Clinical features and risk factors of pulmonary oedema after enterovirus-71-related hand, foot, and mouth disease

Luan Yin Chang, Tzou Yien Lin, Kuang Hung Hsu, Yhu Chering Huang, Kuang Lin Lin, Chuen Hsueh, Shin Ru Shih, Hsiao Chen Ning, Mao Sheng Hwang, Huei Shyoung Wang, Chin Yun Lee

Research output: Contribution to journalArticle

317 Citations (Scopus)

Abstract

Background. In Taiwan, from April to July, 1998, an epidemic of hand, foot, and mouth disease associated with enterovirus 71 (EV71) occurred with fatal complications. We did a clinical study of EV71-related diseases in Taiwan. Methods. We studied 154 children with virus-culture-confirmed EV71 infection. Children were divided into three groups: 11 patients with pulmonary oedema; 38 patients with central nervous system (CNS) involvement and no pulmonary oedema; and 105 children without complications. We compared the clinical features, laboratory findings, risk factors, and outcome among these three groups. Findings. Nine children with pulmonary oedema had hand, foot, and mouth disease, one had herpangina, and one had febrile illness with eight children with limb weakness and one with limb hypesthesia. All children had had sudden onset of tachycardia, tachypnoea, and cyanosis 1-3 days after onset of the disease. Nine of 11 children died within 12 h of intubation; one child was braindead within 15 h and died 17 days after intubation; one child was in deep coma and died 3 months later. In children with CNS complication and no pulmonary oedema, one child died of pneumonia after 4 months of ventilator support and four children had sequelae. All 105 children without complications recovered. There was a significant association between CNS involvement and pulmonary oedema (odds ratio 12.4 [95% CI 2.6-60.1], p = 0.001). Risk factors for pulmonary oedema after CNS involvement were hyperglycaemia, leucocytosis, and limb weakness. Hyperglycaemia was the most significant prognostic factor for pulmonary oedema (odds ratio 21.5 [3-159], p = 0.003). Interpretation. EV71 can cause hand, foot, and mouth disease, CNS involvement with severe sequelae, and fatal pulmonary oedema. Hyperglycaemia is the most important prognostic factor.

Original languageEnglish
Pages (from-to)1682-1686
Number of pages5
JournalLancet
Volume354
Issue number9191
DOIs
Publication statusPublished - Nov 13 1999
Externally publishedYes

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Hand, Foot and Mouth Disease
Enterovirus
Pulmonary Edema
Central Nervous System
Hyperglycemia
Extremities
Taiwan
Intubation
Herpangina
Odds Ratio
Enterovirus Infections
Tachypnea
Cyanosis
Hypesthesia
Leukocytosis
Mechanical Ventilators
Coma
Tachycardia

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Clinical features and risk factors of pulmonary oedema after enterovirus-71-related hand, foot, and mouth disease. / Chang, Luan Yin; Lin, Tzou Yien; Hsu, Kuang Hung; Huang, Yhu Chering; Lin, Kuang Lin; Hsueh, Chuen; Shih, Shin Ru; Ning, Hsiao Chen; Hwang, Mao Sheng; Wang, Huei Shyoung; Lee, Chin Yun.

In: Lancet, Vol. 354, No. 9191, 13.11.1999, p. 1682-1686.

Research output: Contribution to journalArticle

Chang, LY, Lin, TY, Hsu, KH, Huang, YC, Lin, KL, Hsueh, C, Shih, SR, Ning, HC, Hwang, MS, Wang, HS & Lee, CY 1999, 'Clinical features and risk factors of pulmonary oedema after enterovirus-71-related hand, foot, and mouth disease', Lancet, vol. 354, no. 9191, pp. 1682-1686. https://doi.org/10.1016/S0140-6736(99)04434-7
Chang, Luan Yin ; Lin, Tzou Yien ; Hsu, Kuang Hung ; Huang, Yhu Chering ; Lin, Kuang Lin ; Hsueh, Chuen ; Shih, Shin Ru ; Ning, Hsiao Chen ; Hwang, Mao Sheng ; Wang, Huei Shyoung ; Lee, Chin Yun. / Clinical features and risk factors of pulmonary oedema after enterovirus-71-related hand, foot, and mouth disease. In: Lancet. 1999 ; Vol. 354, No. 9191. pp. 1682-1686.
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abstract = "Background. In Taiwan, from April to July, 1998, an epidemic of hand, foot, and mouth disease associated with enterovirus 71 (EV71) occurred with fatal complications. We did a clinical study of EV71-related diseases in Taiwan. Methods. We studied 154 children with virus-culture-confirmed EV71 infection. Children were divided into three groups: 11 patients with pulmonary oedema; 38 patients with central nervous system (CNS) involvement and no pulmonary oedema; and 105 children without complications. We compared the clinical features, laboratory findings, risk factors, and outcome among these three groups. Findings. Nine children with pulmonary oedema had hand, foot, and mouth disease, one had herpangina, and one had febrile illness with eight children with limb weakness and one with limb hypesthesia. All children had had sudden onset of tachycardia, tachypnoea, and cyanosis 1-3 days after onset of the disease. Nine of 11 children died within 12 h of intubation; one child was braindead within 15 h and died 17 days after intubation; one child was in deep coma and died 3 months later. In children with CNS complication and no pulmonary oedema, one child died of pneumonia after 4 months of ventilator support and four children had sequelae. All 105 children without complications recovered. There was a significant association between CNS involvement and pulmonary oedema (odds ratio 12.4 [95{\%} CI 2.6-60.1], p = 0.001). Risk factors for pulmonary oedema after CNS involvement were hyperglycaemia, leucocytosis, and limb weakness. Hyperglycaemia was the most significant prognostic factor for pulmonary oedema (odds ratio 21.5 [3-159], p = 0.003). Interpretation. EV71 can cause hand, foot, and mouth disease, CNS involvement with severe sequelae, and fatal pulmonary oedema. Hyperglycaemia is the most important prognostic factor.",
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T1 - Clinical features and risk factors of pulmonary oedema after enterovirus-71-related hand, foot, and mouth disease

AU - Chang, Luan Yin

AU - Lin, Tzou Yien

AU - Hsu, Kuang Hung

AU - Huang, Yhu Chering

AU - Lin, Kuang Lin

AU - Hsueh, Chuen

AU - Shih, Shin Ru

AU - Ning, Hsiao Chen

AU - Hwang, Mao Sheng

AU - Wang, Huei Shyoung

AU - Lee, Chin Yun

PY - 1999/11/13

Y1 - 1999/11/13

N2 - Background. In Taiwan, from April to July, 1998, an epidemic of hand, foot, and mouth disease associated with enterovirus 71 (EV71) occurred with fatal complications. We did a clinical study of EV71-related diseases in Taiwan. Methods. We studied 154 children with virus-culture-confirmed EV71 infection. Children were divided into three groups: 11 patients with pulmonary oedema; 38 patients with central nervous system (CNS) involvement and no pulmonary oedema; and 105 children without complications. We compared the clinical features, laboratory findings, risk factors, and outcome among these three groups. Findings. Nine children with pulmonary oedema had hand, foot, and mouth disease, one had herpangina, and one had febrile illness with eight children with limb weakness and one with limb hypesthesia. All children had had sudden onset of tachycardia, tachypnoea, and cyanosis 1-3 days after onset of the disease. Nine of 11 children died within 12 h of intubation; one child was braindead within 15 h and died 17 days after intubation; one child was in deep coma and died 3 months later. In children with CNS complication and no pulmonary oedema, one child died of pneumonia after 4 months of ventilator support and four children had sequelae. All 105 children without complications recovered. There was a significant association between CNS involvement and pulmonary oedema (odds ratio 12.4 [95% CI 2.6-60.1], p = 0.001). Risk factors for pulmonary oedema after CNS involvement were hyperglycaemia, leucocytosis, and limb weakness. Hyperglycaemia was the most significant prognostic factor for pulmonary oedema (odds ratio 21.5 [3-159], p = 0.003). Interpretation. EV71 can cause hand, foot, and mouth disease, CNS involvement with severe sequelae, and fatal pulmonary oedema. Hyperglycaemia is the most important prognostic factor.

AB - Background. In Taiwan, from April to July, 1998, an epidemic of hand, foot, and mouth disease associated with enterovirus 71 (EV71) occurred with fatal complications. We did a clinical study of EV71-related diseases in Taiwan. Methods. We studied 154 children with virus-culture-confirmed EV71 infection. Children were divided into three groups: 11 patients with pulmonary oedema; 38 patients with central nervous system (CNS) involvement and no pulmonary oedema; and 105 children without complications. We compared the clinical features, laboratory findings, risk factors, and outcome among these three groups. Findings. Nine children with pulmonary oedema had hand, foot, and mouth disease, one had herpangina, and one had febrile illness with eight children with limb weakness and one with limb hypesthesia. All children had had sudden onset of tachycardia, tachypnoea, and cyanosis 1-3 days after onset of the disease. Nine of 11 children died within 12 h of intubation; one child was braindead within 15 h and died 17 days after intubation; one child was in deep coma and died 3 months later. In children with CNS complication and no pulmonary oedema, one child died of pneumonia after 4 months of ventilator support and four children had sequelae. All 105 children without complications recovered. There was a significant association between CNS involvement and pulmonary oedema (odds ratio 12.4 [95% CI 2.6-60.1], p = 0.001). Risk factors for pulmonary oedema after CNS involvement were hyperglycaemia, leucocytosis, and limb weakness. Hyperglycaemia was the most significant prognostic factor for pulmonary oedema (odds ratio 21.5 [3-159], p = 0.003). Interpretation. EV71 can cause hand, foot, and mouth disease, CNS involvement with severe sequelae, and fatal pulmonary oedema. Hyperglycaemia is the most important prognostic factor.

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