Outcome of enterovirus 71 infections with or without stage-based management: 1998 to 2002
Journal
Pediatric Infectious Disease Journal
Journal Volume
23
Journal Issue
4
Pages
327-331
Date Issued
2004
Author(s)
Abstract
Background. Enterovirus 71 (EV71) infection may progress through four stages, one of which is cardiopulmonary failure. In Taiwan in 1998 almost all the EV71 patients with cardiopulmonary failure died. To improve clinical outcome of EV71 patients, we developed a stage-based management program in 2000. Methods. The medical records of 196 EV71 patients who did not have stage-based management (1998 to 1999) and of 331 EV71 patients who did (2000 to 2002) at Chang Gung Children's Hospital were reviewed for demographic characteristics, clinical syndromes, case-fatality rates and sequelae. We compared and analyzed the results for the 2 groups. Results. Of the patients who did not receive stage-based management, 83% (15 of 18) of cases with both central nervous system (CNS) involvement and cardiopulmonary failure died during the acute stage of the infection. Two patients died at convalescence, and 1 had sequelae of dysphagia and limb weakness. By contrast of the patients who received stage-based management, 33% (12 of 36) of patients with CNS and cardiopulmonary failure died during the acute stage, 8% (3 of 36) died at convalescence, 14% (5 of 36) recovered and 43% (16 of 36) had severe sequelae of central hypoventilation, dysphagia and limb weakness (P < 0.001). For cases with CNS and cardiopulmonary failure, multivariate analysis showed that age older than 2 years and cerebrospinal fluid white blood cell count > 100/μl were associated with a increase in acute mortality [95% confidence interval (CI) 1.9 to 105.3, P = 0.001; 95% CI 1.1 to 66.6, P = 0.04, respectively, but stage-based management was significantly associated with a reduction in acute mortality (95% CI 0.007 to 0.24; P = 0.0004). Stage-based management did not affect the outcome of cases with CNS involvement alone. Conclusions. Stage-based management reduced the case fatality rate of EV71-related cardiopulmonary failure, but two-thirds of the survivors had severe sequelae.
Subjects
Enterovirus 71; Fatality; Management; Pulmonary edema; Sequel; Stage
SDGs
Other Subjects
article; cardiopulmonary insufficiency; case finding; central nervous system; cerebrospinal fluid examination; confidence interval; controlled study; convalescence; demography; disease severity; dysphagia; Enterovirus 71; fatality; female; human; hypoventilation; leukocyte count; major clinical study; male; medical record; mortality; multivariate analysis; muscle weakness; outcomes research; pediatric hospital; priority journal; statistical significance; survival; syndrome delineation; Taiwan; virus infection; virus isolation; Case-Control Studies; Cause of Death; Central Nervous System Viral Diseases; Disease Progression; Enterovirus A, Human; Enterovirus Infections; Female; Follow-Up Studies; Hand, Foot and Mouth Disease; Herpangina; Humans; Logistic Models; Male; Multivariate Analysis; Probability; Reference Values; Retrospective Studies; Risk Assessment; Severity of Illness Index; Survival Analysis; Taiwan; Treatment Outcome
Type
journal article