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Table 4 Studies related to the complications of HFMD

From: A literature review and case report of hand, foot and mouth disease in an immunocompetent adult

Study

Results

Conclusions

Ooi et al. Sarawak, Malasia 2009 [7]

725 HFMD cases

 Risk factors: fever ≥3 days (1), fever ≥38.5 °C (2), lethargy history (3)

 ≥2 factors present in 65 % of children with pleocytosis in CSF, compared to 30 % without it

 2–3: S 28 %, E 89 %, PPV 79 %, NPV 50 %

 1: S 75 %, E 59 %, PPV 75 %, NPV 59 %

There are three risk factors to identify children with possible neurological disorders that are easily identifiable:

 Fever ≥3 days duration

 Fever ≥38.5 °C

 History of lethargy

Cho et al. Seoul, Korea 2010 [23]

16 HFMD cases associated with: meningitis (10), Guillain–Barré syndrome (3), meningoencephalitis (2), poliomyelitis associated with acute flaccid paralysis (1) myoclonus (1)

11 positive cases for C4aEV71

Most neurological manifestations are caused by C4eEV71

Guimbao et al. Zaragoza, Spain 2010 [20]

27 Onychomadesis cases

24 had previously submitted HFMD

Virus CVB1 and 2

Strong association between HFMD and onychomadesis. Microbiological results inconclusive

Davia et al. Valencia, Spain 2011 [19]

221 Onychomadesis cases associated with HFMD: 61 %

CVA10 present in 49 %

Other viruses: CVA5, 6, 16, B1 and B3, echovirus 3, 4, and 9, and EV71

The 2008 onychomadesis outbreak in Spain was associated with HFMD caused primarily by the CVA10 virus

Tian et al. China 2011 [38]

147 HFMD cases. Majority <3 years. 69.4 % males

Rashes and fever ≥38.5 °C 100 %

100 % CNS involvement (lethargy 84.4 %, myoclonus 51.7 %, drowsiness 23.1 %), tachypnea 76.2 %, bradypnea 14.3 %, hypertension 15.5 %, increased chest 51.7 %, consolidation of the thorax 29.9 %, hyperglycemia 86.4 %, high levels of lactic acid 88.4 %, positive EV71 76.9 %

Treatment: mechanical ventilation for 61.2 ± 12.8 h (range 40–96 h), mannitol, dexamethasone, gamma globulin, ribavirin, dopamine (58.5 %), dobutamine (51.0 %), amrinone (21.8 %)

2 % Died during hospitalization. Everyone else had a full recovery and were discharged after 14.2 ± 1.6 days (range, 12–17)

The central nervous system and cardiac system are involved in patients with severe HFMD. Fasting blood sugar and increased lactic acid levels in the majority of patients

Mechanical ventilation support and drug treatment are associated with good clinical outcome of these patients

Wei et al. Taiwan, China 2011 [21]

130 HFMD cases by CVA6

 Perioral rash (22 %), rash on body and/or neck (30 %), general rash (5 %), hand-foot-mouth rash (51 %), peeling of palms and soles of the feet (37 %), onychomadesis (5 %)

Patients with CVA6 associated HFMD symptoms of infection saw a broader spectrum of the destruction to the skin and deeper tissues, such as nail abnormalities and peeling

Chang et al. Taiwan. [45]

219 enterovirus 71 case subjects and 97 control children

 74 % (163 of 219 cases) were complicated cases, 57 % (125 of 219 cases) are complicated cases with central nervous system involvement, and 17 % (38 of 219 cases) involved cardiopulmonary failure after central nervous system involvement

 Necrosis factor α promoter type II (-308 A allele), HLA-A33, and HLA-DR17 were significantly associated with enterovirus 71 susceptibility

 HLA-A33 was the gene most significantly susceptible to enterovirus 71. HLA-A2 was associated with the development of cardiopulmonary failure

HLA-A33, which is a common phenotype in Asian populations but is rare in white populations, was most significantly associated with enterovirus 71 infection, compared with the other candidate genes studied, whereas HLA-A2 was significantly related to cardiopulmonary failure

  1. HFMD hand, foot and mouth disease, S sensitivity, E specificity, PPV positive predictive value, NPV negative predictive value