Clinical Features And Etiology Analysis Of200Cases Hand-foot-mouth Disease With Children

Objective: Hand-foot-mouth disease (HFMD) is a common infectionsdisease caused by enterovirus.Most infections are self-limited,but a fewinfections can be merger encephalitis, neuogenic pulmonary edema and otherserious complications that is life-threatening. Mortality and disability ratecan be greatly reduced if we can early identification severe and critical illchildren and have a positive treatment. The detection of enterovirus plays animportant role in the diagnosis of HFMD. Enterovirus71(EV71) and Coxasckievirus A16(CoxA16) can be tested conventionaliy now,but we don’t clear thepathogenic spectrum and prevalence of non-EV71,non-CoxAl6enterovirus. It hasbeen reported that EV71and CoxA16are the major pathogens which canlead to outbreak and epidemic spread of HFMD.Non-EV71,non-CoxAl6enterovirus can also lead to that in Japan and Finland.In this article,we use realtime FQ-PCR、two steps RT-PCR and gene sequence analyze to test200pathogens of HFMD and analyse related clinical features to know moreabout the composition of pathogen of HFMD and find some means ofmonitoring for early identification of HFMD exacerbation and provide morebases for prevention and control of HFMD. Methods:Making the children who were diagnosed as HFMD andhospitalized in Child Health Hospital of Kunming City from March toNovember2013as the research object.200cases were randomlyselected.According to diagnostic criteria of Hand,foot and Mouth DiseaseTreatment Guidelines2010,the case group is divided into threegroups:group A(ordinary group),group B(intensive symptoms group),groupC(critical severe group).Collect the clinical features and test pathogens byusing real time FQ-PCR、two steps RT-PCR and gene sequence analyze.All ofthe data are entered in the Excel spreadsheets and analyzed by statisticalSPSS17.0software. The inspection level α was0.05.Results:1. In the200cases of HFMD,there are163childrens less than3years old which accounted for81.5%of the total.There are46cases in theordinary group. There are117cases in the intensive symptoms group andcritical severe group. There are37childrens more than3years old whichaccounted for18.5%of the total.There are18cases in the ordinary group.There are19cases in the intensive symptoms group and critical severegroup.There are significant differences among the three groups by chi-squareand rank sum text.Patients less than3years old are more susceptible tosevere and critical performance.2. In the200cases of HFMD,there are117boys and83girls.Themale-to-female ratio is1.41︰1.There are no significant differences amongthe groups by the chi-square test. 3. Patients with fever are159cases.There are52low-grade feverchildrens and69moderate fever childrens and38high-grade feverchildrens.The super high-grade fever patient was not found. There aresignificant differences among the three groups by the chi-square and ranksum text.The temperature of children in the intensive symptoms group andcritical severe group is higher than in the ordinary group.4. The skin rashes of all patients are occurred and the occurrenceof rashes are found in hand-foot-mouth area,hand-foot area and hand-moutharea.The cases whose rashes are occurred in the three locations above areaccounting for27.5%、18.5%、14.5%. The results shows that the importantclinical manifestations of HFMD is the skin rash.5. There are different extent damages of nervous system such asdrowsiness,vomit,easily-shocked and limb tremors in the intensivesymptoms group and critical severe group. They are the common symptomsof nervous system.6. The respiratory rate,heart rate and blood pressure of the200patient are measured. There are significant differences among the threegroups by the chi-square test.The abnormal rate of the intensive symptomsgroup and critical severe group is higher than in the ordinary group.7. White blood cell count,CK-MB,ALT,AST and blood glucoselevel have significant differences among the three groups by the chi-squaretest. But C-reactive protein and LDH values have no significant differences. 8. There are4cases whose CSF White blood cells are less than orequal to10×106∕L,58cases are between10×106∕L and20×106∕L,20casesare between20×106∕L and30×106∕L,54cases are more than30×106∕L.There are significant differences among the three groups by the rank sumtext.9. EEG and skull CT are collected from all cases. There are nosignificant differences among the three groups by the chi-square test.10. The enterovirus are founded in the157specimens.There are46cases in the ordinary group.Among them,11cases are infected with EV71,31cases are infected with CoxA16,3cases are infected with EV71and CoxA16,1case is infected with CoxA6.There are68cases in the intensive symptomsgroup.Among them,35cases are infected with EV71,25cases are infectedwith CoxA16,6cases are infected with EV71and CoxA16,1case is infectedwith CoxA10,1case is infected with CoxB3.There are43cases in the criticalsevere group.Among them,27cases are infected with EV71,9cases areinfected with CoxA16,6cases are infected with EV71and CoxA16,1cases isinfected with CoxA10.By the chi-square test, there are significant differencesamong the three groups.The positive rate of EV71in the intensive symptomsgroup and critical severe group is higher than in the ordinary group,thepositive rate of CoxA16in the ordinary group is higher than in the intensivesymptoms group and critical severe group. Conclusions:1. EV71and CoxA16are the major pathogens inKunming.Given the severe case which are caused by EV71,we shoud focusour attention on the children infected by EV71.2. In addition to EV71and CoxA16,there are many otherenterovirus in the world.Such as CoxA10、CoxA6、CoxB3，and they also can leadto the severe HFMD. We can not ignore determine the non-EV71,non-CoxAl6enterovirus.3. We must have overall and timly treatment for the patients ofHFMD less3years old,because the disease may develop fast.4. Monitoring the respiratory rate,heart rate,blood pressure andother vital signs of patient children timely and effectively was veryimportant in clinical work.