterovirus EV71-PCR was found in 113 (76.9%). All patients were treated with mechanical ventilation for 61.2 ± 12.8 h (range, 40–96 h), as well as mannitol, dexamethasone, gamma globulin and ribavirin. Dopamine, dobutamine or amrinone was administered in 58.5, 51.0 and 21.8%, respectively. Three patients (2%) died during hospitalization. All others had a full recovery and were discharged after 14.2 ± 1.6 days (range, 12–17 days). Conclusion: Central nervous and cardiorespiratory systems were involved in the patients with severe HFMD. Fasting blood glucose and lactic acid levels increased in the majority of patients. Mechanical ventilation and supportive pharmacotherapy were associated with a good clinical outcome in these patients.

Co-Circulation and Genomic Recombination of Coxsackievirus A16 and Enterovirus 71 during a Large Outbreak of Hand, Foot, and Mouth Disease in Central China

“…More interestingly, we also demonstrated that EV71 and CVA16 were co-circulated in this HFMD outbreak. It has been reported that many large outbreaks of HFMD were only EV71-associated [8], [15], [16], [19], [25], [28], [44], [45], [47], [48], [52]–[54], [57]–[59], [89].…”

“…Since 1997, EV71 outbreaks have gained more attention as there is an upward trend in the prevalence of EV71 globally [16], [19], [44]–[52]. In recent years, many large outbreaks of EV71-associated HFMD with high morbidity and mortality have occurred in the Asia-Pacific region [8], [15], [53]–[57]. In China, large scale EV71 outbreaks associated with acute neurological diseases were occurred in 2008 [25], [58], and since then the outbreak pattern has repeated and exacerbated each year, with increasing morbidity and mortality [27], [59].…”

Demographic characteristics of patients with hand-foot-and-mouth disease. Atypical cases series

“…13 Another clinical study on severe HFMD with systemic complications reported that the hips were affected in 53% of patients. 15 The buttocks were affected in 31% of patients with atypical HFMD in a hospital-based prospective study. 6 Moreover, there wasn't a significant difference in the frequency of trunk and scalp involvement according to age group, and the scalp was the least commonly affected.…”

Evaluation on Common Hand, Foot, and Mouth Disease Treated by Integrative Traditional Chinese Medicine and Western Medicine

“…7 Commonly, HFMD is mild and self-limiting, with relief of symptoms within 7-10 days, but viruses can be detected in the stool for weeks after the symptoms dissipate. 4,8 There are no specific treatments for HFMD at present. The most common treatment is to relieve symptoms by supportive therapy and the application of antivirals, antibiotics and immunopotentiators.…”

“…The most common treatment is to relieve symptoms by supportive therapy and the application of antivirals, antibiotics and immunopotentiators. 5,8 According to the guidelines issued by the Ministry of Health of China, 9 HFMD should be paid enough attention during the first five days in case it progress into severe conditions without immediate and effective intervention. Traditional Chinese medicine (TCM) was highly recommended by Ministry of Health of China for HFMD treatment.…”