Clinical Analysis Of Skin Lesion And Severity In149Cases With Hand-foot-mouth Disease

Background and objective: Hand-foot-mouth disease (HFMD) is anacute infectious disease caused by intestinal viruses, the majority ofpatients has a good prognosis, but a few cases may show a severe or atypicalclinical course, accompanied by neurologic complications and even lead todeath. In recent years, with an upward trend in incidence, severe and atypicalcases have became more and more.In addition, the scholars consider thatatypical HFMD are more likely to be severe HFMD.Therefore, the earlyrecognition of atypical HFMD can improve not only the diagnostic rate butalso the cure rate. The clinical data, especially in skin lesion, of atypicalHFMD and severe HFMD, were analyzed retrospectively in this paper. so asto improve clinical diagnostic rate of atypical HFMD and early recognitionof severe HFMD.Methods:Clinical data of149cases of hospitalized children withHFMD from April2012to September2012were collected.And clinicalcharacteristics in general information, the characteristics of skin lesion(including the location, form, size, number), symptom, laboratoryexamination, treatment and prognosis were analyzed retrospectively. Results:一、Comparison of typical and atypical HFMD:Among149cases of HFMD, typical HFMD had62cases (41.6%),atypical HFMD had87patients (58.4%).AtypicalⅠhad59cases(39.6%)， atypical Ⅱhad28cases (18.8%).1.General information: On gender, typical and atypicalⅠ:male>female; atypicalⅡ:male<female.On the age,1-3years old was morecommon. On the course of the disease:there was no difference.2. Characteristics of skin lesion:1)Location: Most typical casesinvolved4-5parts;while the group involving4-5parts of atypicalⅠ wereless than typical HFMD,and the group involving1-3parts of atypicalⅠ weremore than typical HFMD.All cases of atypical Ⅱ involved4-5parts, evenlimbs and trunk,and the group involving5parts was significantly more thantypical HFMD (P<0.05).2)Form: Erythema,papule and crust were morecommon in atypical Ⅰ, while atypicalⅡ wasoften characterized byerythema,papule, vesicle and crust occurring at the same time.There weresome prominent and transparent vesicles, the characteristic vesicle ofatypicalⅡ.3)Size: AtypicalⅠ:the grain size was significantly less thantypical HFMD(P<0.05);AtypicalⅡ: the bean size was significantly morethan typical HFMD(P<0.05).4)Number: AtypicalⅠ w as relatively less thantypical HFMD, and AtypicalⅡ was relatively more than typical HFMD.5)Fusion: A few cases of AtypicalⅡ might appear fused lesion rashes. 3.Symptom and severity: Atypical Ⅰw assignificantly more severe thantypical HFMD (P<0.05), the rate of f ever、neurologic symptoms andcirculatory symptoms were higher than typical HFMD.While,atypicalⅡ wassignificantly milder than typical HFMD (P<0.05),and the rate of theneurologic symptoms、respiratory symptoms and the circulatory symptomswere lower than typical HFMD.4.Etiology: Typical and atypicalⅠ:EVU and EV71were more common;AtypicalⅡ:EVU was more common.二、Comparison of mild and severe HFMD:Among149cases of HFMD,mild group had55cases (36.9%), severegroup had94patients (63.1%).1.General information: On gender, male was more than female in bothgroups.On the age,1-3years old was more common in both groups.Theduration of severe group was significantly longer than that of mildgroup(P<0.05).2.Characteristics of skin lesion:1)Location: There was no differencebetween two groups when the lesion occured in several parts at one time.2)Form: The papule and crust of severe group were significantly morecommon than those of mild group(P<0.05).3)Size: pinpoint size of severegroup was significantly more than that of mild group(P<0.05),and millet tograin size was significantly less than mild group(P<0.05).4)Number: Therewas no significant difference in both groups.5)Type: The severe cases of atypicalⅠ w eresignificantly more than typical type (P<0.05), while Thesevere cases of atypicalⅡ w eresignificantly less than typical type(P <0.05).3.Etiology： The positive rate of EV71in severe group wassignificantly higher than in mild group(P <0.05).Besides, in infection forms,the infection rate of EV71and EVU+EV71in severe group,were bothsignificantly higher than in mild group(P <0.05),and the infection rate ofEVU in severe group was significantly lower than in mild group(P <0.05).Conclusion:1.Most atypical HFMD involved less parts,even a single part. Theerythema, papule and crust were more common.The rashes were smaller andfewer.The main virus were EVU and EV71.The cases were more severe thanthe typical cases.2.A few of atypical HFMD spread to limbs,even the whole body.Itusually presented with erythema,papule, vesicle and crust occurring at thesame time.There were some prominent and transparent vesicles.The rasheswere bigger and more.EVU was the most common virus. The cases were notsevere than the typical cases..3.If the following atypical rashes or etiological characteristics appeared,we should be alert to severe HFMD:1)The papule and crust are morecommon;2)The size is as small as needlepoint;3)Atypical HFMD withlighter rashes;4) EV71(+). If combined with other early warning indicatorsof severe HFMD,we should pay a attention to it more.