Clinical Spectrum of Enterovirus 71 Infection in Children in Southern Taiwan, with an Emphasis on Neurological Complications

• Published in: Clinical infectious diseases Vol. 29; no. 1; pp. 184 - 190
• Main Authors: Wang, Shih-Min, Liu, Ching-Chuan, Tseng, Hui-Wan, Wang, Jen-Ren, Huang, Chao-Ching, Chen, Yung-Jung, Yang, Yao-Jong, Lin, Shio-Jean, Yeh, Tsu-Fuh
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Chicago, IL The University of Chicago Press 01.07.1999; University of Chicago Press
• Subjects: Adolescent; Animals; Bacterial diseases; Bacterial diseases of the nervous system. Bacterial myositis; Biological and medical sciences; Brain stem; Central nervous system; Cercopithecus aethiops; Child; Child, Preschool; Clinical Articles; Disease Outbreaks; Encephalitis; Encephalitis, Viral - epidemiology; Encephalitis, Viral - physiopathology; Encephalitis, Viral - virology; Enterovirus; Enterovirus - isolation & purification; Enterovirus Infections - complications; Enterovirus Infections - epidemiology; Enterovirus Infections - physiopathology; Enterovirus Infections - virology; Female; Fever; Hand foot and mouth disease; Human bacterial diseases; Humans; Infant; Infections; Infectious diseases; Magnetic Resonance Imaging; Male; Medical sciences; Myoclonus; Retrospective Studies; Taiwan - epidemiology; Throat; Treatment Outcome; Tropical medicine; Tumor Cells, Cultured; Vero Cells; Vomiting; Asia; Taiwan; Human; Encephalitis; Nervous system diseases; Picornaviridae; Brain stem; Enterovirus; Hand foot and mouth disease; Cerebral disorder; Infection; Virus; Case study; Symptomatology; Viral disease; Central nervous system disease; Complication; Child
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/520149

An outbreak of enterovirus 71 (EV71) infection occurred in Taiwan in 1998. The clinical spectrums and laboratory findings for 97 patients with virus culture-proven EV71 infections were analyzed. Eighty-seven percent of the patients were younger than age 5 years. Hand-foot-and-mouth syndrome occurred in 79% of the children and central nervous system (CNS) involvement in 35%, including nine fatal cases. The predominant neurological presentations were myoclonus (68%), vomiting (53%), and ataxia (35%). Brain stem encephalitis was the cardinal feature of EV71 CNS involvement during this outbreak. Magnetic resonance imaging and pathological findings illustrated that the midbrain, pons, and medulla were the target areas. EV71 brain stem encephalitis can present either with cerebellar signs and an initially mild, reversible course or with overwhelming neurogenic shock and neurogenic pulmonary edema (NPE) resulting in a fatal outcome. Brain stem encephalitis that progressed abruptly to neurogenic shock and NPE was indicative of poor prognosis in this epidemic. Early aggressive treatment and close monitoring of the neurological signs are mandatory to improve the chance of survival.