Enterovirus Type 71 Infections: A Varied Clinical Pattern Sometimes Mimicking Paralytic Poliomyelitis

Melnick, Joseph L.

doi:10.1093/clinids/6.supplement_2.s387

Cited by 154 publications

(87 citation statements)

References 9 publications

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“…6,9 One enterovirus, EV71, recently caused 2 large epidemics with many fatal cases in Malaysia and Taiwan 10,15 and was studied in Taiwan to delineate the seroepidemiologic background in which an EV71 epidemic occurred and the risk factors associated with EV71 infection and disease.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors of Enterovirus 71 Infection and Associated Hand, Foot, and Mouth Disease/Herpangina in Children During an Epidemic in Taiwan

et al. 2002

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ABSTRACT.Objective. In 1998, an enterovirus 71 (EV71) epidemic in Taiwan was associated with hand, foot, and mouth disease (HFMD)/herpangina and involved 78 fatal cases. We measured EV71 seroprevalence rates before and after the epidemic and investigated risk factors associated with EV71 infection and illness.Methods. Neutralizing antibodies to EV71 were assayed for 539 people before the epidemic and 4619 people of similar ages after the epidemic. Questionnaires, which were completed during household interviews after the epidemic, solicited demographic variables, exposure history, and clinical manifestations.Results. A total of 129 106 cases of HFMD were reported during the epidemic. Age-specific pre-epidemic EV71 seroprevalence rates were inversely related to agespecific periepidemic mortality rates (r ‫؍‬ ؊0.82) or severe case rates (r ‫؍‬ ؊0.93). Higher postepidemic EV71 seropositive rates among children who were younger than 3 years positively correlated with higher mortality rates in different areas (r ‫؍‬ 0.88). After the epidemic, 51 (56%) of 91 younger siblings of elder siblings who were EV71-seropositive were EV71-seropositive; otherwise, 2.2% (4 of 186) of younger siblings were EV71-seropositive (matched odds ratio [OR]: 10; 95% confidence interval [CI]: 3.4 -29). Stepwise multiple logistic regression revealed other factors associated with EV71 infection to be older age (adjusted OR: 2.5; 95% CI: 1.9 -3.4), attendance at kindergartens/child care centers (adjusted OR: 1.8; 95% CI: 1.3-2.5), contact with HFMD/herpangina (adjusted OR: 1.6; 95% CI: 1.2-2.1), greater number of children in a family (adjusted OR: 1.4; 95% CI: 1.1-1.7), and rural residence (adjusted OR: 1.4; 95% CI: 1.2-1.6). Twenty-nine percent of preschool children who were infected with EV71 developed HFMD/herpangina. Younger age and contact with HFMD/herpangina were significant factors for the development of EV71-related HFMD/herpangina in these children.Conclusions. An increased incidence of EV71 infection in young children occurred more often in geographic areas with increased mortality rates. Intrafamilial and kindergarten transmissions among preschool children were major modes of disease transmission during the widespread EV71 epidemic in Taiwan in 1998. Pediatrics 2002;109(6). URL: http://www.pediatrics.org/cgi/content/ full/109/6/e88; enterovirus 71; hand, foot, and mouth disease; seroprevalence; transmission; risk factors; symptomatic ratio; reemerging infectious disease; Taiwan.ABBREVIATIONS. EV71, enterovirus 71; HFMD, hand, foot, and mouth disease; OR, odds ratio; CI, confidence interval; SD, standard deviation. E nterovirus 71 (EV71) has been associated with outbreaks in the United States, Europe, Australia, Japan, Brazil, and Malaysia 1-10 since it was originally recognized in l969 in California. 1 Before 1998, 3 large outbreaks with dozens of fatal cases occurred in Bulgaria in 1975, Hungary in 1978, and Malaysia in 1997 However, few studies have investigated the mode of transmission, the protective effect of preexisting EV71...

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Section: Discussionmentioning

confidence: 99%

Risk Factors of Enterovirus 71 Infection and Associated Hand, Foot, and Mouth Disease/Herpangina in Children During an Epidemic in Taiwan

et al. 2002

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“…Although not seen in the present case, acute flaccid paralysis is one of the CNS complications associated with EV 71 infection. It can be clinically indistinguishable from paralytic poliomyelitis at times because the patterns of spinal involvement are similar (14). Hence, EV 71 should be included in the differential diagnosis of paralytic disease and brainstem encephalitis in children.…”

Section: Discussionmentioning

confidence: 99%

“…Eight sets of primers were used for amplification and sequencing of the entire genome of the viral DNA. They were designed from published sequence data of EV 71 BrCr strain: primer pair I, 5Ј-TTAAAA-CAGCTGTGGGTTG [nucleotide (nt) [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] as the sense strand primer, 5Ј-GAACTTCCAGTACCACCCC (nt 1196 -1178) as the antisense strand primer; primer pair II, 5Ј-TATGGTGAGTGGCCTTCATACTG (nt 1053-75) as the sense strand primer, 5Ј-AGTGAGTGTTAC-TGATCCATGGT (nt 2241-2218) as the antisense strand primer; primer pair III, 5Ј-TACACACCACCAG-GAGGCCCCT (nt 2115-2126) as the sense strand primer, 5Ј-ACCAGCATAATTTGGGTTGGCT (nt 3282-3261) as the antisense strand primer; primer pair IV, 5Ј-TTCCATTCATGT -CACCTGCGA (nt 2964 -2984) as the sense strand primer, 5Ј-GAAATGGGCGAG -GTATGACACA (nt 4291-4269) as the antisense strand primer; primer pair V, 5ЈATTAGTAAGTTTATT-TATTGGCT(nt 4149 -4171) as the sense strand primer, 5Ј-ACAACTGCAACCACAGTTGCTAT(nt 5271-5249) as the antisense strand primer; primer pair VI, 5Ј-TCCATTGCTACTGTGGTAGCAGT (nt 5253-5275) as the sense strand primer, 5Ј-TAGCAGGCTTCTTCC-ATTCTCAT (nt 6241-6219) as the antisense strand primer; primer pair VII, 5Ј-ACTAAGCTGGAA-CCCAGTG (nt 6003-6021) as the sense strand primer, 5Ј-ATAACAAATTTACCCCCACC (nt 7396 -7377) as the antisense strand primer; primer pair VIII, 5Ј-GAGAAATTTGTGAGTACAA (nt 7227-7245) as the sense strand primer, 5Ј-AGCAGTGGTAACAACGC-AGAG-TACT(30)CN (nt 7408 -7342). RT-PCR was carried out by RT-PCR beads (Pharmacia Biotech, Sweden).…”

Section: Reverse Transcriptase-polymerase Chain Reaction (Rt-pcr) Ampmentioning

confidence: 99%

Acute Encephalomyelitis during an Outbreak of Enterovirus Type 71 Infection in Taiwan: Report of an Autopsy Case with Pathologic, Immunofluorescence, and Molecular Studies

et al. 2000

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We report a fatal case of enterovirus type 71 (EV 71) infection in an 8-year-old girl during a summer outbreak of hand, foot, and mouth disease in 1998 in Taiwan. The clinical course was rapidly progressive, with manifestations of hand, foot, and mouth disease, aseptic meningitis, encephalomyelitis, and pulmonary edema. The patient died 24 hours after admission. Postmortem study revealed extensive inflammation in the meninges and central nervous system and marked pulmonary edema with focal hemorrhage. Brain stem and spinal cord were most severely involved. The inflammatory infiltrates consisted largely of neutrophils involving primarily the gray matter with perivascular lymphocytic cuffing, and neuronophagia. The lungs and heart showed no evidence of inflammation. EV 71 was isolated from the fresh brain tissues and identified by immunofluorescence method with type-specific EV 71 monoclonal antibody. It was also confirmed by neutralization test and reverse-transcriptase polymerase chain reaction with sequence analysis. The present case was the first example in which EV 71 was demonstrated to be the causative agent of fatal encephalomyelitis during its epidemic in Taiwan. Enterovirus type 71 (EV 71), a member of the genus enterovirus within the family picornavirus, was initially isolated from the feces of a 9-month-old infant with fatal encephalitis in California in 1969 (1). Subsequent outbreaks were encountered in New

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“…An epidemic of enterovirus 71 infection in 1998 in Taiwan resulted in over 400 cases of neurologic diseases and an estimated 1.5 million cases of HFMD and herpangina (7). Outbreaks of EV71-associated diseases have also been reported in the United States, Australia, Sweden, Japan, Bulgaria, Hungary, Hong Kong, Malaysia, Vietnam, and China (8)(9)(10)(11)(12)(13)(14)(15)(16). It has been associated with a variety of clinical diseases, including HFMD, herpangina, aseptic meningitis, encephalitis, and even fatal pulmonary edema or hemorrhage (17).…”

mentioning

confidence: 99%

Conformational Plasticity of the 2A Proteinase from Enterovirus 71

Cai

Yameen²,

Liu

et al. 2013

J Virol

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Enterovirus Type 71 Infections: A Varied Clinical Pattern Sometimes Mimicking Paralytic Poliomyelitis

Cited by 154 publications

References 9 publications

Risk Factors of Enterovirus 71 Infection and Associated Hand, Foot, and Mouth Disease/Herpangina in Children During an Epidemic in Taiwan

Risk Factors of Enterovirus 71 Infection and Associated Hand, Foot, and Mouth Disease/Herpangina in Children During an Epidemic in Taiwan

Acute Encephalomyelitis during an Outbreak of Enterovirus Type 71 Infection in Taiwan: Report of an Autopsy Case with Pathologic, Immunofluorescence, and Molecular Studies

Conformational Plasticity of the 2A Proteinase from Enterovirus 71

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