Abstract
BackgroundIn 2009, a nationwide sentinel surveillance for hand-foot-mouth disease (HFMD) and herpangina (HA) with neurologic complications was initiated in South Korea. We used this surveillance system to investigate the clinical characteristics of patients with either HFMD or HA with neurologic complications, with the aim of determining risk factors for severe neurologic complications.MethodsA retrospective review of medical records was conducted on all cases of HFMD and HA with neurologic complications that were reported in the national system between April 1, 2009 and December 31, 2014. A severe case was defined as having HFMD or HA with encephalitis, polio-like syndrome, or cardiopulmonary failure, and less-severe cases were defined as having HFMD or HA with aseptic meningitis.ResultsA total of 138 cases (less-severe: 90/138, 65.2%; severe: 48/138, 24.8%) were included from 28 hospitals; 28 ineligible cases were excluded. Of 48 severe cases, 27 (56.2%) had encephalitis; 14 (29.2%) had polio-like syndrome; and seven (14.6%) had cardiopulmonary syndrome. The median patient age was 36 months (IQR: 18–60) and 63 (45.7%) patients were female. Most patients completely recovered, except for seven cases that were fatal or resulted in long-term symptoms (5.1%, 3 patients with neurologic sequelae and 4 deaths). In a multivariable logistic regression analysis, lethargy (OR = 4.67, 95% CI: 1.37–15.96, P = 0.014), female sex (OR = 3.51, 95% CI: 1.17–10.50, P = 0.025), and enterovirus A71 (OR = 3.55, 95% CI: 1.09–11.57, P = 0.035) were significantly associated with severe neurologic complications in HFMD and HA patients.ConclusionIn patients with HFMD and HA, lethargy, female, and enterovirus A71 may predict severe neurologic complications.
Highlights
Hand-foot-mouth disease (HFMD) is a common viral infection syndrome in children that is characterized by macular, maculopapular, or vesicular rash on the hands, feet, mouth, buttocks, and other possible locations
A retrospective review of medical records was conducted on all cases of hand-foot-mouth disease (HFMD) and HA with neurologic complications that were reported in the national system between April 1, 2009 and December 31, 2014
A severe case was defined as having HFMD or HA with encephalitis, polio-like syndrome, or cardiopulmonary failure, and less-severe cases were defined as having HFMD or HA with aseptic meningitis
Summary
Hand-foot-mouth disease (HFMD) is a common viral infection syndrome in children that is characterized by macular, maculopapular, or vesicular rash on the hands, feet, mouth, buttocks, and other possible locations. Herpangina (HA) is characterized by fever and painful vesiculo-ulcerative oral lesions, without an accompanying skin rash [1]. Both HFMD and HA are caused by various enterovirus serotypes, with coxsackievirus A16 and enterovirus A71 (EV-A71) being the most common causative viral strains [1]. In 2009, a nationwide sentinel surveillance for hand-foot-mouth disease (HFMD) and herpangina (HA) with neurologic complications was initiated in South Korea. We used this surveillance system to investigate the clinical characteristics of patients with either HFMD or HA with neurologic complications, with the aim of determining risk factors for severe neurologic complications
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