| Objective:To analyze the etiology of hand-foot-mouth disease(HFMD)cases with bullous lesions on skin mucosa,and explore the clinical characteristics of HFMD,so as to provide valuable information for clinical work.Methods:Totally 81 children with hand-foot-and-mouth disease(HFMD)characterized by bullous rash admitted to the Department of Infectious Diseases of Children’s Hospital of Soochow University from January 1,2018 to December 31,2019were included into the case group.Samples of their pharynx swabs were collected for detection of intestinal viral nucleic acid by real-time fluorescence quantitative PCR.Using gender,age(±6 month),season as the matching condition in the form of sample size 1:2filter matching standard,162 patients were selected as control group from patients with typical hand,foot and mouth disease in the same period.Retrospectively analyzed the clinical features and laboratory results of this two groups of children.Results:1.Among the 81 children diagnosed with HFMD characterized by bullous rash,53(65.4%)were positive for coxsackievirus A6,14(17.3%)were positive for coxsackievirus B5,10(12.3%)were positive for coxsackievirus A10,3 were positive for coxsackievirus A16 and were positive for enterovirus 71(4.9%).The outcome of etiology was statistically significant(?~2=73.123,P<0.01).Time distributition:there were 9 cases in May(11.1%),11 cases in June(13.6%),12 cases in July(14.8%),28 cases in May(34.6%),21cases in September(25.9%),the distribution of month was statistically significant(?~2=15.975,P<0.01).From 2018 to 2019,there were 9 cases in spring(11.1%),52cases in summer(62.4%),22 cases in automn(24.7%),0 cases in winter.The distribution of season was statistically significant(?~2=34.667,P<0.01).Among the 81 cases with positive enterovirus nucleic acid test,50 were male and 31were female,with a male-to-female ratio of 1.61:1.The age of HFMD characterized by bullous rash range from 4 months and 21 days to 5 years old.The mean age was 1.91±1.07years old,and the median age was 1.5 years old.Among the 81 children with HFMD,16(19.8%)were children in child care,61(75.3%)were children scattered,and4(4.9%)were other.The distribution of children type was statistically significant(?~2=66.889,P<0.01)..2.Children with hand,foot and mouth disease characterized by bulla-like rash also had macules,maculopapules,herpes and blisters,and some cases may have ulceration.In terms of rash morphology,the macules and maculopapules in the case group were less than those in the control group,with statistically significant differences(all P<0.01).The incidence of herpes and blisters in the case group was greater than that in the control group,with statistically significant differences(P all<0.01).About the associated symptoms of rash,33cases(40.7%)with itching,which was high than the control group(11,6.8%),the difference was statistically significant(?~2=41.975,P<0.01)。17 cases(21.1%)had pain,which was high than control group(8,4.9%),the difference was statistically significant(?~2=15.071,P<0.01)。24(29.6%)cases had ulcer/scabby,which was high than control group(20,12.3%),the difference was statistically significant(?~2=10.879,P<0.01)。In the case group,46 children(56.8%)had detoxification in the follow-up period,and 50children(61.7%)had detoxification/desquamation in the later period.In the control group,no detoxification/desquamation and detoxification were observed,with statistically significant differences(all P<0.01).In the case group,1 case had pigmentation(1.2%),neither patients in the control group had pigmentation,the difference was not statistically significant(?~2=0.219,P=0.640)。3.The case of patients with high fever in case group(58,70.7%)were more than that in the control group.The difference was statistically significant(?~2=7.485,P<0.01)。The fever duration in the case group was 2.5±1.1 days,which was shorter than that in the control group(3.2±1.4 days),and the difference was statistically significant(t=-4.44,P<0.01).The incidence of neurological symptoms such as headache(1 case,1.2%),convulsion(2cases,2.5%),and shock(0 cases)was lower in the case group than in the control group(22cases,13.5%).Convulsions in 21 cases(12.9%);The differences were statistically significant(P all<0.01).There was no encephalitis/meningitis case in case group,there were19 encephalitis/meningitis case in control group(7.8%),the differences were statistically significant(?~2=10.306,P<0.01)。The average length of stay was 5.5±1.8 days in the case group and 6.3±2.1 days in the control group(t=-4.33,P<0.01).The auxiliary examination results of the case group showed 45 cases(55.6%)of leukocyte elevation,and the number of cases of leukocyte elevation was higher than that of the control group,the difference was statistically significant(P<0.01).The mean white blood cell count of children in the case group(13.45±8.43×10~9/L)was higher than that in the control group(10.12±3.53×10~9/L),and the increase was statistically significant(P<0.01).In the case group,73patients(90.1%)showed an increase in hypersensitive c-reactive protein,which was statistically significant compared with the control group(P<0.01).The increase rate of creatine kinase isoenzyme(CKMB)in the case group was higher than that in the control group.The difference was statistically significant(?~2=4.741,P=0.029).there were no statistically significant difference(P>0.05)of cardiac troponin(c Tn),alanine aminotransferase(ALT),aspartate aminotransferase(AST),serum creatinine(Scr)and lactic acid(LAC)between two groups of children.Conclusions:1.The pathogenic detection of children with hand,foot and mouth disease characterized by bullous rash was mainly coxsackievirus A6.Peak incidence in August-September;Male patients are more than female patients.The age of hand,foot and mouth disease characterized by bullous rash was younger.2.Children with hand,foot and mouth disease characterized by bulla-like rash,have a variety of skin lesions and a wide range of skin involvement,accompanied by obvious symptoms of itching,tingling,ulcer/scab.The incidence of descalation and detoxification was high in the follow-up.3.Children with hand,foot and mouth disease(HFMD)characterized by bulla-like rash have obvious high fever,short heat course,mild nervous system involvement,and short hospital stay.Leukocyte and CRP were significantly increased. |
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