Clinical characteristics and managements of severe hand, foot and mouth disease caused by enterovirus A71 and coxsackievirus A16 in Shanghai, China

• Published in: BMC infectious diseases Vol. 19; no. 1; p. 285
• Main Authors: Cai, Kang, Wang, Yizhong, Guo, Zhongqin, Yu, Huiju, Li, Huajun, Zhang, Liya, Xu, Shanshan, Zhang, Qingli
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 27.03.2019; BioMed Central; BMC
• Subjects: Adolescent; Biological response modifiers; Care and treatment; Child; Child, Preschool; Children; China - epidemiology; Communicable diseases; Complications; Coxsackievirus A16; Coxsackievirus infections; Coxsackievirus Infections - complications; Coxsackievirus Infections - diagnosis; Coxsackievirus Infections - epidemiology; Coxsackievirus Infections - therapy; Coxsackieviruses; Cytokines; Diagnosis; Discharge; Disease control; Encephalitis; Enterovirus - physiology; Enterovirus A, Human - physiology; Enterovirus A71; Enterovirus Infections - complications; Enterovirus Infections - diagnosis; Enterovirus Infections - epidemiology; Enterovirus Infections - therapy; Enteroviruses; Epidemiology; Fasciculation; Female; Fever; Foot and mouth disease; Gamma globulin; Globulins; Hand; Hand, Foot and Mouth Disease - diagnosis; Hand, Foot and Mouth Disease - epidemiology; Hand, Foot and Mouth Disease - microbiology; Hand, Foot and Mouth Disease - therapy; Hand-foot-and-mouth disease; Hands; Health care; Hospitalization - statistics & numerical data; Hospitals; Humans; Hyperthermia; IL-1β; Immunoglobulins; Infant; Infant, Newborn; Infectious diseases; Interferon; Interleukin 2; Interleukin 6; Interleukin 8; Interleukins; Intravenous administration; Intravenous gamma globulin intervention; Laboratories; Laboratory tests; Male; Medical schools; Meningitis; Necrosis; Pediatric research; Pediatrics; Retrospective Studies; Serum levels; Severity of Illness Index; Signs and symptoms; Statistics; Surveillance; Treatment Outcome; Tumor necrosis factor-TNF; Tumor necrosis factor-α; Tumors; Twitching; Vaccines; Vomiting; γ-Interferon; China; Foot and mouth disease; Intravenous gamma globulin intervention; Children; Enterovirus A71; Hand; Coxsackievirus A16
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-019-3878-6

Hand, foot and mouth disease (HFMD) is a transmissible infectious disease caused by human enteroviruses (EV). Here, we described features of children with severe HFMD caused by EV-A71 or coxsackievirus A16 (CV-A16) in Shanghai, China. Severe EV-A71 or CV-A16 caused HFMD children admitted to the Xinhua Hospital from January 2014 and December 2016, were recruited retrospectively to the study. Symptoms and findings at the time of hospitalization, laboratory tests, treatments, length of stay and residual findings at discharge were systematically recorded and analyzed. Of 19,995 children visited clinic service with probable HFMD, 574 children (2.87%) were admitted, 234 children (40.76%) were confirmed with EV-A71 (90/574) or CV-A16 (144/574) disease. Most (91.02%) of the patients were under 5 years. Initial clinical symptoms of EV-A71 and CV-A16 cases were: fever > 39 °C in 81 (90%) and 119 (82.63%), vomiting in 31 (34.44%) and 28 (19.44%), myoclonic twitching in 19 (21.11%) and 11(7.64%), startle in 21 (23.33%) and 20 (13.69%), respectively. Serum levels of interleukin-1β (IL-1β), IL-2, IL-6, IL-8, interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α) were significantly upregulated in severe HFMD subjects. Forty-seven children (20.08%) treated with intravenous gamma globulin (IVIG) showed decreased duration of illness episodes. All children were discharged without complications. EV-A71 and CV-A16 accounted 40.76% of admitted HFMD during 2014 to 2016 in Xinhua Hospital. IVIG appeared to be beneficial in shortening the duration of illness episodes of severe HFMD.