Risk factors of severe hand, foot and mouth disease: A meta-analysis

Fang, Yirong; Wang, Shuiping; Zhang, Lijie; Guo, Zhinan; Huang, Zhaohui; Tu, Chunyu; Zhu, Bao–Ping

doi:10.3109/00365548.2014.907929

Cited by 53 publications

(57 citation statements)

References 21 publications

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“…We found that the absence ulcers or herpes in the mouth and the presence of maculopapular rash were indicators of severe disease, which is consistent with previous studies152122. However, in a recent meta-analysis23, different findings were presented, showing that there may be no association between ulcers in the mouth and the risk of progressing severe complications. Platelet count increase associating with severe HFMD was reported in some studies.…”

Section: Discussionsupporting

confidence: 90%

A Case-control Study on Risk Factors for Severe Hand, Foot and Mouth Disease

Zhang

et al. 2017

Sci Rep

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The objective of this study was to identify potential risk factors for severe hand, foot and mouth disease (HFMD). In this case-control study, 459 severe HFMD patients and 246 mild HFMD patients from Guangdong province and Henan province, China were included. Data comprising demographic characteristics, clinical symptoms and signs, laboratory findings and other factors were collected. Univariate analysis revealed 30 factors associated with severe cases. Further multivariate analysis indicated four independent risk factors: fatigue (p < 0.01, odd ratio [OR] = 204.7), the use of glucocorticoids (p = 0.03, OR = 10.44), the use of dehydrant drugs (p < 0.01, OR = 73.7) and maculopapular rash (p < 0.01, OR = 84.4); and one independent protective factor: herpes or ulcers in mouth (p = 0.01, OR = 0.02). However, more systematic research and validation are needed to understand the underlying risk factors for severe HFMD.

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Section: Discussionsupporting

confidence: 90%

A Case-control Study on Risk Factors for Severe Hand, Foot and Mouth Disease

Zhang

et al. 2017

Sci Rep

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“…As demonstrated, both in our study and other reports282930, the EV-A71 infection accounted for a large proportion in severe cases. It was taken as an independent risk factor in the severity development at all times.…”

Section: Discussionsupporting

confidence: 88%

Epidemiology of 45,616 suspect cases of Hand, Foot and Mouth Disease in Chongqing, China, 2011–2015

Tao

Shi

et al. 2017

Sci Rep

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Epidemiology and etiology of hand, foot, and mouth disease (HFMD) based on large sample size or evaluation of detection for more enterovirus serotypes are not well investigated in Chongqing of China. 45,616 suspect HFMD patients were prospectively enrolled among whom 21,615 were laboratory confirmed HFMD cases over a 5-year period (January 2011 to December 2015). Their epidemiological, clinical, and laboratory data were extracted and stratified by month, age, sex, disease severity, and enterovirus serotype. Subsequently 292 non-EV-A71/CV-A16 HFMD confirmed cases were randomly selected in three consecutive outbreaks to detect CV-A6 and CV-A10, using RT-PCR. Results showed that the HFMD epidemic peaked in early summer and autumn. The median age of onset was 2.45 years with a male-to-female ratio of 1.54:1, and with children under 5 years of age accounting for 92.54% of all confirmed cases. EV-A71 and CV-A16 infection accounted for only 36.05% (7793/21615) of total confirmed cases while EV-A71 accounted for 59.64% (232/389) of severe cases. Importantly, the proportion of EV-A71 infection generally increased with age which showed rapid growth in severe cases. CV-A6 and CV-A10 were tested positive in Chongqing, but CV-A6 had greater positive rates of 62.33% while CV-A10 had 4.79% in non-EV-A71/CV-A16 HFMD confirmed cases.

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“…In the present study, NS involvement variables, including limb jitters, nystagmus, ataxia, and acute flaccid paralysis, were predictors of treatment failure in severe cases, whereas the variables of a poor spirit, headache and vomiting, convulsions, and signs of irritation, were not significantly different between the efficiency and invalid cases of the S. baicalensis group, which is consistent with previous studies [5, 23, 24]. In addition, the FBG level and PWBC count were shown to influence the effectiveness of S. baicalensis injection, and both have been reported to be significantly increased in patients with severe HFMD [25]. Conversely, CSF-WBC counts and EEG and brain MRI abnormalities did not appear to influence the efficacy of the treatment.…”

Section: Discussionsupporting

confidence: 89%

Efficacy of Scutellaria baicalensis for the Treatment of Hand, Foot, and Mouth Disease Associated with Encephalitis in Patients Infected with EV71: A Multicenter, Retrospective Analysis

Lin

Zhou

Lin

et al. 2016

BioMed Research International

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This study aimed to evaluate the clinical efficacy and safety of using the traditional Chinese herbal medicine Scutellaria baicalensis for the treatment of severe HFMD in 725 patients aged >1 year in a multicenter, retrospective analysis. The patients were divided into the S. baicalensis and ribavirin groups, and the temperatures, presence or absence of skin rashes and oral lesions, nervous system (NS) involvement, and viral loads of the patients, as well as the safety of the treatments, were evaluated. The median duration of fever, median time to NS involvement, and the number of patients with oral ulcers and/or vesicles, as well as skin rashes, were decreased in the S. baicalensis group compared with the ribavirin group. In addition, the EV71 viral loads were decreased in the S. baicalensis group, suggesting that S. baicalensis exerted more potent antiviral effects compared with ribavirin. The present study demonstrated that S. baicalensis was suitable for the treatment of severe HFMD in patients aged >1 year, since it was shown to rapidly relieve fever, attenuate oral lesions and rashes, and improve NS involvement. Furthermore, it was demonstrated to be relatively safe for topical application.

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Risk factors of severe hand, foot and mouth disease: A meta-analysis

Abstract: Duration of fever ≥ 3 days, body temperature ≥ 37.5°C, lethargy, hyperglycemia, vomiting, increased neutrophil count, EV71 infection, and young age are risk factors for severe HFMD. A confirmed diagnosis at first visit to hospital can significantly decrease the risk of severe HFMD.

Cited by 53 publications

References 21 publications

A Case-control Study on Risk Factors for Severe Hand, Foot and Mouth Disease

A Case-control Study on Risk Factors for Severe Hand, Foot and Mouth Disease

Epidemiology of 45,616 suspect cases of Hand, Foot and Mouth Disease in Chongqing, China, 2011–2015

Efficacy of Scutellaria baicalensis for the Treatment of Hand, Foot, and Mouth Disease Associated with Encephalitis in Patients Infected with EV71: A Multicenter, Retrospective Analysis

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