The most discussed disease lately is probably HFMD, and the number of infections is still rising every day, which undoubtedly brings panic to many parents of small babies. In fact, hand, foot and mouth disease is a very common childhood disease and has had a significant incidence in the past. With proper understanding, attention to isolation, early detection and early treatment, severe cases only account for about 2-5%.
Hand, foot and mouth disease is an acute infectious disease caused by enterovirus (CoxA16), enterovirus 71 (EV71), which occurs mostly in preschool children, especially in the age group under 3 years old. The main symptoms are maculopapular rash and herpes on the hands, feet and mouth, and in a few severe cases, meningitis, encephalitis, encephalomyelitis, pulmonary edema and circulatory disorders, mostly caused by EV71 infection, with the main cause of death being severe brainstem encephalitis and neurogenic pulmonary edema. Both patients and latently infected persons are the source of infection, which is mainly transmitted through the gastrointestinal tract, respiratory tract and close contact.
Clinical manifestations
(A) Common case manifestations
Acute onset, fever, scattered herpes on the oral mucosa, maculopapular rash and herpes on the hands, feet and buttocks, which may be surrounded by an inflammatory redness and less fluid in the herpes. It may be accompanied by cough, runny nose, and loss of appetite. Some cases present only with a rash or herpetic pharyngitis. The prognosis is good.
(ii) Severe cases
A few cases (especially those younger than 3 years old) may develop meningitis, encephalitis, encephalomyelitis, pulmonary edema, circulatory disorders, etc. The condition is dangerous and may lead to death or sequelae.
1, neurological system: poor mental health, drowsiness, easily startled; headache, vomiting; limb myoclonus, nystagmus, ataxia, eye movement disorders; weakness or acute flaccid paralysis; convulsions. On examination, meningeal stimulation signs and tendon reflexes are seen to be weakened or absent; critical cases may manifest as coma, cerebral edema, and brain herniation.
2. Respiratory system: shallow breathing, dyspnea or rhythm changes, lip cyanosis, oral vomiting of white, pink or bloody foamy fluid (sputum); wet nymphal woven grass can be heard in the lungs
3. Circulatory system: pale, flushed skin, cold extremities, cyanosis of fingers (toes); cold sweating; increased or slowed heart rate, shallow rapid or weakened pulse or even disappearance; increased or decreased blood pressure.
Diagnostic criteria
(A) Clinical diagnosis of cases
Onset in the epidemic season, commonly seen in preschool children, infants and toddlers.
1. common cases: fever with rash on hands, feet, mouth and buttocks; some cases may be feverless.
2. Severe cases: neurological involvement, respiratory and circulatory dysfunction, etc. Laboratory tests may include increased peripheral blood leukocytes, abnormal cerebrospinal fluid, increased blood glucose, and abnormal EEG, brain and spinal cord MRI, chest X-ray, and echocardiography.
In a very few severe cases, the rash is atypical and the clinical diagnosis is difficult and needs to be made in combination with pathogenic or serological examination.
If there is no rash, the clinical diagnosis of HFMD is not appropriate.
(B) Confirmation of diagnosis
Clinical diagnosis can be confirmed if the case has one of the following.
1. Positive specific nucleic acid test for enterovirus (CoxA16, EV71, etc.).
2.Enterovirus is isolated and identified as EV71, CoxA16 or other enterovirus that can cause HFMD.
3.Serum EV71, CoxA16 or other enteroviruses that can cause HFMD have more than 4-fold increase in neutralizing antibody during the acute and recovery periods.
Differential diagnosis
(a) Common cases: need to differentiate from other childhood rash diseases, such as herpetic urticaria, chickenpox, atypical measles, early childhood emergency rash, and rubella. Epidemiological characteristics, rash pattern, location, time of rash and presence of lymph node enlargement can be distinguished, with the rash pattern and location being the most important.
(ii) Severe cases.
1. Differentiation from other central nervous system infections
(1) The manifestations of CNS infections caused by other viruses can be similar to those of severe HFMD. For those with atypical rash, specimens should be taken for virological examination of enteroviruses, especially EV71, as soon as possible, and the diagnosis should be made in combination with pathogenic or serological examination. At the same time, refer to the disposal process of severe cases of HFMD for diagnosis, treatment and management.
(2) Those with delayed paralysis as the main symptom should be differentiated from poliomyelitis.
2. Differentiation from severe pneumonia
Severe HFMD can occur as neurogenic pulmonary edema, which should be differentiated from severe pneumonia. The former cough symptoms are relatively mild, the condition changes rapidly, shallow breathing in the early stage and dyspnea in the late stage, white, pink or bloody foamy sputum may appear, and the chest X-ray shows pulmonary edema.
3, circulatory disorders as the main manifestation should be distinguished from fulminant myocarditis, infectious shock, etc.
Early identification of severe cases
Patients with the following characteristics, especially those under 3 years of age, may develop into critical cases within a short period of time, and should be closely observed for changes in their condition, necessary auxiliary examinations, and targeted rescue and treatment.
(A) Persistent high fever that does not subside.
(B) Poor mental health, vomiting, limb myoclonus, limb weakness, convulsions.
(C) Increased respiration and heart rate.
(D) Cold sweating, poor peripheral circulation.
(E) Hypertension or hypotension.
(F) Significant increase in peripheral blood white blood cell count.
(vii) Hyperglycemia.
Disposition procedure
(a) Parents should pay attention to whether there are similar patients around the baby and isolate them as early as possible. Go to the pediatric department or Ditan Hospital or You’an Hospital designated by the Ministry of Health for screening as soon as possible if any of the above conditions occur in the baby.
(ii) Ordinary cases can be treated on an outpatient basis, with parents closely observing the child and seeking medical attention at any time when the condition changes.
(c) Children under 3 years of age with persistent fever, poor mental health, vomiting, and illness lasting less than 5 days should be kept under observation. During the observation period, closely observe the changes in the condition, especially the function of the heart, lungs, brain and other important organs, and give targeted treatment according to the condition.
If the condition of the patient is eligible for hospitalization during the observation period, the patient should be hospitalized immediately, and the patient can be released from observation if the condition improves within 48 hours.
(D) One of the following conditions should be hospitalized
1.Lethargy, easily startled, restlessness, convulsions.
2. Myoclonus, weakness or paralysis of limbs.
3.Shallow and difficult breathing.
4.Pale face, cold sweat, increased or decreased heart rate (not proportional to the degree of fever), poor peripheral circulation.
Those with one of the above 3 or 4 should be admitted to ICU for treatment.
Treatment
(A) Common cases
1. General treatment: pay attention to isolation and avoid cross-infection. Proper rest, light diet, good oral and skin care.
2, symptomatic treatment: fever and other symptoms are treated with a combination of Chinese and Western medicine.
(II) Serious cases
Hospitalization is required. Parents should cooperate with the hospital for various examinations and comprehensive treatment. After active treatment, the majority of patients have a good prognosis, only a few critical cases. However, the mortality rate of critical cases is high. According to current reports, the mortality rate of critical cases can be as high as 20-30% in some areas. However, because there is no specific drug treatment, comprehensive and symptomatic treatment is still the main focus.
Therefore, HFMD should be primarily prevented, detected early, isolated early and treated early.