Clinical features and risk factors of pulmonary oedema after enterovirus-71-related hand, foot, and mouth disease

Chang, Luan‐Yin; Lin, Tzou Yien; Hsu, Kuang‐Hung; Huang, Yhu Chering; Lin, Kuang; Hsueh, Chuen; Shih, Shin Ru; Ning, Hsiao Chen; Hwang, Mao Sheng; Wang, Huei Shyoung; Lee, Chin‐Yun

doi:10.1016/s0140-6736(99)04434-7

Cited by 381 publications

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“…11 Though most cases of HFMD were mild and self-limited, outbreaks of HFMD caused by EV71 can present with high incidence of neurological complications, leading to severe and fatal cases. 12 Sporadic EV71 cases were common in the Chinese mainland. From 1998 to 2009, there have been annual reports of morbidity and mortality caused by EV71 infection.…”

Section: Discussionmentioning

confidence: 99%

Tolerability and immunogenicity of an inactivated enterovirus 71 vaccine in Chinese healthy adults and children

Meng

et al. 2012

Human Vaccines & Immunotherapeutics

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Section: Discussionmentioning

confidence: 99%

Tolerability and immunogenicity of an inactivated enterovirus 71 vaccine in Chinese healthy adults and children

Meng

et al. 2012

Human Vaccines & Immunotherapeutics

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“…[11][12][13][14][15][16] At that time, a total of 129 106 cases of hand, foot, and mouth disease (HFMD)/herpangina were reported; 405 cases had severe neurologic complications and/or pulmonary edema, and 78 children died. 15 A retrospective review found that sporadic cases of EV71 had occurred in Taiwan in 1980 and 1986.…”

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Risk Factors of Enterovirus 71 Infection and Associated Hand, Foot, and Mouth Disease/Herpangina in Children During an Epidemic in Taiwan

et al. 2002

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ABSTRACT.Objective. In 1998, an enterovirus 71 (EV71) epidemic in Taiwan was associated with hand, foot, and mouth disease (HFMD)/herpangina and involved 78 fatal cases. We measured EV71 seroprevalence rates before and after the epidemic and investigated risk factors associated with EV71 infection and illness.Methods. Neutralizing antibodies to EV71 were assayed for 539 people before the epidemic and 4619 people of similar ages after the epidemic. Questionnaires, which were completed during household interviews after the epidemic, solicited demographic variables, exposure history, and clinical manifestations.Results. A total of 129 106 cases of HFMD were reported during the epidemic. Age-specific pre-epidemic EV71 seroprevalence rates were inversely related to agespecific periepidemic mortality rates (r ‫؍‬ ؊0.82) or severe case rates (r ‫؍‬ ؊0.93). Higher postepidemic EV71 seropositive rates among children who were younger than 3 years positively correlated with higher mortality rates in different areas (r ‫؍‬ 0.88). After the epidemic, 51 (56%) of 91 younger siblings of elder siblings who were EV71-seropositive were EV71-seropositive; otherwise, 2.2% (4 of 186) of younger siblings were EV71-seropositive (matched odds ratio [OR]: 10; 95% confidence interval [CI]: 3.4 -29). Stepwise multiple logistic regression revealed other factors associated with EV71 infection to be older age (adjusted OR: 2.5; 95% CI: 1.9 -3.4), attendance at kindergartens/child care centers (adjusted OR: 1.8; 95% CI: 1.3-2.5), contact with HFMD/herpangina (adjusted OR: 1.6; 95% CI: 1.2-2.1), greater number of children in a family (adjusted OR: 1.4; 95% CI: 1.1-1.7), and rural residence (adjusted OR: 1.4; 95% CI: 1.2-1.6). Twenty-nine percent of preschool children who were infected with EV71 developed HFMD/herpangina. Younger age and contact with HFMD/herpangina were significant factors for the development of EV71-related HFMD/herpangina in these children.Conclusions. An increased incidence of EV71 infection in young children occurred more often in geographic areas with increased mortality rates. Intrafamilial and kindergarten transmissions among preschool children were major modes of disease transmission during the widespread EV71 epidemic in Taiwan in 1998. Pediatrics 2002;109(6). URL: http://www.pediatrics.org/cgi/content/ full/109/6/e88; enterovirus 71; hand, foot, and mouth disease; seroprevalence; transmission; risk factors; symptomatic ratio; reemerging infectious disease; Taiwan.ABBREVIATIONS. EV71, enterovirus 71; HFMD, hand, foot, and mouth disease; OR, odds ratio; CI, confidence interval; SD, standard deviation. E nterovirus 71 (EV71) has been associated with outbreaks in the United States, Europe, Australia, Japan, Brazil, and Malaysia 1-10 since it was originally recognized in l969 in California. 1 Before 1998, 3 large outbreaks with dozens of fatal cases occurred in Bulgaria in 1975, Hungary in 1978, and Malaysia in 1997 However, few studies have investigated the mode of transmission, the protective effect of preexisting EV71...

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“…E nterovirus 71 (EV71) has caused acute fatal epidemics in at least 5 regions of the world, including Malaysia and Taiwan. [1][2][3][4][5][6][7] In 1998, an epidemic of EV71 infection affected Ͼ90 000 children in Taiwan. Among the 405 children hospitalized with acute neurologic disease, 78 died.…”

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“…Among the 405 children hospitalized with acute neurologic disease, 78 died. [1][2][3][4] In this outbreak, there was clinical, neuroradiologic, and pathologic evidence that the chief neurologic complication was rhombencephalitis or brainstem lesions. [1][2][3][4][5][6][7] Most of the fatal cases initially involved minor neurologic symptoms, but the children rapidly died of acute onset of pulmonary edema (PE) and/or hemorrhage (PH) with rapid progression of cardiopulmonary failure within hours after admission.…”

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confidence: 99%

“…[1][2][3][4] In this outbreak, there was clinical, neuroradiologic, and pathologic evidence that the chief neurologic complication was rhombencephalitis or brainstem lesions. [1][2][3][4][5][6][7] Most of the fatal cases initially involved minor neurologic symptoms, but the children rapidly died of acute onset of pulmonary edema (PE) and/or hemorrhage (PH) with rapid progression of cardiopulmonary failure within hours after admission. [1][2][3][4][5][6][7] The pathogenesis of acute fatality with PE alone or PE and concurrent PH during EV71 infection is not completely understood.…”

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Cardiopulmonary Manifestations of Fulminant Enterovirus 71 Infection

Wang

Tsai

et al. 2002

Pediatrics

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ABSTRACT. Background. The pathogenesis of acute pulmonary edema and cardiac collapse after enterovirus 71 (EV71) infection are not completely understood.Objective. To determine the hemodynamic features and the mechanism of pulmonary edema (PE) after EV71 infection by direct intracardiac monitoring.Design. Prospective clinical and laboratory study at a tertiary medical center.Participants. Five consecutive infants, ages 2 to 13 months, with EV71 infection-proved by viral isolation in 4 and antibody in 1-with PE were enrolled. The clinical characteristics were systemically assessed. Hemodynamic profiles were determined every 4 hours by simultaneously implanted pulmonary arterial and central venous catheters during the acute stage.Results. Magnetic resonance imaging revealed that all 5 infants had brainstem lesions. All patients had tachycardia and hyperthermia. Transient systolic hypertension was noted in 1 patient, and 1 presented with hypotension. Pulmonary artery pressure in all 5 infants was normal or mildly elevated (26 -31 mm Hg), and central venous pressure ranged from 10 to 22 mm Hg. Pulmonary artery occlusion pressures were normal or slightly elevated (13-16 mm Hg). Systemic and pulmonary vascular resistances were transiently increased in only 1 patient. The stroke volume index decreased to 15.3 to 35.7 mL/M 2 (normal: 30 -60 mL/M 2 ), but because of the elevated heart rate, the cardiac index did not decrease. All hemodynamics normalized within days.Conclusion. Fulminant EV71 infection may lead to severe neurologic complications and acute PE. The acute PE and cardiopulmonary decompensation in EV71 infection are not directly caused by viral myocarditis. The mechanism of PE may be related to increased pulmonary vascular permeability caused by brainstem lesions and/or systemic inflammatory response instead of increased pulmonary capillary hydrostatic pressure. Pediatrics 2002;109(2). URL: http://www.pediatrics.org/ cgi/content/full/109/2/e26; enterovirus 71, pulmonary edema, pathogenesis, hemodynamics, hand-foot-mouth disease.

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Clinical features and risk factors of pulmonary oedema after enterovirus-71-related hand, foot, and mouth disease

Cited by 381 publications

References 18 publications

Tolerability and immunogenicity of an inactivated enterovirus 71 vaccine in Chinese healthy adults and children

Tolerability and immunogenicity of an inactivated enterovirus 71 vaccine in Chinese healthy adults and children

Risk Factors of Enterovirus 71 Infection and Associated Hand, Foot, and Mouth Disease/Herpangina in Children During an Epidemic in Taiwan

Cardiopulmonary Manifestations of Fulminant Enterovirus 71 Infection

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