Enterovirus A71 neurologic complications and long-term sequelae

Abstract

During recent 20 years, enterovirus A71 (EV-A71) has emerged as a major concern among pediatric infectious diseases, particularly in the Asia-Pacific region. The clinical manifestations of EV-A71 include uncomplicated hand, foot, and mouth disease, herpanina or febrile illness and central nervous system (CNS) involvement such as aseptic meningitis, myoclonic jerk, polio-like syndrome, encephalitis, encephalomyelitis and cardiopulmonary failure due to severe rhombencephalitis. In follow-up studies of patients with EV-A 71 CNS infection, some still have hypoventilation and need tracheostomy with ventilator support, some have dysphagia and need nasogastric tube or gastrostomy feeding, some have limb weakness/astrophy, cerebellar dysfunction, neurodevelopmental delay, lower cognition, or attention deficiency hyperactivity disorder. Long term sequelae may be related to greater severity of CNS involvement or neuron damage, hypoxia and younger age of onset.

Keywords: Age of onset; Attention deficiency hyperactivity disorder; Cognition; Encephalitis; Enterovirus A71; Polio-like syndrome; Rhombencephalitis; Sequelae; Tracheostomy.

Fig. 1

A child who had tracheostomy with ventilator support because he had central hypoventilation

Fig. 2

High-intensity lesions in the tegmentum of the brain stem (black arrow) and high-intensity lesions in the cervical spinal cord (gray arrow) on the T₂-weighted image of MRI in a case with the sequelae of central hypoventilation and right upper limb weakness and atrophy

Fig. 3

A boy who had left shoulder subluxation and left arm atrophy (arrow) due to polio-like syndrome