Hand-foot-mouth disease and use of steroids, intravenous immunoglobulin, and traditional Chinese herbs in a tertiary hospital in Shantou, China

William Ba-Thein,Dangui Zhang,Jieling Chen

doi:10.1186/s12906-018-2259-9

Abstract

BackgroundIn contrast to the guidelines of World Health Organization (WHO) and United States-Centers for Disease Control and prevention (US-CDC), the Chinese national guidelines recommend the use of steroids, intravenous immunoglobulin (IVIG), or traditional Chinese herbs (TCHs) in hand-foot-mouth disease (HFMD) management. Their use and therapeutic efficacies are, however, unclear. We aimed to describe their use in and the clinical outcomes of hospitalized HFMD cases.MethodsA retrospective review of hospital medical records for HFMD cases during 2008–2016 was conducted in a medical school-affiliated tertiary hospital in Shantou, Guangdong, China.ResultsHospitalized children with the discharge diagnosis of HFMD (n = 3778), comprising mild (58.4%), severe (41.5%), and very severe (0.1%) cases, were enrolled in the study. Steroids, IVIG, and antiviral TCH Lan-Qin were respectively prescribed in 60.5, 37.1, and 71.0% of cases. Most cases (99.8%) recovered and six died. Recovery rate was lower with the use of IVIG and higher with Lan-Qin (alone or in combination with steroid) in the mild cases (Ps < 0.05). Longer hospital stay was observed with steroid/IVIG with or without Lan-Qin in the severe cases (Ps < 0.05).ConclusionsThis nine-year retrospective review shows 1) an increase in the incidence of HFMD as well as the use of steroids, IVIG, and TCH over time, 2) no significant advantage of using steroids and IVIG, either alone or in combination, in the management of mild HFMD cases, and 3) a higher recovery rate in mild HFMD cases with the use of antiviral TCH (Lan-Qin). Our findings need verification in a larger prospect study with cases from hospitals in other regions of China. Lan-Qin efficacy should be evaluated in randomized trials. Meanwhile, caution should be exercised in the extensive use of steroids and IVIG in HFMD management.

Highlights

In contrast to the guidelines of World Health Organization (WHO) and United States-Centers for Disease Control and prevention (US-Centers for Disease Control and Prevention (CDC)), the Chinese national guidelines recommend the use of steroids, intravenous immunoglobulin (IVIG), or traditional Chinese herbs (TCHs) in hand-foot-mouth disease (HFMD) management
In contrast to the WHO [2] or United States-Centers for Disease Control and prevention (US-CDC) guidelines [6], the Chinese national guidelines recommend the use of steroids and intravenous immunoglobulin (IVIG) for severe cases and traditional Chinese herbs (TCHs) for all HFMD cases [8]
Since the use and therapeutic efficacies of steroids, IVIG, and/or TCHs in HFMD remain unclear, we aimed to describe their use in hospitalized HFMD cases and the clinical outcomes

Summary

Introduction

In contrast to the guidelines of World Health Organization (WHO) and United States-Centers for Disease Control and prevention (US-CDC), the Chinese national guidelines recommend the use of steroids, intravenous immunoglobulin (IVIG), or traditional Chinese herbs (TCHs) in hand-foot-mouth disease (HFMD) management. Their use and therapeutic efficacies are, unclear. Hand-foot-mouth disease (HFMD) is a common viral illness that usually affects infants and children younger than 5 years old. It has been shown that anti-IL-6 neutralizing antibody therapy in EV71-infected mice increases the survival rates and immune cell activation and reduces tissue damage, indicating the potential usefulness of immunoglobulins in HFMD management [5]

Objectives

Methods

Results

Discussion

Conclusion