Hand, foot and mouth disease in Singapore: a comparison of fatal and non-fatal cases

被引:97
作者
Chong, CY
Chan, KP
Shah, VA
Ng, WYM
Lau, GKK
Teo, TES
Lai, SH
Ling, AE
机构
[1] KK Womens & Childrens Hosp, Dept Paediat Med, Singapore 229899, Singapore
[2] Singapore Gen Hosp, Dept Pathol, Singapore 0316, Singapore
[3] Hlth Sci Author, Ctr Forens Med, Singapore, Singapore
关键词
encephalitis; enterovirus; hand; foot and mouth disease; interstitial pneumonitis;
D O I
10.1080/08035250310005242
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Aim: An epidemic of hand, foot and mouth disease (HFMD) occurred in Singapore between September and November 2000. During the epidemic, there were four HFMD-related deaths and after the epidemic, another three HFMD-related deaths. This study sought to determine the risk factors predictive of death from HFMD disease. Methods: The risk factors for fatal HFMD were determined by comparing clinical and laboratory findings between fatal cases (n = 7) and non-fatal controls (n = 131) admitted between September 2000 and April 2001. Enterovirus 71 positive fatal cases (n = 4) and non-fatal controls (n = 63) were also compared. Results: In total, 138 HFMD cases with a mean age of 32 mo were studied. The majority of fatal cases died from interstitial pneumonitis, of whom three also had brainstem encephalitis. Of the 131 non-fatal cases, 3 had concomitant infections (respiratory syncytial virus bronchiolitis, right-sided pneumonia, Haemophilus influenzae type b meningitis), 2 had aseptic meningitis, and 1 each had transient drowsiness, intravenous immunoglobulin-related complications and transverse myelitis. By multivariate logistic regression analysis, atypical physical findings (p = 0.0006), raised total white cell count (p = 0.0128), vomiting (p = 0.0116) and absence of mouth ulcers (p = 0.043) were predictive of a fatal course. Although previous epidemics have described neurogenic pulmonary oedema as the main cause of death, the fatal cases in this study died mainly from interstitial pneumonitis alone or with myocarditis or encephalitis. Conclusion: Although HFMD is generally a benign disease, risk factors such as vomiting, absence of mouth ulcers, atypical presentation and raised total white cell count should alert the physician of a fatal course of illness.
引用
收藏
页码:1163 / 1169
页数:7
相关论文
共 26 条
  • [1] NEONATAL ENTEROVIRUS INFECTION - VIROLOGY, SEROLOGY, AND EFFECTS OF INTRAVENOUS IMMUNE GLOBULIN
    ABZUG, MJ
    KEYSERLING, HL
    LEE, ML
    LEVIN, MJ
    ROTBART, HA
    [J]. CLINICAL INFECTIOUS DISEASES, 1995, 20 (05) : 1201 - 1206
  • [2] BLOMBERG J, 1974, LANCET, V2, P112
  • [3] A polymerase chain reaction-based epidemiologic investigation of the incidence of nonpolio enteroviral infections in febrile and afebrile infants 90 days and younger
    Byington, CL
    Taggart, EW
    Carroll, KC
    Hillyard, DR
    [J]. PEDIATRICS, 1999, 103 (03) : art. no. - e27
  • [4] Isolation of subgenus B adenovirus during a fatal outbreak of enterovirus 71-associated hand, foot, and mouth disease in Sibu, Sarawak
    Cardosa, MJ
    Krishnan, S
    Tio, PH
    Perera, D
    Wong, SC
    [J]. LANCET, 1999, 354 (9183) : 987 - 991
  • [5] Chan KP, 2003, EMERG INFECT DIS, V9, P78
  • [6] Comparison of enterovirus 71 and coxsackievirus A16 clinical illnesses during the Taiwan enterovirus epidemic, 1998
    Chang, LY
    Lin, TY
    Huang, YC
    Tsao, KC
    Shih, SR
    Kuo, ML
    Ning, HC
    Chung, PW
    Kang, CM
    [J]. PEDIATRIC INFECTIOUS DISEASE JOURNAL, 1999, 18 (12) : 1092 - 1096
  • [7] Clinical features and risk factors of pulmonary oedema after enterovirus-71-related hand, foot, and mouth disease
    Chang, LY
    Lin, TY
    Hsu, KH
    Huang, YC
    Lin, KL
    Hsueh, C
    Shih, SR
    Ning, HC
    Hwang, MS
    Wang, HS
    Lee, CY
    [J]. LANCET, 1999, 354 (9191) : 1682 - 1686
  • [8] Enterovirus associated neurological disease in an HIV-1 infected man
    Dyer, JR
    Edis, RH
    French, MAH
    [J]. JOURNAL OF NEUROVIROLOGY, 1998, 4 (05) : 569 - 571
  • [9] PEDUNCULAR HALLUCINOSIS - MAGNETIC-RESONANCE-IMAGING CONFIRMATION OF MESENCEPHALIC INFARCTION DURING LIFE
    GELLER, TJ
    BELLUR, SN
    [J]. ANNALS OF NEUROLOGY, 1987, 21 (06) : 602 - 604
  • [10] PONTINE LESION IN OPSOCLONUS-MYOCLONUS SYNDROME SHOWN BY MRI
    HATTORI, T
    HIRAYAMA, K
    IMAI, T
    YAMADA, T
    KOJIMA, S
    [J]. JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 1988, 51 (12) : 1572 - 1575