Outcome of Enterovirus 71 Infections with or without Stage-Based Management: 1998 to 2002

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 cerebro- spinal fluid white blood cell count >100/[mu]l 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.