Case report

Abstract

Rationale:Hand, foot and mouth disease (HFMD) is caused by enterovirus. The virus may exist in secretions.Patient concerns:Five neonates had symptoms of fever and maculopapular rashes involving face, trunk, breech, arms, and legs, especially scattering on palms and feet. Blood, oropharyngeal fluid, urine, and cerebrospinal fluid (CSF) samples were collected and detected for further diagnoses with the consent of the infants’ parents. Some of them suffered aseptic meningitis.Diagnoses:They were diagnosed as HFMD with CSF enterovirus positive.Interventions:All of them continued breastfeed. Water bag was used during the pyrogenic stage. Antibiotics were administrated at first and withdrawn as soon as possible.Outcomes:None of them developed into brainstem encephalitis or pulmonary edema and they all recovered well.Lessons:HFMD is more common in neonates than it has been thought. Enterovirus may exist in neonatal CSF and cause CSF cell to increase similar to purulent meningitis. Medical history, physical examination, and CSF enterovirus detection are important in making correct diagnosis. Unlike bacterial infection, HFMD is a self-limited disease. Once HFMD is determined and bacterial infection is ruled out, antibiotics should be avoided.

Analysis of Clinical Related Factors of Neonatal Hand-Foot-Mouth Disease Complicated With Encephalitis

“…Contrast-enhanced MRI scan of the neonatal head was mainly manifested as enhanced meningeal signals and increased vascular shadows on the brain surface, without obvious brain parenchymal injury. Therefore, routine follow-up of all newborns after discharge showed that the prognosis was generally good, which was consistent with foreign reports ( 3 ).…”

“…The main source of infection is HFMD and its recessive infection (including adults and children). Neonatal HFMD is rare clinically, but in recent years, neonatal HFMD has an increasing trend year by year ( 3 ), mostly in summer. Among the newborns with HFMD complicated with encephalitis in our hospital, most of them were infected with HFMD common virus, a few were infected with CA16 and no EV71 infection, and most of them developed into severe cases because of EV71 infection, which may be one of the reasons for the good prognosis of most of the newborns with HFMD in our hospital.…”

“…Because of the special age of newborns, there is little contact with the outside world, HFMD is easy to be ignored, and there are few reports about neonatal HFMD at home and abroad. However, among the patients admitted to our hospital in recent years, neonatal HFMD is increasing year by year ( 3 ), but there are differences in clinical manifestations and laboratory indicators between preschool children and newborns, which may be because newborns are protected by maternal antibodies.…”

Clinical characterization of benign enterovirus infection in neonates

“…The characteristic rashes which presented on the whole surface of the body particularly on the soles and palms might highly suggest EV infection. [ 22 ] Although irritability was reported in some cases, the symptom was more subjective by the parents’ narrative as “angry baby.” Vomiting, myoclonic twitching, and startle which are more objective are common in infants or children at older ages but scarce in neonates. [ 23 ] In case of neonates with fever and typical rashes during the epidemic season, especially to those who had a history contacting family member with a flu, EV infection should be considered in the differential diagnosis.…”

“…The most common symptom of EV infection in neonates at presentation was fever, followed by rashes. The characteristic rashes which presented on the whole surface of the body particularly on the soles and palms might highly suggest EV infection [22] . Although irritability was reported in some cases, the symptom was more subjective by the parents’ narrative as “angry baby.” Vomiting, myoclonic twitching, and startle which are more objective are common in infants or children at older ages but scarce in neonates [23] .…”