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 cerebrospinal fluid white blood cell count > 100/μl 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.
| Original language | English |
|---|---|
| Pages (from-to) | 327-331 |
| Number of pages | 5 |
| Journal | Pediatric Infectious Disease Journal |
| Volume | 23 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Apr 2004 |
| Externally published | Yes |
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Keywords
- Enterovirus 71
- Fatality
- Management
- Pulmonary edema
- Sequel
- Stage
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Microbiology (medical)
- Infectious Diseases
Cite this
Outcome of enterovirus 71 infections with or without stage-based management : 1998 to 2002. / Chang, Luan Yin; Hsia, Shao Hsuan; Wu, Chang Teng; Huang, Yhu Chering; Lin, Kuang Lin; Fang, Tsui Yen; Lin, Tzou Yien.
In: Pediatric Infectious Disease Journal, Vol. 23, No. 4, 04.2004, p. 327-331.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Outcome of enterovirus 71 infections with or without stage-based management
T2 - 1998 to 2002
AU - Chang, Luan Yin
AU - Hsia, Shao Hsuan
AU - Wu, Chang Teng
AU - Huang, Yhu Chering
AU - Lin, Kuang Lin
AU - Fang, Tsui Yen
AU - Lin, Tzou Yien
PY - 2004/4
Y1 - 2004/4
N2 - 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 cerebrospinal fluid white blood cell count > 100/μl 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.
AB - 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 cerebrospinal fluid white blood cell count > 100/μl 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.
KW - Enterovirus 71
KW - Fatality
KW - Management
KW - Pulmonary edema
KW - Sequel
KW - Stage
UR - http://www.scopus.com/inward/record.url?scp=1942451895&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=1942451895&partnerID=8YFLogxK
U2 - 10.1097/00006454-200404000-00010
DO - 10.1097/00006454-200404000-00010
M3 - Article
VL - 23
SP - 327
EP - 331
JO - Pediatric Infectious Disease Journal
JF - Pediatric Infectious Disease Journal
SN - 0891-3668
IS - 4
ER -