Acute encephalomyelitis during an outbreak of enterovirus type 71 infection in Taiwan: Report of an autopsy case with pathologic, immunofluorescence, and molecular studies

Chuen Hsueh, Shih Ming Jung, Shin Ru Shih, Tseng Tong Kuo, Wun Ju Shieh, Sherif Zaki, Tzou Yien Lin, Luan Yin Chang, Hsiao Chen Ning, Da Chin Yen

Research output: Contribution to journalArticle

98 Citations (Scopus)

Abstract

We report a fatal case of enterovirus type 71 (EV 71) infection in an 8-year-old girl during a summer outbreak of hand, foot, and mouth disease in 1998 in Taiwan. The clinical course was rapidly progressive, with manifestations of hand, foot, and mouth disease, aseptic meningitis, encephalomyelitis, and pulmonary edema. The patient died 24 hours after admission. Postmortem study revealed extensive inflammation in the meninges and central nervous system and marked pulmonary edema with focal hemorrhage. Brain stem and spinal cord were most severely involved. The inflammatory infiltrates consisted largely of neutrophils involving primarily the gray matter with perivascular lymphocytic curing, and neuronophagia. The lungs and heart showed no evidence of inflammation. EV 71 was isolated from the fresh brain tissues and identified by immunofluorescence method with type-specific EV 71 monoclonal antibody. It was also confirmed by neutralization test and reverse-transcriptase polymerase chain reaction with sequence analysis. The present case was the first example in which EV 71 was demonstrated to be the causative agent of fatal encephalomyelitis during its epidemic in Taiwan.

Original languageEnglish
Pages (from-to)1200-1205
Number of pages6
JournalModern Pathology
Volume13
Issue number11
Publication statusPublished - 2000
Externally publishedYes

Keywords

  • And mouth disease
  • Encephalitis
  • Encephalomyelitis
  • Enterovirus
  • Enterovirus type 71
  • Foot
  • Hand
  • Meningitis

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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