Clinical features of 484 patients with severe hand, foot and mouth disease in a certain hospital in Western China

YANG De-hua; YI Dong-ling; TAN Jun-yuan; ZHOU Xiao-fei; LAN Ying; ZHANG Chao-yong; ZHANG Yi-wei; L0NG Lu-ping; LI Ji-ke

Abstract：Objective To investigate the clinical features of children with severe hand, foot and mouth disease (HFMD), and summarize the experience in diagnosis and treatment of severe HFMD. Methods The clinical manifestations and treatment of 484 children with severe HFMD treated in our hospital from Jan. 2011 to Dec. 2012 were analyzed retrospectively. Results The ratio of male and female children was 1.5∶1, the average age was 2.17±0.60 years old, the average disease course was 2.74±1.19 days, and the average duration of hospitalization was 6.14±1.78 days. The main clinical signs and symptoms were rash on hand and/or foot (100%), fatigue (98.1%), fever (95.7%), startling (95.7%), irritation (94.4%), increased heart rate (81.8%), vomiting (40.1%), hypertension (36.6%) and limb shaking (33.9%). Laboratory abnormalities were abnormally elevated white blood cell count (60.1%), myocardial injury (38.0%), elevated blood glucose (32.9%) and elevated blood lactate (31.0%). Cerebrospinal fluid examination showed viral en-cephalitis, but brain CT and MRI showed that no brain abnormality was found. Enterovirus 71 (65.1%) was the most common pathogen. After antiviral therapy and symptomatic treatment, such as intravenous injection of intravenous immunoglobulin (IVIG), milrinone, man-nitol and dexamethasone, all the patients were cured and discharged, and no patient progressed to critical illness. Conclusions The early clinical features of severe HFMD are hard to detect. The typical neurological features include fatigue, startling and irritation. Early di-agnosis and treatment with mannitol and dexamethasone timely, with milrinone timely when hypertension is found and with IVIG proper-ly when significantly elevated blood glucose and white blood cell count are found, will achieve good prognosis.