Comparative Analysis Of Clinic Characteristics Of Severe Hand-foot-mouth Diseases Caused By Coxsackievirus A6 And Enterovirus 71

Objective: To analyze the difference of clinic features of severe hand-foot-mouth diseases caused by coxsackievirus A6(CA6) and enterovirus 71(EV71), in order to provide evidence for prevention and control of hand-foot-mouth disease in chongqing.Methods: We collected clinic data of children with severe hand-foot-mouth diseases hospitalized in Children’s Hospital of Chongqing Medical University from January 2013 to December 2014, and constructed phylogenetic trees after RT-PCR to detect.Results: A total of 73 severe hand-foot-mouth cases including 29 cases in CA6 group and 44 cases in EV71 group were recruited into the study with the radio of male to female of 1.92:1. There were different seasonal distributions in two groups with the peak of CA6 was in autumn and winter and the peak of EV71 was in spring and summer. The cases in CA6 group were younger than those in EV71 group,(1.46±0.59) years VS(2.50±1.26) years, P<0.05.Fever was the main mode of onset in both two groups, while longer duration of fever and higher incidence of duration of fever more than 3 days was noted in the cases associated with EV71(all P<0.05). The rashes in CA6 group were widely distributed, also the forms of rashes were diverse with a higher rate of herpes(P < 0.05). The incidence of vomiting, limb shaking, high blood pressure, increasing heartrate and respiratory rate caused by EV71 were higher than by CA6(all P<0.05). However, respiratory catarrhal symptoms and follow-up onychomadesis were frequently seen in CA6 infection(all P < 0.05).The laboratory indicators showed that mean WBC and the rate of elevated CRP in CA6 group was significantly higher than those in EV71 group(all P <0.05). There were no significant difference in blood glucose and creatine kinase MB(CK-MB) and alnanine aminotransferace(ALT) between two groups(all P > 0.05). Phylogenetic analysis shows that CA6 strain isolated from Chongqing during 2013-2014 has high homology with the typical strains in Japan and Spain, EV71 virus strain is the subtype of C4 a.Conclusions: Severe hand-foot-mouth disease caused by CA6 has its relatively specific clinic features in comparison with the disease caused by EV71. Clinicians can roughly distinguish CA6 infection from EV71 infection according to children’s clinical manifestations and laboratory parameters, so as to take timely treatment and improve prognosis effectively.