OVERVIEW
Enterovirus Cox A16 hand, foot, and mouth disease is caused by enterovirus Coxsackie A16 (Cox A16) infection. Detection of the enterovirus Cox A16 pathogen allows early diagnosis of HFMD and is clinically important for the prevention and treatment of HFMD.
Etiology
Enterovirus EV71 and enterovirus Cox A16 infections are the main causes of HFMD. Infants and young children like to put their hands or toys into their mouths and bite them, and the virus spreads through the digestive tract.
1. It is commonly spread through close contact with people in daycare centers or public places. The virus is spread through contaminated hand towels, washcloths, toys and other items.
2. Spread by throat secretions (droplets).
3. Drinking or eating contaminated water and food.
4. Children who do not know how to differentiate and eat food that has been bitten by the virus or flies.
Epidemiology
Infection by the enterovirus Cox A16 pathogen. During epidemics, kindergartens and day-care centers are prone to collective infections, and clusters of illnesses can also occur in families. The disease is mainly transmitted through close contact with the population. The virus is transmitted through indirect contact with contaminated hands, towels, dental cups, toys, eating utensils, milking utensils and bedding through saliva, herpes fluid and feces. The virus in the patient’s throat secretions and saliva can be spread by droplets.
Symptoms
1. Incubation period
2-7 days, upper respiratory tract infection symptoms, acute onset, runny nose, cough, sore throat, fever, general malaise.
2. Typical symptoms
Herpetic pharyngitis, i.e. small herpes in nasopharynx, epiglottis, tongue and soft palate, mucosal erythema, lymphoid follicular hyperplasia, oozing, enlarged tonsils, accompanied by dysphagia, loss of appetite, pimples, papules on the hands, feet and buttocks, and a similar rash may appear on the trunk, with a centrifugal distribution.
Examination
1. Laboratory examination
(1) Peripheral blood leukocytes The total number of leukocytes and neutrophils are mostly normal in general cases. In severe cases, the white blood cell count may be significantly elevated;
(2) Blood biochemistry tests Some cases may have mild elevation of ALT (alanine aminotransferase), AST (glutamic oxaloacetic aminotransferase, aspartic aminotransferase), CK-MB (creatine kinase isoenzyme MB), and blood glucose may be elevated in severe cases;
(3) Pathogenetic examination Specific Cox Al6 nucleic acid positivity or isolation of Cox Al6 virus.
(4) Serologic examination: The diagnosis is confirmed by a 4-fold or greater elevation of specific Cox Al6 antibodies during the acute and recovery phases.
(5) Cerebrospinal fluid examination Clear appearance, increased pressure, increased white blood cell count (mostly monocytes), normal or mildly increased protein, normal sugar and chloride. When there are complications in the central nervous system, the cell count of cerebrospinal fluid may be increased and the protein is elevated.
2. Physical examination
(1) Chest X-ray may show increased texture of both lungs, lattice-like, point-like or large patchy shadows, which may be unilateral in some cases and rapidly progress to large bilateral shadows;
(2) Electrocardiogram No specific changes. Sinus tachycardia or bradycardia and ST-T changes are seen;
(3) Magnetic resonance: brainstem and spinal cord gray matter damage is predominant.
(4) Electroencephalogram Some cases may show diffuse slow waves, and a few cases may show spikes and slow waves.
Diagnosis
Diagnosis can be confirmed on the basis of epidemiologic data, clinical manifestations and relevant examinations.
Treatment
The disease has a complex transmission route and there is a lack of safe and effective vaccines and antiviral therapeutic drugs. This poses a serious challenge to the prevention and control of the disease as well as the rescue and treatment of seriously ill children. At present, the main treatment is symptomatic.
1. Symptomatic treatment
(1) Oral B vitamins such as Vitamin B1, Vitamin B2, Vitamin C.
(2) Give fluids to those who vomit and find it difficult to eat. When there is erosion in the mouth and it is difficult to eat, easy-to-digest liquid food can be given and mouth rinsing can be done after meals.
(3) Oral ulcers Give external application of Qingdai San, Double Ingredient Throat Breeze San, and Bingbosan, etc., and keep the local area clean to avoid secondary infection of bacteria.
(4) Take antiviral drugs such as viral azole and antiviral oral solution. If accompanied by fever, some traditional Chinese medicines can be used to remove heat and toxins.
2. Treatment of complications
HFMD may be combined with myocarditis, encephalitis, meningitis and other diseases.
Prevention
1. Strengthening monitoring and improving the sensitivity of monitoring is the key to controlling the epidemic of this disease. Timely collection of qualified specimens, clear pathogenic diagnosis.
2. Do a good job of epidemic reporting, timely detection of patients, and actively take preventive measures to prevent the spread of the disease.
3. Child care institutions do a good job in the morning physical examination, found suspected cases, timely isolation and treatment.
4. Contaminated daily necessities and eating utensils should be disinfected, clothing in the sun, indoor ventilation.
5. In times of epidemic, do a good job of environmental, food hygiene and personal hygiene.
6. Wash your hands before and after meals to prevent diseases from entering through the mouth.
7. Parents should minimize the number of children going to crowded public places to reduce the chance of being infected.
8. Pay attention to the nutrition and rest of infants and young children, avoid sun exposure, and prevent excessive fatigue, which will lower the resistance of the body.
9. Hospitals should strengthen pre-diagnosis and set up specialized clinics to prevent cross-infection.