I. Case diagnosis
(A) Suspected cases in children
1.Epidemic season;
2, children with acute fever onset;
3, with symptoms of upper respiratory tract infection or gastrointestinal symptoms; Yang Guoping, Department of Pediatrics, Cangzhou Hospital of Integrative Medicine, Hebei Province, China
4, there is an atypical rash or oral ulcers.
(B) Clinical diagnosis of cases
1.History of epidemiological contact or from infected areas ;
2. Acute febrile onset with maculopapular and herpetic rash on the palms of hands or feet, and rash on the buttocks or knees. The rash is surrounded by an inflammatory redness with little fluid in the blisters; scattered herpes on the oral mucosa and pain is evident;
3. Some children may have cough, runny nose, loss of appetite, nausea, vomiting and headache.
(C) Laboratory diagnosis of cases
A clinical diagnosis case is a laboratory diagnosis case if it meets one of the following conditions
1.Serological test: the patient’s serum is positive for specific IgM antibodies, or there is a 4-fold or more elevation of serum IgG antibodies in the acute and recovery periods.
2.Nucleic acid test: pathogenic nucleic acid was detected in the patient’s serum, cerebrospinal fluid, pharyngeal swab or throat wash, stool or anal swab, cerebrospinal fluid or herpes fluid, and tissue specimens such as brain, lung, spleen and lymph nodes.
3. Virus isolation: Enterovirus was isolated from throat swabs or throat washings, stool or anal swabs, cerebrospinal fluid or herpes fluid, and tissue specimens of brain, lung, spleen, lymph nodes, etc.
(iv) Severe cases.
A clinically diagnosed case is considered severe if it is accompanied by one of the following manifestations.
1, persistent high fever that does not subside ;
2, muscle weakness, limb tremors, convulsions, etc. aggravated, impaired consciousness, diminished or absent tendon reflexes, positive meningeal stimulation signs;
3.Pale face, increased heart rate, poor peripheral circulation, abnormal blood pressure;
4, dyspnea or irregular rhythm, cyanosis, increased pulmonary wet rales or signs of pulmonary solids;
5.Significant increase (>15×10 9/L) or significant decrease (9 mmol/L) in peripheral blood leukocyte count;
7.Significant increase in chest abnormalities in a short period of time.
II. Treatment principles
(A) Outpatient treatment criteria
Most HFMD have a good prognosis. If there is only mild fever; typical rash; and good general condition, outpatient treatment is possible, with home observation and follow-up when the condition changes.
(B) Outpatient and community treatment principles
1. Pay attention to isolation, do not go to crowded public places to avoid cross-infection;
2, improve personal hygiene, pay attention to hand washing and home ventilation;
3, proper rest, light diet, drink more water;
4, with pharyngitis, gargle with light salt water, hand and foot herpes can be wiped with external iodine volts skin;
5, symptomatic treatment: fever to give physical cooling, ibuprofen preparations, etc., careful use of aspirin;
6, there is no effective antiviral drugs, Chinese and Western medicine combined with Chinese medicine treatment is the main, according to the child’s disease period, the severity of the use of our agreement on Chinese medicine prescription;
7.You can take vitamin C, vitamin B6, vitamin B12, etc. orally;
8, the condition changes at any time to the hospital for follow-up;
9.The community doctor should follow up by phone within 2-3 days after the consultation to understand the condition and guide the rehabilitation treatment.
III. Hospital admission criteria
(A) Fever of 38 degrees or above, accompanied by mental weakness, or vomiting;
(ii) Neurological symptoms: headache, vomiting, depression, irritability/drowsiness, irritability, weakness, convulsions, unstable holding/standing, tremor, etc;
(iii) Cardiopulmonary symptoms: dyspnea, chest tightness, panic, shortness of breath, pallor, grayness, cyanosis, chills at the end of the extremities, etc;
(iv) persistent high fever, marked increase in blood leukocytes, and rapid progression of the disease;
(v) Patients with increased or decreased blood pressure, decreased oxygen saturation, increased blood glucose, rapid or irregular respiration, significantly increased or decreased heart rate, increased intracranial pressure, etc. should be transferred to ICU;
(vi) Infants and children less than 3 years old should be highly alert to the tendency of severe illness.
IV. Principles of inpatient treatment
(a) Contact person should pay attention to disinfection and isolation to avoid cross-infection;
(2) Closely monitor changes in the condition, especially brain, lung, heart and other important organ functions; pay special attention to monitoring blood pressure, blood gas analysis, blood sugar and chest X-ray in critically ill patients;
(C) strengthen symptomatic support treatment, good oral care;
(d) Pay attention to the maintenance of water, electrolytes, acid-base balance and the protection of vital organs;
(e) If there is an increase in intracranial pressure, mannitol and other dehydration treatment can be given, and in severe cases, methylprednisolone, intravenous gammaglobulin and other drugs can be given as appropriate;
(f) Early mechanical ventilation is recommended for those with hypoxemia, respiratory distress, and other signs of respiratory failure;
(vii) Maintain stable blood pressure, and give vasoactive drugs if necessary.
V. Principles of treatment for critically ill children
(A) General treatment
Bed rest, isolation of the digestive tract, adequate water and light and easily digestible food should be given.
(B) Symptomatic treatment
Antipyretic: physical cooling or medication can be used to reduce fever (aspirin is prohibited);
Rash management: local rubbing of acne (Androflux);
Supportive treatment: appropriate rehydration and maintenance of hydrophobic acid-base balance.
(C) Complication management
1, pneumonia: add cefuroxime, a cephalosporin II antibiotic;
2, myocardial damage: add vitamin C, inosine, sodium fructose diphosphate, sodium creatine phosphate;
3, heart failure: add cardiac drugs;
4, expiratory failure: mechanical ventilation, respiratory support;
5.Encephalitis: lower cranial pressure and dehydration, antispasmodic;
6, shock: monitor blood pressure, apply vasoactive drugs if necessary;
7, DIC: if warranted, early application of heparin;
(iv) hormone therapy: choose as appropriate
(E) intravenous propecia: use
(vi) Chinese herbal treatment: clear heat and detoxify, cool the blood and penetrate the rash
(vii) antiviral therapy: no special antiviral drugs
(viii) Monitoring of electrocardiography and partial pressure and saturation of blood oxygen.
VI. Laboratory tests for critically ill children
1.Emergency blood tests, emergency biochemistry, cardiac enzymes and blood gas analysis after admission.
2. Routine tests: blood, urine, stool routine, heterogeneity, blood type, PTA, renal function electrolytes glucose, liver function II, CRP, coagulation three, D-dimer, ECG, chest X-ray, chest and brain CT if necessary.
3, if there is headache, nausea, frequent vomiting, drowsiness, meningeal irritation signs, cerebrospinal fluid examination should be performed.
4.Pathogenetic examination. Keep one copy of serum (2ml) each in the acute recovery period, one copy of stool (5-8g), pharyngeal swab, herpes fluid, cerebrospinal fluid, and send to network laboratory uniformly.