Clinical Studies Of Severe Hand-Foot-Mouth Disease

Part 1 The clinical manifestations and stage-based management of 62 severe hand-foot-mouth disease casesObjective:To probe into the clinical features, management and outcome of severe hand-foot-mouth disease.Methods:we retrospectively reviewed the clinic data of 62 severe hand-foot-mouth disease children, who were admitted into Hezhe traditional Chinese medical hospital in Shandong province during April of 2009. These children were diagnosed and treated according to the stage-based management protocol of enterovirus 71 (EV71) infection. According to whether to use high dose methylprednisolone, these cases were divided into 2 groups, hormone impaction group and non-hormone impaction group, and the outcome were analyzed for each group.Results:The majority of severe hand-foot-mouth disease cases were under the age of 3 years, clinical progress may develop rapidly. All these sick children developed into stage 2 with fever, skin rashes and neurological symptoms or signs, and 2 cases among these children developed rapidly into stage 3 combing with neurological pulmonary edema and led to death. Neurological complications mainly presented as brainstem encephalitis (85.4%), and the most common symptoms included fatigue (100%),myoclonic jerks(85.4%), Vomiting(51.6%), irritation (50%). About 85.4% cases were with hypertension and 69.3% with rapid heart rate. Increased WBC,PLT,GLU were found in patients of 53.2%,41.9% and 48.3% respectivly. The pathogens were investigated in 29 cases, and 26 cases (89.6%) were verified as EV71 infection.56 cases (90.3%) recovered completely, and 2 cases (3.2%) were dead,4 cases (6.4%) sequeled with minor to moderate neurologic defects. No were administered with respiratory support except 2 dead cases. The rates of recovery were similar between two groups with or without stosstherapy with high dosage of methylprednisolone(P>0.05).Conclusion:severe hand-foot-mouth disease is mostly caused by EV71 infection. Early recognition of the clinical characteristics of EV71 infection is crucial to reduce the fatality rate of severe hand-foot-mouth disease resulted from EV71 infection. The stage-based management in EV71 infection will also play an important role in the guidance for the diagnosis and treatment of severe hand-foot-mouth disease. Part 2 Implication of Cellular Immune Function in Severe Hand-Foot-Mouth Disease CasesObjective:To study the change of T-lymphocyte and subsets change in severe hand-foot-mouth disease, and explore it's significant in the course of disease.Methods:The T-lymphocyte and subsets (CD3+,CD4+,CD8+) were detected by flow cytometry in 20 severe hand-foot-mouth disease children and 20 cases of healthy controls.Results:The results showed that the.numbers of CD3+(48.53±8.12 vs 64.9±5.3),CD4+ (27.68±6.56 vs 38.53±4.88), CD8+(20.59±3.7 vs 26.32±3.77) T-lymphocyte and subsets in severe hand-foot-mouth disease children was significantly lower than that of normal control group(P <0.05). The numbers of CD3+(41.58±7.11 vs 52.7±5.97), CD4+ (23.04±5.86 vs 30.18±5.62) T-lymphocyte and subsets in critical group was also much lower than non-critical group(P<0.05).Conclusion:The cellular immunity was damaged in children with Severe hand-foot-mouth disease, and may influence the course of disease. Monitoring the cellular immunity and giving immunity modifiers are necessary for treatment.