Analysis Of The Clinical Features And Related Factors In 331 Cases Of The Critical Hand-Foot-Mouth Disease Deaths

Objective By retrospective analysis of 331 cases of Hand-foot-mouth disease deaths clinical data, there has been investigated in the clinical features of HFMD death of critically ill patients, the autopsy and pathological features, the relationship of the degree of the disease progression and the risk factors.Methods By collecting and retrospectively analyzing clinical data, laboratory test results, the etiology of pathological findings and 15 cases autopsy results of 331 cases of Hand-foot-mouth disease deaths from the Guangxi region and county hospitals in 2010-2014, the relationship between the clinical and pathological characteristics and disease progression has been understood.Results Among 331 cases of deaths, there are 209 cases in men and 122 cases of female. The proportion between male and female is 1.71:1. The majority is less than 36 months. In those three years, there were no significant differences in sex structure. The value of X2 is 1.806. The value of P is 0.405. The main type of pathogens is EV71. The longest time from onset to death is 20 days and the shortest time is 5 hours. The average duration is 3.74 days and the plus or minus is 2.19 days. The longest time from the start of seeing a doctor to death is 17 days and the shortest time is 10 minutes. The average time is 21.42 hours and the plus or minus is 10.68 hours. The average time from the onset to the nervous system symptoms is 36.88 hours and the plus or minus is 30.38 hours. In the second stage, the main symptoms are vomiting, easily surprised, irritability, crying and poor spirit. There are more serious nervous system symptoms in the third stage than the second stage, such as Limb jitter, nystagmus, double lower limbs weakness, lethargy and even coma. In the forth stage, the main symptoms are convulsions and coma. The average time from the onset to respiratory symptoms is 72.53 hours and the plus or minus is 36.17 hours. The median time from the respiratory symptoms to death is 8 hours. That is to say, the time from entering the third stage to death is about 8 hours. The proportion of patient whose characterize is shortness of breath, difficulty breathing and lung sound is 56.80 to 79.46. The 80.06 proportion of children appear pulmonary hemorrhage before his death. The average time from the onset to the cardiovascular system symptoms is 72.06 hours and the plus or minus is 36.34 hours. The median time from the cardiovascular system symptoms to death is 8.5 hours. The cardiovascular system symptoms mainly include tachycardia or bradycardia, high blood pressure and low blood pressure. However, the change of heart rate and blood pressure are not completely consistent in stages. The heart rate speed cannot be served as the judgment standard of critical Hand-foot-mouth disease in the third and forth stage. The monitoring of blood pressure is more important to the critical Hand-foot-mouth disease patients in the forth stage. The elevated count of white blood cell is a risk factor to the Hand-foot-mouth disease children in the third stage to forth stage. The higher neutrophil percentage and the lower PH are the risk factors to the Hand-foot-mouth disease children in first to second stage. The proportion of patients with higher CK-MB is 57.09. The proportion of patients with higher troponin I is 34.07. The proportion of them increased at the same time is 23.7. Among 331 cases of deaths, there are 36 cases who accept the examination of routine lumbar puncture cerebrospinal fluid. The proportion of patients with higher CSF white blood cells is 52.78. The proportion of patients with higher CSF protein is 38.89. Autopsy of the 15 cases showed that the brain, especially the brainstem and the medulla oblongata, are most severely involved. There are some Pathological changes in the brain such as neuronal necrosis, softening in the brain stem, neuronophagia phenomenon and colloid in the brain stem, Interstitial small angiectasis hyperemia, blood vessels around more lymphocytes and monocytes infiltration, perivascular cuffing in the brain stem. In addition, some pour wild po’s cell in the cerebellum has degenerated and died, without inflammatory cells infiltration. All lung pathological changes show large amounts of pink fluid and red blood cells in the alveolar space. The 2 cases have a small amount of transparent film formation. In most cases, there are not inflammatory cells infiltration and myocarditis in the hearts. The myocardium of one case has small lymphocytes and mononuclear cell infiltration, without necrosis of myocardial cells. The one case of local myocardial fibers has a stove degeneration necrosis. The one case of cardiac muscle cells has no abnormalities. Other organs pathologic changes are not obvious. No matter whether the type is COX virus, EV71 or other intestinal virus, the cerebral and myocardial pathological changes have no obvious difference.Conclusion 1、This datas show that the Hand-foot-mouth disease death cases are mainly found in boys, whose age is always under three years. The main type of pathogens is EV71.2、The main pathological changes of severe and critical Hand-foot-mouth disease always happen in brain, especially the brainstem and the medulla oblongata. Pathological changes performance as neuronal necrosis and softening in the brain stem. There are no inflammatory cells infiltration in the hearts. The lung is given priority to hemorrhage. To different type of enterovirus infection, there is no obvious difference in the cerebral and myocardial pathological changes.3、The elevated count of white blood cell is a risk factor to the Hand-foot-mouth disease children in the third stage to forth stage. The higher neutrophil percentage and the lower PH are the risk factors to the Hand-foot-mouth disease children in first to second stage. 4、The critical Hand-foot-mouth disease children mainly die of severe brain function failure and neurogenic cardiorespiratory failure. Pulmonary hemorrhage, heart rate, blood pressure change of clinical manifestations are not completely consistent in progress in clinical stage. Heart rate speed cannot serve as the judgment standard of critical Hand-foot-mouth disease in the third and forth stage. Low blood pressure is more important to the critical hand foot and mouth disease children in the forth stage.