Children with severe enterovirus A71 infection
Wenjuan Wu1, Baoguang Li2, Tao Xie3
1Department of Neurology, Hebei Children's Hospital, Hebei Children's Hospital of Hebei Medical University, Hebei Provincial Key Laboratory of Pediatric Epilepsy and Neurological Diseases, 133 Jianhua Nan street, Shijiazhuang, 050031, China.
Insights
Enterovirus A71 (EV-A71) infection in children often presents with fever, rash, irritability, and lethargy. Neurological imaging may show abnormalities, and cerebrospinal fluid analysis can reveal increased white blood cells and neutrophils.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Neurology
Background:
- Enterovirus A71 (EV-A71) infection is a significant concern in pediatric populations.
- The timing of onset and specific symptoms of EV-A71 can be challenging to diagnose.
- Severe EV-A71 infections require a better understanding of their clinical manifestations.
Purpose of the Study:
- To investigate the clinical characteristics of severe enterovirus A71 (EV-A71) infection in children.
- To identify common symptoms and neurological findings associated with severe EV-A71.
- To explore potential correlations in cerebrospinal fluid parameters.
Main Methods:
- A retrospective observational study was conducted.
- Data from 101 children with severe EV-A71 infection admitted to Hebei Children's Hospital (January 2016-January 2018) were analyzed.
- Clinical symptoms, neurological magnetic resonance imaging (MRI) findings, and cerebrospinal fluid (CSF) parameters were reviewed.
Main Results:
- The study included 101 children (57 males, 44 females) aged 1-13 years.
- Common symptoms included fever (93.1%), irritability (69.3%), lethargy (55.4%), and rash (45.5%).
- Abnormal neurological MRI findings were observed in 19 patients, affecting areas like the pontine tegmentum, medulla oblongata, and cerebellum. A positive correlation was found between the neutrophil-to-white blood cell ratio in CSF within the first 3 days of illness (r=0.415, P<0.001).
Conclusions:
- Severe EV-A71 infection in children typically presents with fever, rash, irritability, and lethargy.
- Neurological involvement is common, as indicated by MRI findings.
- Cerebrospinal fluid analysis, particularly the neutrophil and white blood cell counts, may aid in diagnosis.
Background:
There are few reports on the timing of onset and the symptoms of enterovirus A71 (EV-A71) infection, which can easily be misdiagnosed. This study aimed to explore the clinical characteristics of children with severe EV-A71 infection.
Methods:
This retrospective observational study included children with severe EV-A71 infection admitted to Hebei Children's Hospital between January 2016 and January 2018.
Results:
A total of 101 patients were included: 57 males (56.4%) and 44 females (43.6%). They were 1-13 years of age. The symptoms were fever in 94 patients (93.1%), rash in 46 (45.5%), irritability in 70 (69.3%), and lethargy in 56 (55.4%). There were 19 (59.3%) patients with abnormal neurological magnetic resonance imaging [pontine tegmentum (n = 14, 43.8%), medulla oblongata (n = 11, 34.4%), midbrain (n = 9, 28.1%), cerebellum and dentate nucleus (n = 8, 25.0%), basal ganglia (n = 4, 12.5%), cortex (n = 4, 12.5%), spinal cord (n = 3, 9.3%), and meninges (n = 1, 3.1%)]. There was a positive correlation between the ratio of neutrophil count and white blood cell count in cerebrospinal fluid in the first 3 days of the disease (r = 0.415, P < 0.001).
Conclusion:
The clinical symptoms of EV-A71 infection are fever and/or skin rash, irritability, and lethargy. Some patients have abnormal neurological magnetic resonance imaging. The white blood cell count in the cerebrospinal fluid of children with EV-A71 infection may increase alongside neutrophil counts.
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