| Background HFMD is a global infectious disease,in recent years,the incidence o f HFMD in China and different countries of the Asia-Pacific region showed a gradual rise,at the same time,there are more severe cases and deaths reported,this is a tremendous impact on the social and family.Thus,HFMD has become a public health problem in China and Asia-Pacific region.In China,HFMD had been included in the statutory management of Class C infectious diseases in May 2008.Children under 5 years old are suffering fro m hand-foot-mouth disease in the main crowd,the main symptoms is rash or herpes in hand,foot,mo uth,etc.Most mild sy mptoms of children can be successfully treated,but part of a serious condition in children,if not treated timely or unreasonable,rapid progression,prone to encephalitis,cerebral edema,myocarditis and other complications,severe and even death.A variety of intestinal virus can caus e hand-foot-mouth disease,in our country enterovirus 71(EV71)and Coxsacki e virus type A16(Cox A16)is the most,More severe and deaths caused by EV71 infection.hand-foot-mouth disease is caused by the intestinal virus,so highly infectious,not only the source of infection include children,further comprising a latent infection,there are many viral infection and route of infection.Hand-foot-mouth disease which is contagious.transmission complex and generally susceptible children,so it is difficult to control.Objective 1.To understand HFMD patients and their families in Chongqing areas;the overall distribution of Pathogenesis,di agnosis and treat ment of patients with HFMD cases;past history and other relevant information about the case;Sample collection and laboratory inspection;Clinical symp toms,signs and complications.2.To understand the distribution of the differences about these five aspects of the characteristics patients between severe HFMD cases and mild cases,and which between severe HFMD viable and deaths cases in Chongqing areas.3.To explore the region the influence factors of severe HFMD cases,and the influence of deaths occurred in severe cases of hand-foot-mouth disease,sign for the future to carry out intervention work,reduce the incidence of severe cases and mo rtality.Methods A total of 90 severe HFMD cases diagnosed from 2011 to 2014 in Chongqing(Chongqing children's hospital)were enrolled as case group while another 90 mild HFMD cases were randomly selected as control group in the same period.Severe cases include 52 cases of severe No deaths and 38 cases of severe deaths,Severe and mild cases,Severe deaths and Severe no-deaths use the unmatched case-control study.One on one unified questionnaire inquiry and read the patients' medical records,the survey included: the overall distribution of Pathogenesis,diagnosis and treatment of patients with HFMD cases;past history and other relevant information about the case;Sample collection and laboratory inspection;Clinical symptoms,signs and complications.Data was processed by Epi Data(V3.1)and analyzed by SPSS(V19.0),Univariate and mu ltivariate non-conditi onal logistic regression analysis.Results 1.This study investigated a total of 180 hand-foot-mouth disease cases,there are 90 severe cases and 90 mild cases,38 severe cases died(42.2% of all severe cases);Male 117 cases(65.0%),fe male 63 cases(35%);the age range of 4 months to 6 years ol d,the average age of 1.64 ± 1.22 years,infants(? 3 years)167 cases(92.8%),school age Early children(4-6 years)13 cases(7.2%).We collected samples of 172 cases,the most samples are stool 135 cases(78.5%),there are any one of the samples tested positive for 140 cases;The positive rate of 81.40%,which is the most EV71 virus type 85 cases,the detection rate was 49.71%.2.Survey onset and initial treatment intervals are shorter,an average of less than one day;initial treatment and diagnosis time interval average nearly two days.65.6% of respondents in newly diagnosed type hospitals are at the county level and below the level of medical institutions,62.2 percent of first diagnosed cases are missed diagnosis of hand-foot-mouth disease,84.4% of the cases are first diagnosed with HFMD at the provincial level and above hospitals.And below the county level medical institutions HFMD mi sdiagnosis rate was higher,68.67%,With the hospital level rise of HFMD gradually reduce the rate of misdiagnosis.3.Survey in 168 cases(93.33%)had symptoms of fever,58 cases(32.22%)cough sy mpto ms,175 cases(9 7.22%)had symptoms of rash,most types of rash are pimples and herpes,there are 141 cases(78.33%)and 106 cases(58.89%)cases,most parts of the rash are present in hands,feet,account for 85% above.4.Children surveyed comp lications and the most frequent signs is the nervous system,followed by respiratory system,there are 98.3%,83.3% of the cases.The most frequent complications and signs of the nervous system before 3 as follows: abnormal pupil status(95.56%),spirit of the poor(53.33%),easily frightened(32.78%);The most frequent complications and signs of the respiratory system before 3 as follows: sore throat(38.89%),cough(25.00%),cyanosis(25.00%),The most frequent complications and signs of the circulatory system before 3 as follows: heart rate(43.33%),cold extremities(20.00%),facial / hand / foot-terminal pale gray(17.78%),The main frequent complications and signs of the digestive system is vomit(34.44%).5.Severe and mild cases univariate analysis showed that:Virus type.Registered residence type.Current address type.Cultural degree of people who look after.Whe ther fever.Whether rash.maximum body temperature above 39?.First diagnosis hospital type.The mean duration of rash.Whether the first diagnosis of hand-foot-mouth disease.Duration of rash,complications arise digestive system,complications arise circulatory system,etc.There are significant differences in distribution between the two groups.6.Severe HFMD deaths and severe non-fatal HFMD cases univariate analysis showed that: gender.registered residence type.Onset of the season.Number of children under the age of 14.First di agnosis hospital type.The mean duration of fever.The mean duration of rash.Pharyngeal isthmus has herpes or ulcers.Complications arise digestive system.Deep coma.Difficulty breathing.finger / toe or lips cyanosis,pulse weakened,vomiting,brown vomit,There are significant differences in distribution between the two groups.7.Multivariate logistic regression showed that factors including : Current residence for rural type,the initial treatment of undiagnosed hand-foot-mouth disease,infected virus type EV71,complications arise circulatory system are risk factors for mild hand-foot-mouth disease cases become severe cases.Influencing factors of death in patients with severe hand-foot-mouth disease: number of children under the age of 14.The mean duration of fever.The mean duration of rash and Deep coma.Vomiting,the first 3 are protective factors;the last 2 are risk factors.Conclusion Through the investigation of 180 cases of HFMD in Chongqing areas areas from 2011 to 2014,the following conclusions were drawn: 1.To improve the ability of medical institutions at the county level and below for the diagnosis and treatment of HFMD,it is particularly important in the prevention and control of HFMD.It is urgent to strengthen the training of medical institutions at the county level and below.2.We should increase the prevention and health care of R ural Kindergartens and families.We should attach great importance to ti me to go to hospital when family and preschool institutions found that these symptoms of children.3.To imp rove the ability of medical institutions for the diagnosis and treat ment of HFMD,when children were found to be infected with a virus type EV71 or a circulatory complication,Symptomatic treatme nt of patients in a timely manner;it helps reduce the incidence of severe HFMD cases.4.We should monitor the risk factors of deaths of severe HFMD;strengthen the close observation and treatment care of cases,to reduce the mortality of severe HFMD. |
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