A Clinical Analysis Of626Children With Hand, Footand Mouth Disease

Objective The goal to explore differences among different types ofHFMD, be in order to early diagnosis, further recognize severe HFMD orserious HFMD, take early treatment, prevent complication and improve theprognosis.Methods102mild cases,499severe cases and25serious cases inChongqing medical children’s hospital from march2011to September2011were observed, differences among mild HFMD, severe HFMD and seriousHFMD were compared by Chi-square test (or rank sum test).Results There was no significant difference on the age and gendercomposition among different types. Various types of HFMD mainlyoccurred in male children under age ofthree, The proportinof children under3years in serious group is80%, which is higher thanthat in mild(67.7%)andsever(67.9%). The mortality (40%) of serious group was significantly higherthan the mild and severe group. The incidence of Persistent high fever (bodytemperature≥39°C or fever≥3days),vomiting, fatigue, drowsiness orlethargy, startle, limb tremble, limb weakness, convulsion cervical rigiditywas more frequent insevere group compared with mild group;The incidence of persistent high fever, atypical rash, fatigue, coma, irritability, repeatedconvulsions, pupil change, cervical rigidity, muscle tension change (increaseor decrease), positive babinski sign, tachypnea, dyspnea, changes inrespiratory rhythm, pulmonary rales, tachycardia (heart rate≥160beats/min), heart sound change (blunt or less powerful), peripheral circulationchange (extremities cold or prolonged capillary refill time) was morefrequent in serious group compared with severe group. About auxiliaryexamination, the stool intestinal virus EV71detection rate of the severe andserious group was significantly higher than that of the mild group; Thesignificantly increased blood glucose(blood glucose≥10mmol/L) andwhite blood cell (WBC≥16×109/L), abnormal liver function, the positiverate of EEG, positive rate of brain MRI, the positive rate of brain CT, chestX-ray exudative changes were significantly higher in the serious group thanthat of severe group;Conclusion For the early diagnosis, active treatment and favorableprognosis of the serious HFMD cases, the pathogeny for the clinicaldiagnosed cases should be completed as soon as possible,we could be paymore attention to the patients who are under3years with EV71infection,persistent high fever and atypical rash, the performance of the nervoussystem such as startle, limb tremble, limb weakness and etc could beintensively observed, the respiration, heart rate, peripheral circulation andother vital signs could be close monitored, the blood routine, blood glucose, chest radiography could be early completed, and in necessityelectroencephalogram or cranial imaging studies.