OVERVIEW
Enterovirus 71 hand, foot and mouth disease is an acute infectious disease caused by enterovirus 71 (EV71) infection. It is most common in children, especially in the age group of less than 3 years old, and most of the patients are in good condition, but a few children with severe disease may have complications such as aseptic meningitis, brainstem encephalitis, neurogenic pulmonary edema, etc. A very small number of them are in critical condition, which may lead to death. Survivors may have sequelae, seriously jeopardizing children’s health and life safety, and has been described as the “polio” of the 21st century.
Causes
Enterovirus 71 Hand, Foot and Mouth Disease (HFMD) is an acute infectious disease caused by Enterovirus 71 (EV71) infection.
Symptoms
Children of all ages can be infected, but the highest incidence is in the age group ≤ 3 years.
1. Early stage of infection
Patients present with low-grade fever, runny nose, cough, decreased appetite and sore mouth. Fever is a common clinical symptom of enterovirus 71 infection in infants and children.
2. Oral mucosa
Small herpes appear, often distributed in the tongue, buccal mucosa, hard palate, and ulcers are formed after herpes breaks out.
3. Skin
In the oral lesions at the same time the skin can appear maculopapular rash and herpes, hands, feet and buttocks are common, occasionally in the trunk, thighs, upper arms, etc., was centrifugal distribution, the liquid in the blisters is small, from a few to dozens of ranging from the rash subsides without scarring and hyperpigmentation.
4.Nervous system
The main manifestations are aseptic meningitis, encephalitis, encephalomyelitis, mostly occurring in young children under 5 years old, with the highest incidence in infants under 1 year old. The clinical manifestations are varied and the severity of the disease varies. Generally, the manifestations include clonus, vomiting, poor mental performance, headache, drowsiness and even coma, ataxia, intentional tremor, nystagmus and muscle weakness, convulsions, and so on.
5. Other
Most of the conditions are benign processes, mostly self-healing, but can recur.
Examination
1. Laboratory tests
(1) Peripheral blood leukocytes The total number of leukocytes and neutrophils are mostly normal in general patients. The total white blood cell count and neutrophil count are mostly normal in normal patients, but in severe cases, the white blood cell count may be significantly elevated;
(2) Blood biochemistry examination Some cases may have mildly elevated alanine aminotransferase (ALT), alanine transaminase (AST), cardiac creatine kinase isoenzyme (CK-MB), and blood glucose may be elevated in severe cases;
(3) Pathogenetic examination Specific EV71 nucleic acid positivity or isolation of EV71 virus.
(4) Serologic examination Acute and recovery phase specific EV71 antibody test 4 times or more elevated can confirm the diagnosis.
(5) Cerebrospinal fluid examination: clear appearance, elevated pressure, increased white blood cell count (mostly monocytes), normal or mildly increased protein, normal sugar and chloride.
2. Physical examination
(1) Chest X-ray may show increased texture of both lungs, lattice-like, point-like or large sheet-like shadows, which are unilaterally prominent in some cases, and rapidly progress to bilateral large shadows;
(2) Electrocardiogram No specific changes. Sinus tachycardia or bradycardia and ST-T changes are seen;
(3) MRI Brainstem and spinal cord gray matter damage is predominant.
(4) Electroencephalogram Some cases may show diffuse slow waves, and a few may show spikes and slow waves.
Diagnosis
The diagnosis can be confirmed based on epidemiologic data, clinical manifestations and relevant examinations.
Treatment
1. Principles of treatment
Mainly symptomatic treatment.
(1) Oral B vitamins such as vitamin B1, vitamin B2, vitamin C. (2) If vomiting makes it difficult to eat, give fluids.
(2) Give fluids if vomiting makes 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 coatings such as Qingdai San, Double Ingredient Throat Breeze San, Bingbosan, etc., and keep the area clean to avoid secondary infection of bacteria.
(4) Antiviral drugs Take antiviral drugs, such as viral azole and antiviral oral solution. If accompanied by fever, some heat-clearing and detoxifying traditional Chinese medicines can be used.
2. Treatment of complications
(1) Treatment of neurological involvement
(1) Control of intracranial hypertension Actively give mannitol to lower the cranial pressure, and add furosemide if necessary.
(2) Glucocorticoid therapy Apply glucocorticoid therapy as appropriate, such as methylprednisolone or dexamethasone within 2-3 days.
(3) Injection of immunoglobulin Intravenous immunoglobulin should be given as appropriate.
(2) Treatment of respiratory and circulatory failure
1) Keep the airway open and administer oxygen.
(2) Ensure that the two venous channels are open, and monitor respiration, heart rate, blood pressure and oxygen saturation.
3）In case of respiratory dysfunction, timely endotracheal intubation, use of positive-pressure mechanical ventilation, should not carry out frequent suctioning and other nursing operations.
4）Maintain blood pressure stable.
5）Elevate the head and shoulders 15～30 degrees, keep the neutral position; leave gastric tube and urinary catheter.
6) Drug application according to the changes of blood pressure, circulation can be used Milrinone, dopamine, dobutamine and other drugs; discretionary application of diuretic drug therapy.
7）Protect the function of important organs and maintain the stability of internal environment.
8）Monitor blood glucose changes, insulin can be applied in case of severe hyperglycemia.
(9) Inhibit the secretion of gastric acid: gastric mucous membrane protector and acid inhibitor can be applied.
(3) Treatment during the recovery period
1）Promote the recovery of each organ function.
2) Functional rehabilitation treatment.
(3) Combination of traditional Chinese and western medicine.