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Case report: Features of hand, foot and mouth disease in neonates
Wen-Wen Chen1, Zhao-Bin Yang, Lian-Shu Lian
1Department of Neonatology Internal Medicine Intensive Care Unit, Zhangzhou Municipal Hospital affiliated to Fujian Medical School, Zhangzhou, China.
Insights
Hand, foot, and mouth disease (HFMD) is more common in neonates than previously thought. CSF enterovirus detection aids diagnosis, and HFMD is self-limiting, warranting avoidance of antibiotics once bacterial infection is ruled out.
Area of Science:
- Neonatal infectious diseases
- Pediatric neurology
- Virology
Background:
- Hand, foot, and mouth disease (HFMD) is a common childhood illness caused by enteroviruses.
- Enteroviruses can be present in various bodily secretions.
Observation:
- Five neonates presented with fever and maculopapular rashes on the face, trunk, limbs, palms, and soles.
- Some neonates developed aseptic meningitis.
- Cerebrospinal fluid (CSF) samples were positive for enterovirus.
Findings:
- Neonates diagnosed with HFMD showed enterovirus in their CSF.
- The condition in these neonates was self-limiting, with full recovery.
- No severe complications like brainstem encephalitis or pulmonary edema were observed.
Implications:
- HFMD is more prevalent in neonates than commonly recognized.
- Enterovirus in neonatal CSF can mimic symptoms of purulent meningitis.
- Accurate diagnosis relies on clinical presentation, medical history, and CSF enterovirus testing.
- Antibiotic use should be avoided in confirmed HFMD cases after ruling out bacterial infections.
Rationale:
Hand, foot and mouth disease (HFMD) is caused by enterovirus. The virus may exist in secretions.
Patient Concerns:
Five neonates had symptoms of fever and maculopapular rashes involving face, trunk, breech, arms, and legs, especially scattering on palms and feet. Blood, oropharyngeal fluid, urine, and cerebrospinal fluid (CSF) samples were collected and detected for further diagnoses with the consent of the infants' parents. Some of them suffered aseptic meningitis.
Diagnoses:
They were diagnosed as HFMD with CSF enterovirus positive.
Interventions:
All of them continued breastfeed. Water bag was used during the pyrogenic stage. Antibiotics were administrated at first and withdrawn as soon as possible.
Outcomes:
None of them developed into brainstem encephalitis or pulmonary edema and they all recovered well.
Lessons:
HFMD is more common in neonates than it has been thought. Enterovirus may exist in neonatal CSF and cause CSF cell to increase similar to purulent meningitis. Medical history, physical examination, and CSF enterovirus detection are important in making correct diagnosis. Unlike bacterial infection, HFMD is a self-limited disease. Once HFMD is determined and bacterial infection is ruled out, antibiotics should be avoided.
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