Outbreaks of hand, foot, and mouth disease by enterovirus 71. High incidence of complication disorders of central nervous system.

Abstract

SUMMARY In Japan we have had two outbreaks of hand, foot, and mouth disease associated with disorders of the central nervous system, one in 1973 and the other in 1978. The isolated virus in both outbreaks was enterovirus 71. Central nervous system disorders were present in 24% of patients in 1973 and in 8% of patients in 1978. These disorders were localised encephalitis with cerebellar signs as the main feature, aseptic meningitis, and polio-like paresis. The enterovirus 71 isolated in Japan had strong dermatotropic as well as neurotropic tendencies. However in cross-neutralisation tests, no difference in antigenicity from the prototype, BrCr strain, was recognised.

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

“…The topographic distribution of EV 71 infection in CNS is localized to brain stem, basal ganglia and spinal cord (3,6,7,9). Our findings were comparable with those described in previous reports: de- spite widespread inflammation in CNS, the gray matter of spinal cord and brain stem was most severely involved, the areas from which EV 71 was isolated.…”

“…The epidemic areas were much smaller, the number of patients affected was fewer, and no fatality was reported. The variation in clinical presentations in different epidemics or in different patients in a particular epidemic might be caused by varying dermatotropic or neurotropic character of the virus strain involved (6). It seems that such difference depends upon the interaction between the binding sites of the virus and cell receptors of the target organs.…”

“…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).…”

“…Other than EV 71, Coxsackie virus A16 causes HFMD most frequently. The disease is usually self-limited without neurological deficits (6), whereas in HFMD associated with EV 71, serious and lethal complications may develop. There were two such outbreaks of EV 71 with rapid deterioration to death in young children previously (3,7).…”

Disease burden of enterovirus 71 in rural central China: A community-based survey

“…10 Most of the severe or fatal cases occurred in children under 3 years of age and were associated with EV71 infection. 11,12 In addition to the pain and suffering of children, these EV71-associated events resulted in increased medical expenses, lost productivity, and other costs to society while significantly impacting social and economic development.…”