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Korean J Pediatr 2010 May;53(5) :639-643.
Enterovirus 71-associated hand, foot and mouth diseases with neurologic symptoms, a university hospital experience in Korea, 2009
Hye Kyung Cho (Cho HK)1, Na Yong Lee (Lee NY)1, Hyunju Lee (Lee Hj)1, Hae Soon Kim (Kim HS)1, Jeong Wan Seo (Seo JW)1, Younf Mi Hong (Hong YM)1, Seung Joo Lee (Lee SJ)1, Sun Wha Lee (Lee SW)2, Doo Sung Cheon (Cheon DS)3, Ji Young Hong (Hong JY)3, Byung Hak Kang (Kang BH)3, Jong-Hyun Kim (Kim JH)3, Kyung-Hyo Kim (Kim KH)1
1Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea
2Department of Radiology, School of Medicine, Ewha Womans University, Seoul, Korea
3Division of Enteric and Hepatitis Viruses, Korea National Institute of Health, Korea Centers for Disease Control and Prevention, Seoul, Korea
Copyright © 2010 by The Korean Pediatric Society
Purpose : Hand-foot-mouth disease (HFMD) is a common viral illness in children, which is usually mild and self-limiting. However, in recent epidemics of HFMD in Asia, enterovirus 71 (EV71) has been recognized as a causative agent with severe neurological symptoms with or without cardiopulmonary involvement. HFMD was epidemic in Korea in the spring of 2009. Severe cases with complications including death have been reported. The clinical characteristics in children with neurologic manifestations of EV71 were studied in Ewha Womans University Mokdong Hospital. Methods : Examinations for EV71 were performed from the stools, respiratory secretion or CSF of children who presented neurologic symptoms associated with HFMD by realtime PCR. Clinical and radiologic data of the patients were collected and analyzed. Results : EV71 was isolated from the stool of 16 patients but not from respiratory secretion or CSF. Among the 16 patients, meningitis (n=10) was the most common manifestation, followed by Guillain-Barré syndrome (n=3), meningoencephalitis (n=2), poliomyelitis-like paralytic disease (n=1), and myoclonus (n=1). Gene analysis showed that most of them were caused by EV71 subgenotype C4a, which was prevalent in China in 2008. Conclusion : Because EV71 causes severe complications and death in children, a surveillance system to predict upcoming outbreaks should be established and maintained and adequate public health measures are needed to control disease.
Keywords: Human enterovirus 71 | Hand- foot-mouth disease | Neurologic manifestation
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