A multicenter study on clinical characteristics of severe hand, foot and mouth disease in East China

Abstract

Objective To investigate the clinical features of severe hand, foot and mouth disease(HFMD) in recent three years, and to analyse the risk factors of severe HFMD. Methods A multicenter collaborative research group was set up, including five children′s hospitals(pediatric department)with high incidence of HFMD.Prospective epidemiologic approaches were adopted.After training, staffs from the collaborative center executed the study by filling up the record forms. Results We collected 114 HFMD cases in stage 2, 75 cases of HFMD in stage 3, 37 cases of HFMD in stage 4 from April 2014 to October 2016.The age ranged from 2 months to 13 years old, the median age was 2 years old, younger than 3 years accounted for 86.3%.Fever was observed in all the severe HFMD, mean temperature was (39.2±0.7) ℃, fever lasted for (4.54±2.89)d.The mean heart rates in stage 2, 3, 4 were (128.2±13.3, 176.1±22.2, 184.2±27.5)times/min, respectively.The mean arterial pressure was (84.4±14.6) mmHg(1 mmHg=0.133 kPa), the mean respiratory rate was (39.0±8.4)times/min, the mean respiratory rates in stage 2, 3, 4 were (37.8±7.36, 38.7±8.13, 43.4±10.7) times/min, respectively.Respiratory rhythm abnormality in stage 2, 3, 4 were 9.6%, 14.9% and 56.8%, respectively.The blood glucose increased gradually in 2, 3 and 4 stages, the mean blood glucose in stage 4 was (12.4±4.74)mmol/L.The incidence of coma in stage 4 was higher than those in stage 2 and 3.Multivariate Logistic regression analysis found that tachycardia, drowsiness, coma, respiratory rate increase, respiratory rhythm abnormality, capillary refilling time more than 3 seconds were risk factors for severe HFMD. Conclusion The incidence of severe HFMD is still high in children under 3 years of age in last three years.The severe patients have obvious changes in the nervous, respiratory and circulatory system.Tachycardia, drowsiness, coma, respiratory rate increase, respiratoy rhythm abnormality, capillary refilling time more than 3 seconds are risk factors for severe HFMD. Key words: Severe hand, foot and mouth disease; Risk factors; Epidemiology,