Analysis Of Clinical Characteristics Of HFMD Caused By Different Pathogens In Su Zhou

Objective:To analyze the pathogenic composition of hand,foot and mouth disease(HFMD),search out clinical characteristics of HFMD caused by different pathogens in Su Zhou.Methods:1.A total of 336 cases with HFMD hospitalized in Children's Hospital of Soochow University from May to June 2018 were collected in this study.A semi-nested reverse transcription polymerase chain reaction method(semi-nested RT-PCR)was used to detect the etiological types of HFMD.The specimen solutions of the throat swabs of 30 cases which CVB5 is positive were inoculated to the A549 cells.Observe the cytopathic effect to prove the result of the semi-nested RT-PCR.2.A total of 338 cases with HFMD hospitalized in Children's Hospital of Soochow University from January 2017 to December 2018 were collected.The cases were divided into three groups,133 cases was in the group of enterovirus 71(group E),99 cases was in the group of coxsackievirus A16(group A),106 cases was in the group of coxsackievirus B5(group B).And 45 healthy children who underwent physical examination in Children's Hospital of Soochow University were enrolled as control group(group C)in the same time.Analyze blood routine,biochemical indicators and immune function of four groups restrospectively.Results:1.218 cases were detected positive of enterovirus among the specimen solutions of the throat swabs of 336 cases with HFMD,the rate was 64.88%.The positive rates of CVB5,CVA6,CVA10,CVA16,EV71,CVA16 with CVB5,CVA6 with CVA10,CVA6 with CVB5,CVA10 with CVB5,EV71 with CVB5 and CVA16 were 36.05%(121),10.71%(36),3.57%(12),2.98%(10),0.60%(2),5.36%(18),4.76%(16),0.30(1),0.30(1),0.30(1)respectively.2.The main onset age of HFMD is 1-3years old,male was more than female.There is no statistical difference among the three groups in the factors of gender constitution,contact history of HFMD and only child or not.3.The duration of fever and hospitalization in group E was longest,the febrile peak value in group B was highest,and the duration of pre-hospitalization in group A was shortest.4.The symptoms of wobble of the hands and feet,startle,vomiting,stiff neck,Babinski sign in group E was most detected,the symptoms of oral herpes in group E was least detected,the quantity and scope of skin rash in group B was the most.5.The counts of leukocytes,neutrophils,Neutrophil-to-lymphocyte ratio(NLR),Platelet-to-lymphocyte ratio(PLR),C-reaction protein(CRP)in three groups were higher than those in group C,and the count of lymphocytes was lower.The count of leucocytes in group A was highest,and the level of CRP in group B was highest.6.The levels of Alanine aminotransferase(ALT),Aspartate aminotransferase(AST),y-Glutamyl transpeptidase(y-GT)and Uric acid were no statistical difference among the three groups and group C,but the ratio of ascension of Uric acid in group B was highest.The level of Prealbumin(PA),Creatine kinase isoenzyme-MB(CKMB),Serum creatinine and blood urea nitrogen in three groups was lower than those in group C,but there was no statistical difference among the group E,A and B.7.The ratios of CD3+in group E,A and B were lower than those in group C.But there were no statistical differences in the ratio of CD3+CD8+,CD3-CD19+,CD4+/CD8+among four groups.In the ratio of CD19+CD23+,group A and B were lower than group E and group C,there were statistical differences.The ratio of CD3+CD4+in three groups were lower than those in group C,but there was statistical difference only between group E and group C.8.The levels of IgA and IgM in group E were highest,and those in group B were lowest,there were statistical differences.The levels of IgG in four groups were no statistical difference.9.The levels of blood sugar in four groups were no statistical differences.The level of lactic acid in group B was higher than that in group C,there was statistical difference.The levels of potassium,sodium and chloride in group E,A and B were in normal scope.The level of calcium in group B was lower than that in group C.Conclusions:1.The method of semi-nested RT-PCR and virus culture and isolation were appropriate,the results were credible.2.CVB5 was the main etiological type of HFMD in Su Zhou Area from May to June 2108,CVA6 was in the second place,CVA10 was in the third place,the three etiological types was more than the sum of EV71 and CVA16 respectively.A small quantity of mixed infection cases was detected.3.The duration of fever and hospitalization were longest,the quantity and scope of skin rash was least,the ratio of symptoms of oral herpes was smallest,the ratio of severe cases was most in children with hand-foot-mouth disease of EV71 infection.The clinical features of these cases were not typical.The ratios of CD3+,CD3+CD4+were lowest while the levels of IgA and IgM were highest,it was presented that the function of humoral immunity was hyperactive and cellular immunity was depressed.4.The febrile peak value was highest,the quantity and scope of skin rash was most in children with hand-foot-mouth disease of CVB5 infection.The levels of CRP and lactic acid were highest,the levels of IgA,IgM and calcium were lowest,it was presented that the function of humoral and cellular immunity were depressed,the inflammatory response of these cases was most serious.5.The clinical feature of cases in children with hand-foot-mouth disease of CVA16 infection was typical.