Clinical spectrum of enterovirus 71 infection in children in southern Taiwan, with an emphasis on neurological complications

Shih Min Wang, Ching Chuan Liu, Hui Wan Tseng, Jen Ren Wang, Chao Ching Huang, Yung Jung Chen, Yao Jong Yang, Shio Jean Lin, Tsu Fuh Yeh

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232 Citations (Scopus)

Abstract

An outbreak of enterovirus 71 (EV71) infection occurred in Taiwan in 1998. The clinical spectrums and laboratory findings for 97 patients with virus culture-proven EV71 infections were analyzed. Eighty-seven percent of the patients were younger than age 5 years. Hand-foot-and-mouth syndrome occurred in 79% of the children and central nervous system (CNS) involvement in 35%, including nine fatal cases. The predominant neurological presentations were myoclonus (68%), vomiting (53%), and ataxia (35%). Brain stem encephalitis was the cardinal feature of EV71 CNS involvement during this outbreak. Magnetic resonance imaging and pathological findings illustrated that the midbrain, pons, and medulla were the target areas. EV71 brain stem encephalitis can present either with cerebellar signs and an initially mild, reversible course or with overwhelming neurogenic shock and neurogenic pulmonary edema (NPE) resulting in a fatal outcome. Brain stem encephalitis that progressed abruptly to neurogenic shock and NPE was indicative of poor prognosis in this epidemic. Early aggressive treatment and close monitoring of the neurological signs are mandatory to improve the chance of survival.

Original languageEnglish
Pages (from-to)184-190
Number of pages7
JournalClinical Infectious Diseases
Volume29
Issue number1
Publication statusPublished - 1999
Externally publishedYes

ASJC Scopus subject areas

  • Immunology

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    Wang, S. M., Liu, C. C., Tseng, H. W., Wang, J. R., Huang, C. C., Chen, Y. J., Yang, Y. J., Lin, S. J., & Yeh, T. F. (1999). Clinical spectrum of enterovirus 71 infection in children in southern Taiwan, with an emphasis on neurological complications. Clinical Infectious Diseases, 29(1), 184-190.