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. 2019 Mar 27;19(1):285.
doi: 10.1186/s12879-019-3878-6.

Clinical characteristics and managements of severe hand, foot and mouth disease caused by enterovirus A71 and coxsackievirus A16 in Shanghai, China

Kang Cai  1 , Yizhong Wang  2 , Zhongqin Guo  3 , Huiju Yu  1 , Huajun Li  1 , Liya Zhang  1 , Shanshan Xu  1 , Qingli Zhang  4   5
Affiliations

Clinical characteristics and managements of severe hand, foot and mouth disease caused by enterovirus A71 and coxsackievirus A16 in Shanghai, China

Kang Cai et al. BMC Infect Dis. .

Abstract

Background: Hand, foot and mouth disease (HFMD) is a transmissible infectious disease caused by human enteroviruses (EV). Here, we described features of children with severe HFMD caused by EV-A71 or coxsackievirus A16 (CV-A16) in Shanghai, China.

Methods: Severe EV-A71 or CV-A16 caused HFMD children admitted to the Xinhua Hospital from January 2014 and December 2016, were recruited retrospectively to the study. Symptoms and findings at the time of hospitalization, laboratory tests, treatments, length of stay and residual findings at discharge were systematically recorded and analyzed.

Results: Of 19,995 children visited clinic service with probable HFMD, 574 children (2.87%) were admitted, 234 children (40.76%) were confirmed with EV-A71 (90/574) or CV-A16 (144/574) disease. Most (91.02%) of the patients were under 5 years. Initial clinical symptoms of EV-A71 and CV-A16 cases were: fever > 39 °C in 81 (90%) and 119 (82.63%), vomiting in 31 (34.44%) and 28 (19.44%), myoclonic twitching in 19 (21.11%) and 11(7.64%), startle in 21 (23.33%) and 20 (13.69%), respectively. Serum levels of interleukin-1β (IL-1β), IL-2, IL-6, IL-8, interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α) were significantly upregulated in severe HFMD subjects. Forty-seven children (20.08%) treated with intravenous gamma globulin (IVIG) showed decreased duration of illness episodes. All children were discharged without complications.

Conclusions: EV-A71 and CV-A16 accounted 40.76% of admitted HFMD during 2014 to 2016 in Xinhua Hospital. IVIG appeared to be beneficial in shortening the duration of illness episodes of severe HFMD.

Keywords: Children; Coxsackievirus A16; Enterovirus A71; Foot and mouth disease; Hand; Intravenous gamma globulin intervention.

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Conflict of interest statement

Ethics approval and consent to participate

This study was carried out in accordance with the recommendations of the Declaration of Helsinki, World Medical Association. The protocol was approved by the Ethical Review Board of Xinhua Hospital. Written informed consent was obtained from parents or legal guardians of all children eligible for study enrollment.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The seasonal pattern of HFMD clinic visits (a), admissions (b), and EV-A71, CV-A16 admissions (c) from January 2014 to December 2016 in Xinhua Hospital
See this image and copyright information in PMC

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