Analysis Of Clinical Characteristics Of Severe Hand-foot-mouth Disease Caused By Coxsackievirus A6

BackgroundHand-foot-mouth disease(HFMD)is a global epidemic of children caused by multiple enterovirus infections.With the popularization of hand-foot-mouth disease vaccines in recent years,patients with severe hand-foot-mouth disease such as neurogenic pulmonary edema caused by enterovirus 71(EV71)have been significantly reduced,but hand-foot-mouth disease caused by other serotypes is still more common.In particular,the number of cases of hand-foot-mouth disease caused by Coxsackie virus A6(CoxA6)infection has increased significantly.Currently,there is a lack of relevant information in Henan Province.In view of this,we conducted a targeted retrospective study.Objective1.By retrospectively analyzing the clinical data of children with hand,foot and mouth disease admitted to a third-class A-level children’s hospital in Henan,the epidemiological characteristics of HFMD caused by CoxA6 were clarified.2.To explore the clinical characteristics of severe children caused by CoxA6,to clarify the risk factors of severe hand-foot-mouth disease.Methods1.Collect case data of children with hand-foot-mouth disease admitted to the tertiary A-level children’s hospital from February 2017 to February 2018,including: personal information,general conditions,neurological symptoms,respiratory symptoms,circulatory symptoms and auxiliary Inspection and other items;2.According to the genotyping of the serotypes,the eligible cases are divided into CoxA6 group and other serotype groups(including EV71,CoxA16,Coxsackie virus A10(CoxA10),etc.);the children of each group are classified according to clinical manifestations: Normal and heavy.3.Summarize the clinical data of common and severe hand,foot and mouth disease caused by CoxA6 infection;summarize the clinical data of CoxA6 severe group and other serotype enterovirus severe group4.Use statistical analysis software SPSS23.0 to analyze the above data,use independent sample T test to compare the measurement data between the two groups,and use chi-square test to compare the count data.When P <0.05,the difference was considered statistically significant.Logistic regression analysis was used to analyze the risk factors of severe HFMD.Result:1.A total of 1805 children with confirmed hand,foot and mouth disease were included,including 540 CoxA6 infections,accounting for 29.92%,278 CoxA16 infections,accounting for 15.40%,195 EV71 infections,accounting for 10.80%,and CoxA10 infection 76 Cases,accounting for 4.21%,and the remaining 716 cases were infected by other serotypes such as CoxA4,CoxA2,CoxA5,CoxA12,etc.,accounting for 39.67%.Of the 540 children with HFMD infected by CoxA6,53 were severe;the other serotypes of enterovirus infection were 170 with severe HFMD,including 105 with EV71 infection,64 with CoxA16 infection,and 1 with CoxA10 infection.The incidences of CoxA6,EV71,CoxA16,and CoxA10 infection were 9.81%,53.85%,23.02%,and 1.31%,respectively.2.The demographic characteristics of the CoxA6 general group and the heavy group are compared.The average age of the children in the heavy group is lower than that of the general group(P <0.05),and the number of scattered children in the heavy group is higher than that of the normal group(P <0.05).The number of children in the kindergarten group was lower than that of the normal type(P <0.05),the number of children with a history of exposure in the heavy group was significantly lower than that of the normal group(P<0.05),and the number of children in the heavy group was the second child and above at home It was lower than the normal group(P <0.05),and the number of early breastfeeding and mother care in the heavy group was lower than that of the normal group(P <0.05).3.The number of children with CoxA6 severe group with rash as the first symptom was significantly lower than that of the normal group(P <0.05),and the number of patients with fever as the first symptom was significantly higher than that of the normal group(P<0.05).The number of patients with fever as the first symptom was significantly higher than that of the normal group(P <0.05).The average heat course and average heat peak of the children in the severe group were significantly higher than that of the normal group(P<0.05).The CK-MB count,CRP count,blood glucose and ALT values were significantly higher than those in the normal group(all P <0.05),and the number of children in the severe group with CRP> 10 mg / L was significantly higher than that in the normal group(P <0.05).4.Compared with CoxA6 and other severe HFMD caused by enterovirus of other serotypes,the number of people aged 1-2 years is higher than that of other severe serotype groups,and the number of people aged 2-3 years is lower than that of other severe serotype groups(P <0.05),the number of people with fever> 3 days was significantly lower than that of other severe serotype groups(P <0.05);children with CoxA6 severe group and other severe serotype groups developed rash during the course of the disease,and other severe serotype groups Mainly concentrated in the typical parts(hands,hips,mouth),and the trunk and limbs are less involved.The number of children with CoxA6 in the heavy group who experienced rashes at atypical parts(face,mouth,vulva)was higher than that in other serotype heavy groups,And the incidence of rashes in the CoxA6 severe group was mostly erythema multiforme,herpes and bullous herpes(P <0.05);in terms of neurological symptoms,compared with other serotype groups,the occurrence of vomiting and limb shaking The rate was significantly reduced(P <0.05);in terms of respiratory system,the number of people with elevated blood pressure,increased heart rate and increased breathing rate were significantly lower than those of other serotype heavy groups(P <0.05);WBC count level and CRP concentration level Significantly higher than Serotype severe group(P <0.05).5.Multi-factor Logistic analysis proves that long heat course,high fever,elevated blood sugar,and elevated CRP are the risk factors for CoxA6 severe hand-foot-mouth disease.Conclusion1.CoxA6 infection leads to severe hand,foot and mouth disease with a young age,the first symptom is more common with fever,the incidence of atypical rash is high,and the clinical characteristics are lower.2.Long fever,high fever,elevated blood glucose,and elevated CRP are risk factors for CoxA6 severe hand-foot-mouth disease.