Hand, foot and mouth disease in Singapore: a comparison of fatal and non‐fatal cases

Abstract

Aim: An epidemic of hand, foot and mouth disease (HFMD) occurred in Singapore between September and November 2000. During the epidemic, there were four HFMD‐related deaths and after the epidemic, another three HFMD‐related deaths. This study sought to determine the risk factors predictive of death from HFMD disease. Methods: The risk factors for fatal HFMD were determined by comparing clinical and laboratory findings between fatal cases (n= 7) and non‐fatal controls (n= 131) admitted between September 2000 and April 2001. Enterovirus 71 positive fatal cases (n= 4) and non‐fatal controls (n= 63) were also compared. Results: In total, 138 HFMD cases with a mean age of 32 mo were studied. The majority of fatal cases died from interstitial pneumonitis, of whom three also had brainstem encephalitis. Of the 131 non‐fatal cases, 3 had concomitant infections (respiratory syncytial virus bronchiolitis, right‐sided pneumonia, Haemo‐philus influenzae type b meningitis), 2 had aseptic meningitis, and 1 each had transient drowsiness, intravenous immunoglobulin‐related complications and transverse myelitis. By multivariate logistic regression analysis, atypical physical findings (p= 0.0006), raised total white cell count (p= 0.0128), vomiting (p= 0.0116) and absence of mouth ulcers (p= 0.043) were predictive of a fatal course. Although previous epidemics have described neurogenic pulmonary oedema as the main cause of death, the fatal cases in this study died mainly from interstitial pneumonitis alone or with myocarditis or encephalitis. Conclusion: Although HFMD is generally a benign disease, risk factors such as vomiting, absence of mouth ulcers, atypical presentation and raised total white cell count should alert the physician of a fatal course of illness.

Enterovirus infections in Singaporean children: an assessment of neurological manifestations and clinical outcomes

“…While several previous studies examined Singaporean children with enterovirus infections, (1,9,(13)(14)(15) none of them focused on the neurological manifestations associated with the disease. This is of clinical concern, as enterovirus infection is one of the more common childhood infections and the neurological manifestations arising from enterovirus infections can lead to long-term neurological sequelae.…”

“…(1,9,(13)(14)(15) This study aimed to describe the prevalence and range of neurological manifestations in Singaporean children diagnosed with enterovirus infections. It also aimed to determine the possible clinical characteristics associated with the development of neurological manifestations in these children and to assess differences in clinical outcomes for patients with and without neurological manifestations.…”

Performance of reversed transcription loop-mediated isothermal amplification technique detecting EV71: A systematic review with meta-analysis

“…In recent years, EV71 associated outbreaks have been reported worldwide and its infection has become serious threat to the health of infants and young children (3)(4)(5)(6)(7). EV71 infection can cause various clinical manifestations and has been associated with severe neurological and cardiopulmonary complications, such as aseptic meningitis, encephalitis, and poliomyelitis-like paralysis, resulting in higher mortality rates (8)(9)(10)(11).…”

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“…Taiwan reported the largest HFMD outbreak in 1998 involving 1.5 million cases with 78 deaths [14]. In 2000, a large HFMD outbreak occurred in Singapore involving 3790 patients and there were 5 deaths, 3 due to HFMD and 2 to non-HFMD [15]. Since then, HFMD is recognised as an endemic mild disease in both Malaysia and Singapore.…”