Enterovirus 71-associated hand, foot and mouth diseases with neurologic symptoms, a university hospital experience in Korea, 2009

• Main Authors: Hye Kyung Cho, Na Yong Lee, Hyunju Lee, Hae Soon Kim, Jeong Wan Seo, Young Mi Hong, Seung Joo Lee, Sun Wha Lee, Doo Sung Cheon, Ji Young Hong, Byung Hak Kang, Jong-Hyun Kim, Kyung-Hyo Kim
• Format: Article
• Language: English
• Published: Korean Pediatric Society 2010-05-01
• Series: Korean Journal of Pediatrics
• Subjects: Human enterovirus 71; Hand- foot-mouth disease; Neurologic manifestation
• Online Access: http://kjp.or.kr/upload/pdf/kjped-53-639.pdf
• ISSN: 1738-1061; 2092-7258

PurposeHand-foot-mouth disease (HFMD) is a common viral illness in children, which is usually mild and self-limiting. However, in recent epidemics of HFMD in Asia, enterovirus 71 (EV71) has been recognized as a causative agent with severe neurological symptoms with or without cardiopulmonary involvement. HFMD was epidemic in Korea in the spring of 2009. Severe cases with complications including death have been reported. The clinical characteristics in children with neurologic manifestations of EV71 were studied in Ewha Womans University Mokdong Hospital.MethodsExaminations for EV71 were performed from the stools, respiratory secretion or CSF of children who presented neurologic symptoms associated with HFMD by realtime PCR. Clinical and radiologic data of the patients were collected and analyzed.ResultsEV71 was isolated from the stool of 16 patients but not from respiratory secretion or CSF. Among the 16 patients, meningitis (n=10) was the most common manifestation, followed by Guillain-Barré syndrome (n=3), meningoencephalitis (n=2), poliomyelitis-like paralytic disease (n=1), and myoclonus (n=1). Gene analysis showed that most of them were caused by EV71 subgenotype C4a, which was prevalent in China in 2008.ConclusionBecause EV71 causes severe complications and death in children, a surveillance system to predict upcoming outbreaks should be established and maintained and adequate public health measures are needed to control disease.