A case–control study of risk factors for severe hand–foot–mouth disease among children in Ningbo, China, 2010–2011

Abstract

Clinicians should pay increased attention to children diagnosed as HFMD with the independent risk factors above.

Serum Inflammatory Cytokine Levels Correlate with Hand-Foot-Mouth Disease Severity: A Nested Serial Case-Control Study

“…Notably, myoclonic jerks (100% in cases and 0 in controls) presented during the early stage of onset of severe HFMD, which is easily identifiable and can be used as an early sign to predict central nervous system (CNS) involvement. Chong et al reported that vomiting may be a signal indicating CNS involvement [19], whereas Yang et al showed that leg trembling was associated with severe HFMD [13]. In our study, vomiting occurred in 23.1% of the severe cases and 5.4% of the mild HFMD, and only 12.3% of the severe cases exhibited leg trembling.…”

“…In addition, the severe cases presented a high proportion of complications for brainstem encephalitis, neurogenic pulmonary edema and sepsis. These results may be attributed to the higher number of EV71 positive cases compared to the controls [13]. Previous studies indicated that EV71 is more likely to cause serious complications than other enteroviruses and usually leads to brainstem encephalitis, neurogenic pulmonary edema, and circulation failure [14]–[16].…”

“…The cases were defined as having severe or fatal HFMD [13], with severe neurological symptoms, such as febrile seizures, myoclonic jerks, and leg trembling, and more serious complications, including encephalitis, meningitis, acute flaccid paralysis (AFP), cardio respiratory failure, or death. Controls with mild HFMD were without any serious complications.…”

The absence of exanthema is related with death and illness severity in acute enterovirus infection

“…1,4 Considering that an ulcer is the remnant of a ruptured vesicle, the absence of oral ulcers being related to fatal HFMD is similar to our results. Free EV or infected leukocytes localizing in the small blood vessels is the prerequisite of a lesion in the skin or mucosa.…”

“…have been found to be related to severe neurological complications or death in hand, foot, and mouth disease (HFMD). [1][2][3][4] Our study indicates that the absence of exanthema was related to death and illness severity in children with acute EV infection in Guangdong Province, China during 2009-2012. Significantly higher percentages of death (7.2% vs. 1.1%; p = 0.001), severe CNS involvement + CPF (9.6% vs. 2.3%; p = 0.025), severe CNS involvement (21.7% vs. 11.0%; p = 0.005), CNS involvement (41.0% vs. 31.0%; p = 0.041), altered level of consciousness (15.7% vs. 7.6%; p = 0.013), convulsions (14.4% vs. 6.3%; p = 0.007), and fever !3 days (67.5% vs. 56.1%; p = 0.048) were found in the group of patients without exanthema compared to the group of patients with exanthema (Table 1).…”