The Characteristics of Blood Glucose and WBC Counts in Peripheral Blood of Cases of Hand Foot and Mouth Disease in China: A Systematic Review

Abstract

BackgroundOutbreaks of Hand Foot and Mouth Disease (HFMD) have occurred in many parts of the world especially in China. We aimed to summarize the characteristics of the levels of blood glucose and white blood cell (WBC) counts in cases of HFMD in Mainland China and Taiwan, using meta-analysis based on systematic review of published articles.MethodsWe systematically reviewed published studies, from the MEDLINE and WANFANG Data, about the levels of blood glucose and WBC counts in cases of HFMD until 15th June 2011, and quantitatively summarized the characteristics of them using meta-analysis.ResultsIn total, 37 studies were included in this review. In Mainland China and Taiwan, generally, the average level of blood glucose, the prevalence of hyperglycemia, WBC counts and the prevalence of leukocytosis increased with the severity of the illness. There was no significant difference in the prevalence of leukocytosis between ANS (autonomic nervous system dysregulation)/PE (pulmonary edema) group and CNS (central nervous system) group, and in the average level of blood glucose between healthy controls and mild cases of HFMD. WBC counts in cases infected by EV71 were less than those in cases infected by CA16.Conclusionsour analyses indicated that blood glucose and WBC counts increased with the severity of HFMD disease, which would help doctors to manage patients efficiently.

Hand, foot, and mouth disease: Identifying and managing an acute viral syndrome

“…Because some patients who have neurologic disease respond to treatment with highdose methylprednisolone and intravenous immune globulin, there is reason to suspect that an autoimmune phenomenon triggered by the culprit enterovirus may be the cause of many of the neurologic symptoms. 25 A 2012 meta-analysis 26 found that an elevated white blood cell count and hyperglycemia could be clinically useful in distinguishing benign from severe HFMD. In patients with benign HFMD, white blood cell counts and blood glucose values were no different from those in healthy controls.…”

“…In patients with benign HFMD, white blood cell counts and blood glucose values were no different from those in healthy controls. 26…”

Low Birth Weight is Associated with Lower Respiratory Tract Infections in Children with Hand, Foot, and Mouth Disease

“…The pathogenesis is not completely understood but can lead to a rapid disease progression and a higher mortality rate especially in EV71-infected children [5][6][7]. Specific biomarkers were identified to estimate the severity of HFMD cases [8][9][10]. Hyperglycemia and leukocytosis are two important characteristics in severe patients, and blood glucose and peripheral white blood cell (WBC) count seem to change with the severity of the disease [8,9].…”

Risk factors of severe hand, foot and mouth disease in Shantou, China: a case-control study

“…Laboratory abnormalities are commonly observed in children at early stage of severe disease, which include a raised white cell count with relative neutrophilia, hyperglycaemia and elevated CSF lactate [16,24,25]. Recently, a systematic review including 37 studies, mostly from Mainland China and Taiwan, indicated the prevalence of WBC counts and leukocytosis increased with the severity of the illness [26]. Although these indicators seem more likely to present in severe HFMD cases, their diagnostic value is limited for clinically predicting children at high risk of severe HFMD, particularly in primary care settings, as leukocytosis and hyperglycemia appear later in the course of fulminant cardiorespiratory failure in our opinion.…”