Abstract
BackgroundEnterovirus 71 (EV71) is a great disease burden across the whole world, particularly in Southeast Asia. However, in recent decades, the pathogenesis of severe EV71 infection was not well understood. This study was aimed to investigate the correlation between the presence of viremia and the clinical severity of EV71 infection.MethodsWe organized a prospective cohort study and enrolled laboratory-confirmed EV71 cases in six tertiary care hospitals in Taiwan during the EV71 epidemic from 2011 to 2012. Blood samples were collected once in the acute stage, on the first day of admission. We used real-time RT-PCR to detect EV71 viremia. Demographical and clinical data were collected and the clinical severity was categorized into four grades. Data analysis was performed to identify the risk factors of viremia and the correlation between viremia and clinical severity of EV71 infection.ResultsOf the total 224 enrolled patients, 59 (26%) patients were confirmed to have viremia. Two-thirds (68%) of viremic cases were detected within the first three days of infection. Viremia occurred more frequently in children under the age of one year old (odds ratios [OR] 4.82, p < 0.001) but the association between the presence of viremia and complicated EV71 infection was not found (OR 1.02, p = 0.96). In the viremia group, patients had significantly more severe complications if viremia was detected after the third day of disease onset (26% vs. 5%, p = 0.03).ConclusionsViremia occurred more frequently in children under the age of one year and viremia detected beyond three days after the onset of disease correlated with more severe disease in EV71 patients.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-417) contains supplementary material, which is available to authorized users.
Highlights
Enterovirus 71 (EV71) is a great disease burden across the whole world, in Southeast Asia
We aimed to investigate whether viremia is correlated to the clinical severity of EV71 infection and seek to provide more information for further management of severe EV71 infection
Patients According to the laboratory-based surveillance system of Taiwan CDC, the baseline proportion of EV71 among all the enterovirus isolates from patients with enterovirus infections was about 2% but the proportion increased sharply between 2011 and 2012 and peaked in 2012 (45%) [26]
Summary
Enterovirus 71 (EV71) is a great disease burden across the whole world, in Southeast Asia. Environmental factors and viral factors have been investigated for a long time but no conclusion has been achieved [13,19,20,21,22] This problem impedes the progress of the development of a more focused treatment strategy. Intravenous immunoglobulin was used to treat severe EV71 infection based on its ability of virus neutralization and anti-inflammation, but the effectiveness was only based on retrospective researches [8,18]. It is crucial for the development of EV71-specific treatment to test whether a new antiviral drug or an immunomodulator is effective. We aimed to investigate whether viremia is correlated to the clinical severity of EV71 infection and seek to provide more information for further management of severe EV71 infection
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