Risk factors for severe hand foot mouth disease in Singapore: a case control study.

So-Phia Chew,Jan Hau Lee,Shu-Ling Chong,Yoke Hwee Chan,Sylvaine Barbier,Aji Matthew

doi:10.1186/s12879-015-1195-2

So-Phia Chew, Jan Hau Lee + Show 4 more

Open Access

https://doi.org/10.1186/s12879-015-1195-2

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Abstract

BackgroundHand foot mouth disease (HFMD) is a common childhood infection that can potentially lead to serious complications. The aim of this study is to identify risk factors of acquiring severe HFMD in our population.MethodsWe performed a case control study using patients admitted to our hospital from August 2004 to July 2014. Cases were patients with severe HFMD disease while controls were age-matched patients obtained from the same year, in a 2:1 ratio. Data comprising demographic characteristics, clinical symptoms and signs, and lab findings were collected. Conditional univariable logistic regression was performed to determine risk factors for severe disease.ResultsA total of 24 cases of severe HFMD were identified and matched with 48 controls. Seventeen (70.8 %) cases had central nervous system complications. Seven (29.2 %) had cardiovascular complications without evidence of myocarditis. One patient died of encephalitis. The overall mortality of severe disease is 4 %. Evidence of hypoperfusion, seizure, altered mentation, meningeal irritation, tachycardia, tachypnea, raised absolute neutrophil count and EV-A71 (Enterovirus A71) positivity were significantly associated with a severe course of HFMD.ConclusionIn managing children with HFMD, physicians should consider these factors to help identify patients at risk for severe disease.

Highlights

Hand foot mouth disease (HFMD) is a common childhood infection that can potentially lead to serious complications
We identified a total of 24 cases of severe HFMD disease during the study period, which were matched with 48 controls
The patient with only 1 day of Intensive care unit (ICU) stay died shortly after admission. Out of those who were admitted to ICU, 5 children required intubation for prolonged seizure or poor Glasgow Coma Score (GCS)

Summary

Introduction

Hand foot mouth disease (HFMD) is a common childhood infection that can potentially lead to serious complications. Hand foot and mouth disease (HFMD) is a common childhood infection characterized typically by fever with mouth ulcers, eruption of vesiculo-papular rash over the hands, soles and/or buttocks It is caused by a group of enteroviruses, most frequently Coxsackie A16 and Enterovirus-A71 (EV-A71). While the majority of HFMD cases are mild and selflimiting, severe complications such as encephalitis, meningitis, acute flaccid paralysis, myocarditis and pulmonary edema have been reported [2,3,4]. These complications may result in significant morbidity or even mortality.

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