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Research
Management of Severe Hand, Foot and Mouth Disease in Xiangyang, China from 2008-2013.
Jian Liu
Affiliated Shenzhen Baoan Hospital, Southern Medical University
Corresponding Author
ORCiD: https://orcid.org/0000-0003-1772-7575
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This work is licensed under a CC BY 4.0 License. Read Full License
Therapeutic strategies for severe hand, foot and mouth disease (HFMD) are currently either inconsequent or deficient in evidence. We retrospectively surveyed HFMD outbreaks in Xiangyang from June 2008 to December 2013. FHMD is staged form I to V according to clinical severity and the case with central nervous system involvement is defined as a severe one. Most severe cases were investigated to analyse risk factors for fatality and to compare the efficiency and outcome of some therapies by binary logistic regression. The overall HFMD cases included 637 (1.26%) severe cases, 38 fatal cases (0.75‰). Analysis indicates that age (<3 y), enterovirus 71 (+), autonomic nervous system dysregulation, pulmonary edema/hemorrhage, CRP (>40 mg/L) and cardiac troponin I (>0.04 ng/mL) are risk factors for fatality (all P < 0.05). Intravenous immunoglobulin (IVIG) and mechanical ventilation applied in early stage IV significantly improved HFMD progression (both P < 0.05) with odds ratios of 0.24 (95% CI: 0.10-0.57) and 0.01 (95% CI: 0.00-0.10), respectively. Methylprednisolone and milrinone administered in any stage, and all therapies applied in stage III made no significant difference on mortality (all P > 0.05). Precise recognition of the severe HFMD cases in early stage IV and timely IVIG and mechanical ventilation application may decrease mortality. Mechanical ventilation training programs and dispatching specialists to county-level or district hospitals when there is no chance for severe HFMD cases to be transferred to superior hospitals are two key successful administrative initiatives.
Keywords
Hand foot and mouth disease, human enterovirus 71, coxsackievirus A16, lung-protective ventilation, contagious disease
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This is a preprint. It has not completed peer review.
Research
Management of Severe Hand, Foot and Mouth Disease in Xiangyang, China from 2008-2013.
Jian Liu
Affiliated Shenzhen Baoan Hospital, Southern Medical University
Corresponding Author
ORCiD: https://orcid.org/0000-0003-1772-7575
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 08 Jan, 2020
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Virology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Therapeutic strategies for severe hand, foot and mouth disease (HFMD) are currently either inconsequent or deficient in evidence. We retrospectively surveyed HFMD outbreaks in Xiangyang from June 2008 to December 2013. FHMD is staged form I to V according to clinical severity and the case with central nervous system involvement is defined as a severe one. Most severe cases were investigated to analyse risk factors for fatality and to compare the efficiency and outcome of some therapies by binary logistic regression. The overall HFMD cases included 637 (1.26%) severe cases, 38 fatal cases (0.75‰). Analysis indicates that age (<3 y), enterovirus 71 (+), autonomic nervous system dysregulation, pulmonary edema/hemorrhage, CRP (>40 mg/L) and cardiac troponin I (>0.04 ng/mL) are risk factors for fatality (all P < 0.05). Intravenous immunoglobulin (IVIG) and mechanical ventilation applied in early stage IV significantly improved HFMD progression (both P < 0.05) with odds ratios of 0.24 (95% CI: 0.10-0.57) and 0.01 (95% CI: 0.00-0.10), respectively. Methylprednisolone and milrinone administered in any stage, and all therapies applied in stage III made no significant difference on mortality (all P > 0.05). Precise recognition of the severe HFMD cases in early stage IV and timely IVIG and mechanical ventilation application may decrease mortality. Mechanical ventilation training programs and dispatching specialists to county-level or district hospitals when there is no chance for severe HFMD cases to be transferred to superior hospitals are two key successful administrative initiatives.
Figure 2