Identification and validation of clinical predictors for the risk of neurological involvement in children with hand, foot, and mouth disease in Sarawak

Abstract

BackgroundHuman enterovirus 71 (HEV71) can cause Hand, foot, and mouth disease (HFMD) with neurological complications, which may rapidly progress to fulminant cardiorespiratory failure, and death. Early recognition of children at risk is the key to reduce acute mortality and morbidity.MethodsWe examined data collected through a prospective clinical study of HFMD conducted between 2000 and 2006 that included 3 distinct outbreaks of HEV71 to identify risk factors associated with neurological involvement in children with HFMD.ResultsTotal duration of fever ≥ 3 days, peak temperature ≥ 38.5°C and history of lethargy were identified as independent risk factors for neurological involvement (evident by CSF pleocytosis) in the analysis of 725 children admitted during the first phase of the study. When they were validated in the second phase of the study, two or more (≥ 2) risk factors were present in 162 (65%) of 250 children with CSF pleocytosis compared with 56 (30%) of 186 children with no CSF pleocytosis (OR 4.27, 95% CI2.79–6.56, p < 0.0001). The usefulness of the three risk factors in identifying children with CSF pleocytosis on hospital admission during the second phase of the study was also tested. Peak temperature ≥ 38.5°C and history of lethargy had the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 28%(48/174), 89%(125/140), 76%(48/63) and 50%(125/251), respectively in predicting CSF pleocytosis in children that were seen within the first 2 days of febrile illness. For those presented on the 3rd or later day of febrile illness, the sensitivity, specificity, PPV and NPV of ≥ 2 risk factors predictive of CSF pleocytosis were 75%(57/76), 59%(27/46), 75%(57/76) and 59%(27/46), respectively.ConclusionThree readily elicited clinical risk factors were identified to help detect children at risk of neurological involvement. These risk factors may serve as a guide to clinicians to decide the need for hospitalization and further investigation, including cerebrospinal fluid examination, and close monitoring for disease progression in children with HFMD.

Joint diagnosis of pediatric and dermatology clinics: Prospective observation of thirtynine patients with hand, foot and mouth disease

“…EAAH'nin salgınlara yol açtığı bölgeler dikkate alındığında, literatürde hekimler için uyarıcı olabilecek hastalık şiddet skorlamaları yapıldığı görülmektedir. EAAH'nin şiddetini gösteren kriterler Tablo 4'de paylaşıldı 14,20,21 . Hastalarımızın çoğu 5 yaş altı çocuklardan oluşsa da, hiçbirinde hastalığın şiddetli seyredeceğine dair klinik ve laboratuvar göstergelere rastlanmadı.…”

“…'nın 8 bir çalışmasında, 127 hastanın sadece 1'inde onikomadezis tespit etmiştir 7,9 . Yurtdışından yapılan çalışmalarda 21 Liu et al 14 Ooi et al 20 Solunum sayısı >26/dk Kostipasyon Yaş <2 yıl ise, tırnak tutulumu %37,6-46,6 arasında değişen oranlarda bildirilmektedir 13,28 . Hastalarımızın 10'unda (%25,6) onikomadezis ve/veya Beau's çizgileri görüldü.…”

Identification of 20 Common Human Enterovirus Serotypes by Use of a Reverse Transcription-PCR-Based Reverse Line Blot Hybridization Assay

“…These range from asymptomatic infection to serious illness, especially in children (20) and the immunocompromised. Clinical syndromes include aseptic meningitis (1,25), encephalitis (8,26), fever and rash, acute flaccid paralysis (29), and gastrointestinal and respiratory illness.…”

Hand, Foot and Mouth Disease: A case report

“…Approximately 10%-30% of hospitalized cases during EV71 associated HFMD epidemics in Asia have developed a spectrum of CNS complications, including aseptic meningitis, encephalitis and acute flaccid paralysis [13,14,15]. Brainstem encephalitis, a distinctive form of encephalitis with stereotypic neuropathological characteristics has become the hallmark of severe EV71-associated HFMD in the recent recurrent EV71 epidemics in Asia, which began in the late 1990s [16,17].…”