Clinical Features And Logistic Regression Analysis On Severe Illness Risk Factors With Hand,Floot And Mouth Disease

Objective:summarize and analysize the clinical features, Laboratory features, treatment and prognosis of mild and severe hand, foot and mouth disease, study the high risk factors for occurrence of severe cases, and provide reference for predictor factors and diagnosis of severe case.Methods:The sick children with HFMD treated in Zibo maternal and Child Health Hospital from January2008to December2010were recruited and divided into the general illness and severe illness groups according to their status. The difference was analyzed on the clinical manifestation and the laboratory findings between the two groups. Then the high risk factors of severe illness were analyzed by logistic regression analysis.Results:1465recruited cases with HFMD included912males and553females, among which there were907cases involving children younger than3years old (61.9%), The general illness group included1246cases and the severe illness group included219cases.(1)249cases were with high fever (20%) and the fever duration was(2.42±1.42)d in the general illness group, while111cases were with high fever (50.1%) and the fever duration was (4.60±2.11)d in the severe illness group.(2) The nosocomial infection took place in42cases(4.2%) in the general illness group, while20cases(9.4%) in the severe illness group.(3)The hospitalization time was (6.56±1.61)d in the general illness group and (12.86±2.70)d in the severe illness group.(4)The leukocyte count, neutrophil count, blood glucose and ESR in the severe illness group were obviously higher than those in the general illness group (P<0.05), while CK and CKMB in the severe illness group were obviously lower than those in the general illness group (P<0.05). There was no statistical significance in CRP, cardiac troponin, platelet count and hemoglobin between the two groups (P>0.05). Etiology detection was conducted in256cases (the general illness group included182cases and the severe illness group included74cases) with swabs, feces, each copy of serum during acute phase and convalescence phase respectively to detect EV71. Positive EV71was detected in23cases including13cases (7.1%) from the general illness group and10(13.5%) from the severe illness group. The electrocardiographic abnormality rate amounted to40.4%(288/625cases) in the general illness group and48.3%(85/176cases) in the severe illness group. Chest X-ray abnormal rate came to33.9%(217/640cases) in the general group and34.2%(54/158) in the severe group.The clinical manifestations of nervous in the severe illness group included symptoms:myoclonic tic (86.76%,190/219), weakness(74.89%,164/219), vomiting (31.51%,69/219), sleepiness (30.59%,67/219), limb asthenia (28.77%,63/219), limbs tremor (20.55%,45/219), headache (15.07%,33/219), dysphasia (14.61%,32/219), panic (9.13%,20/219), convulsion (1.83%,4/219), limb paralysis (0.91%,2/219), coma(0.46%,1/219). Signs:positive Babinski sign(28.3%,62/219), neck resistance (13.7%,4/219), Knee tendon hyperreflexia (11.42%,25/219) muscular hypertonia (3.65%,8/219),Knee tendon reflexes diminished or disappeared (3.20%,7/219), klinefelter’s syndrome (1.83%,4/219), decreasing of muscle tone (1.37%,3/219), positive of ankle clonus (1.37%,3/219),muscle weakness (0.91%,2/219), Brudzinski’ syndrom (0.91%,2/219).The main manifestations of the respiratory and circulatory system with regard to the severe group were as follows:increased respiratory rate was detected in29cases (13.2%) and increased heart rate in32cases(14.6%), CRT extended in2cases (0.91%), increased blood pressure in43cases (19.6%), bad peripheral circulation in7cases (3.2%) and lung moist rale in1case(0.46%).Electroencephalogram abnormalities accounted for51.9%(69/133cases) in the sever illness group with such characteristics as slow wave and spike and slow complex waves together with47of133cases in borderline states (35.3%) and head CT4/61cases(6.6%) and head MRT17/109case(15.6%) as well.The multi-factors Logistic analysis showed that the high risk factors key to the translation from the severe illness cases to the critical illness cases were as follows: high fever (OR=1.7812,95%CI:1.41262.2459), fever duration(OR=1.7174,95%CI:1.52671.9319), neutrophils elevation (OR=1.1867,95%CI:1.09621.2846), blood sugar elevation(OR=1.6199,95%CI:1.30732.0073).treatment and prognosis:all patients were cured or got better to leave the hospital without death cases, and the6-12month follow-up found no evidence of obvious mental retardation and secondary epilepsy and body paralysis, etc.Conclusion:Hand, foot and mouth disease mainly occurrs to children ranging from one year old to three years old with the characteristics of more occurences to boys and rural regions and a high incidence period beginning from June to August. The incipient symptoms and physical signs of severe hand,foot and mouth disease cover listless, fidget,somnolence,headache, vommitting, panic, body tremor, muscle spasm and muscle weakness. The high risk factors critical to the translation from the severe illness cases to the critical illness cases include high fever, fever duration, neutrophils elevation, blood sugarelevation.