Factors associated with severe neurologic complications in patients with either hand-foot-mouth disease or herpangina: A nationwide observational study in South Korea, 2009-2014

• Published in: PloS one Vol. 13; no. 8; p. e0201726
• Main Authors: Kim, Bongyoung, Moon, Shinje, Bae, Geun-Ryang, Lee, Hyungmin, Pai, Hyunjoo, Oh, Sung Hee
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 10.08.2018; Public Library of Science (PLoS)
• Subjects: Aseptic meningitis; Biology and Life Sciences; Cerebrospinal fluid; Complications; Disease control; Disease prevention; Edema; Encephalitis; Feet; Hospitals; Infections; Infectious diseases; Internal medicine; Lethargy; Medical records; Medicine; Medicine and Health Sciences; Meningitis; Neurological complications; NMR; Nuclear magnetic resonance; Observational studies; Patients; Pediatrics; People and places; Poliomyelitis; Regression analysis; Risk analysis; Risk factors; Surveillance; Viral infections; South Korea; Malaysia; China; Taiwan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0201726

In 2009, a nationwide sentinel surveillance for hand-foot-mouth disease (HFMD) and herpangina (HA) with neurologic complications was initiated in South Korea. We used this surveillance system to investigate the clinical characteristics of patients with either HFMD or HA with neurologic complications, with the aim of determining risk factors for severe neurologic complications. A retrospective review of medical records was conducted on all cases of HFMD and HA with neurologic complications that were reported in the national system between April 1, 2009 and December 31, 2014. A severe case was defined as having HFMD or HA with encephalitis, polio-like syndrome, or cardiopulmonary failure, and less-severe cases were defined as having HFMD or HA with aseptic meningitis. A total of 138 cases (less-severe: 90/138, 65.2%; severe: 48/138, 24.8%) were included from 28 hospitals; 28 ineligible cases were excluded. Of 48 severe cases, 27 (56.2%) had encephalitis; 14 (29.2%) had polio-like syndrome; and seven (14.6%) had cardiopulmonary syndrome. The median patient age was 36 months (IQR: 18-60) and 63 (45.7%) patients were female. Most patients completely recovered, except for seven cases that were fatal or resulted in long-term symptoms (5.1%, 3 patients with neurologic sequelae and 4 deaths). In a multivariable logistic regression analysis, lethargy (OR = 4.67, 95% CI: 1.37-15.96, P = 0.014), female sex (OR = 3.51, 95% CI: 1.17-10.50, P = 0.025), and enterovirus A71 (OR = 3.55, 95% CI: 1.09-11.57, P = 0.035) were significantly associated with severe neurologic complications in HFMD and HA patients. In patients with HFMD and HA, lethargy, female, and enterovirus A71 may predict severe neurologic complications.