Study on Risk Factors for Severe Hand, Foot and Mouth Disease in China

Abstract

BackgroundEpidemics of HFMD are elevated every year globally, especially in mainland China. The disease now presents as an increasing threat to public health worldwide.MethodsFive hundred and seventy-one EV71-infected HFMD patients in Beijing You'an Hospital were grouped by disease severity: Mild (no severe complication) (n = 221), and Severe group (complicated with brainstem encephalitis (BE), and/or pulmonary edema (PE) (n = 350)). Clinical and laboratory findings and levels of 7 serum cytokines were analyzed.ResultsUnivariate analysis showed that (RR)>26/min (p<0.001), age<4 yo (p = 0.001), GLU>8.3 mmol/L (p = 0.008), CL<98 mmol/L (p = 0.026), and WBC>1.2×109/L (p = 0.040) were associated with severe cases. Results of multivariate analysis indicated five independent risk factors (RR>26/min (p<0.001), Age<4 yo (p<0.001), GLU>8.3 mmol/L (p = 0.011), LYM>40% (p = 0.010), and ALT>40 U/L (p = 0.045)). In addition to single-factor analysis, we further analyzed the use of different combinations of risk factors. “GLU>8.3 and CL<98 and RR>26” (confidence ration (CR) = 100%) is the top indicator, followed by “ALT>40 and LYM>40% and RR>26 and Age<4 yo” (CR = 92.9%).Serum levels of IL-2, IL-4, IL-10, IFNγ, GM-CSF, and TNFα were higher in severe cases than in mild cases. A new evaluation scoring system by scoring each risk factor 1 and independent risk factor 2 was developed for early identification of severe HFMD cases.ConclusionsFive independent risk factors, along with indicative combinations of risk factors, for severe cases were identified, and a scoring system was created to facilitate the use of indicators for early medical intervention.

Factors associated with hand foot mouth disease among children in day care center, Chiang Rai, Thailand

“…This is similar with the meta analysis from the papers published in Asia which reported that age and being female were the major risk factors of HFMD [24]. Some studies [25][26][27] reported that age was the main risk factor for HFMD particularly age < 4 years old.…”

New Findings, Classification and Long-Term Follow-Up Study Based on MRI Characterization of Brainstem Encephalitis Induced by Enterovirus 71

“…Brainstem encephalitis, which can cause neurogenic pulmonary edema/hemorrhage and cardiorespiratory failure, or even fatality, was considered as the most critical neurological complication, drawing great attention from the medical community[1]. Results of multivariate analysis indicated RR.26/min, Age<4yo, GLU.8.3>mmol/L, LYM.>40% were risk factors [8]. In our present study, the average age was 2.6 (±1.9) years, 54 were males, accounting for 59%.…”

Joint diagnosis of pediatric and dermatology clinics: Prospective observation of thirtynine patients with hand, foot and mouth disease

“…EAAH'nin salgınlara yol açtığı bölgeler dikkate alındığında, literatürde hekimler için uyarıcı olabilecek hastalık şiddet skorlamaları yapıldığı görülmektedir. EAAH'nin şiddetini gösteren kriterler Tablo 4'de paylaşıldı 14,20,21 . Hastalarımızın çoğu 5 yaş altı çocuklardan oluşsa da, hiçbirinde hastalığın şiddetli seyredeceğine dair klinik ve laboratuvar göstergelere rastlanmadı.…”

“…'nın 8 bir çalışmasında, 127 hastanın sadece 1'inde onikomadezis tespit etmiştir 7,9 . Yurtdışından yapılan çalışmalarda 21 Liu et al 14 Ooi et al 20 Solunum sayısı >26/dk Kostipasyon Yaş <2 yıl ise, tırnak tutulumu %37,6-46,6 arasında değişen oranlarda bildirilmektedir 13,28 . Hastalarımızın 10'unda (%25,6) onikomadezis ve/veya Beau's çizgileri görüldü.…”