Clinical manifestations of severe enterovirus 71 infection and early assessment in a Southern China population

BMC Infectious Diseases

Research Article

Yan-ling Chen¹  Wei Li¹  Jun Shen²  Dan-dan Hu²  Min-xiong Situ²  Cui-ping Zhu²  Yan Hong²  Hong-sheng Liu²  Jia-ming Lu²  Yu-ting Liang²  Jian-ping Tao²  Li Deng²  Yi Zhou²  Pei-qing Li²  Wen-cheng Ma²  Yuan-yuan Gao²  Si-da Yang²  Yi-min Li³  Wen-ying Lai⁴ 

[1] Dongguan Taiping People’s Hospital, 523905, Dongguan, China;Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, 510623, Guangzhou, China;Respiratory Research Institute, the First Affiliated Hospital of Guangzhou Medical University, 510120, Guangzhou, China;Zhongshan People’s Hospital, 528403, Zhongshan, China;

关键词: Enterovirus 71;    Clinical manifestations;    Children;    Southern China;   

DOI  :  10.1186/s12879-017-2228-9

 received in 2015-10-10, accepted in 2017-01-27,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundEnterovirus 71 (EV-A71) shows a potential of rapid death, but the natural history of the infection is poorly known. This study aimed to examine the natural history of EV-A71 infection.MethodsThis was a prospective longitudinal observational study performed between January 1st and October 31st, 2012, at three hospitals in Guangdong, China. Subjects with positive EV-A71 RNA laboratory test results were included. Disease progression was documented with MRI, autopsies, and follow-up. Symptoms/signs with potential association with risk of death were analyzed.ResultsAmong the 288 patients, neurologic symptoms and signs were observed (emotional movement disorders, dyskinesia, involuntary movements, autonomic dysfunction, and disturbance of consciousness). Some of them occurred as initial symptoms. Myoclonic jerks/tremors were observed among >50% of the patients; nearly 40% of patients presented fatigue and 25% were with vomiting. Twenty-eight patients (9.7%) presented poor peripheral perfusion within 53.4 ± 26.1 h; 23 patients (8.0%) presented pulmonary edema and/or hemorrhage within 62.9 ± 28.6 h. Seventeen (5.9%) patients were in a coma. Seven (2.4%) patients died within 62.9 ± 28.6 h. Seventy-seven survivors underwent head and spinal cord MRI and 37.7% (29/77) showed abnormalities. Two fatal cases showed neuronal necrosis, softening, perivascular cuffing, colloid, and neuronophagia phenomenon in the brainstem.ConclusionsPatients with EV-A71 infection showed high complexity of symptoms and onset timing. Death risk may be indicated by autokinetic eyeball, eyeball ataxia, severe coma, respiratory rhythm abnormality, absent pharyngeal reflex, ultrahyperpyrexia, excessive tachycardia, pulmonary edema and/or hemorrhage, and refractory shock and ataxic respiration. Early assessment of these symptoms/signs is important for proper management.

【 授权许可】

CC BY   
© The Author(s). 2017