Risk Factors And Early Identification Of Severe Hand,Foot And Mouth Disease

ObjectiveTo summarize and analyze the clinical features,laboratory features of general and severe hand,foot and mouth disease which was after EV71 vaccine promotion in September 2016 of Henan,the distribution of the serotype of pathogenic enterovirus of different types of HFMD,in order to explore the high risk factors of severe hand,foot and mouth disease,provide the basis for the early identification of children in clinic with hand,foot and mouth disease especially kind of severe.MethodsThe clinical data were collected from children with hand,foot and mouth disease?HFMD?who were treated in Henan Children's Hospital.Retrospective collection of clinical data,the clinical features and auxiliary examination were compared between the general group and the severe group.Use SPSS21.0 statistical sofeware package for data statistics analysis,the independent sample T test are compared,and measuring data between the two groups using chi-square test to count data comparison between the two groups,using multiariable logistic regression method of LR back to analyze the results.ResultsFrom October 2016 to December 2017,1590 children with hand,foot and mouth disease were hospitalized in Henan Children's Hospital,148 in the severe group and 146 in the general group.?1?General condition:Among which there were 205 males and 89 females,100 cases?67.6%?were male,48 cases?32.4%?were female in severe group,105 cases?71.9%?were male,41 cases?28.1%?were female in general group,in two groups of patients with gender is chi-square=0.283,P=0.595,there was no statistically significant difference?P>0.05?.Age distribution:severe illness group<3years,105 cases?70.9%?;3 to 7 years,34 cases?23%?;>7years,9cases?6.1%?;general illness group<3years,80 cases?54.1%?;3 to 7years 52 cases?35.1%?;>7years 16 cases?10.8%?.The distribution was compared with that of the chi-square=9.106,P=0.011,and the difference has statistical significance?P<0.05?.Habitat distribution:severe illness group includ city patients 35 cases?23.6%?,rural patients 113 cases?76.4%?;general illness group includ city patients 92 cases?63%?,rural patients 54 cases?37%?,two groups of patients Habitat distribution chi-square=46.416,P=0.000,the difference was statistically significant?P<0.05?.?2?Clinical manifestations:thermal range:thermal range of general illness group was?3.42�2.19?d,thermal range of severe illness group was?9.19�4.93?d.Thermal range is statistically significant.In severe illness group includ 6 cases of no fever?4.1%?,7 cases of mild fever?4.7%?,62 cases of moderate fever?41.9%?,73 cases of severe fever?49.3%?;In general illness group includ 50 cases of no fever?34.2%?,12 cases of mild fever?8.2%?,58 cases of moderate fever?39.7%?,26 cases of severe fever?17.8%?.The comparison chi-square=58.323,P=0.000,the difference was statistically significant?P<0.05?.Rash:294 patients with rash was included in the study eventually.Rash distribution in general illness group includ 3 cases of no rash?2.2%?and 143 cases with rash?97.8%?;in severe illness group includ 35 cases of no rash?23.6%?and 113 cases with rash?76.4%?,two groups of patients were compared with chi-square=10.708,P=0.001,the difference was statistically significant?P<0.05?.Hospital stay:general illness group was?4.54�1.50?d,severe illness group was?18.05�15.94?d.The main manifestations of respiratory and circulatory system with regard to severe group were as follow:increased respiratory rate in 64 cases?43.2%?,abnormal breathing rhythm in 21 cases?14.1%?,lung moist rale in 20 cases?13.5%?,increased heart rate was detected in 58 cases?39.1%?,increased blood pressure in 25 cases?16.9%?,decreased blood pressure in 18 cases?12.1%?,peripheral circulation audible in 53 cases?35.8%?.The clinical manifestations of nervous in the severe illness group included symptoms:weakness 93 cases?62.8%?,merging vomiting 94 cases?63.5%?,somnolence 38 cases?25.7%?,convulsion of 14 cases?9.5%?,limb weakness 55 cases?37.1%?,limb tremor 102cases?68.9%?,merging nystagmus 20 cases?13.5%?,signs:neck resistance 34 cases?22.9%?,abnormal tendon reflex 9 cases?6%?,low strength of 55 cases?37.1%?,Meningeal irritation sign positive 34 cases?22.9%?.Weakness,with vomiting,convulsions,somnolence,limb tremor,limb weakness was early symptoms and physical signs of severe hand,foot and mouth disease.?3?Laboratory inspection:general group white blood cell count was?10.76�3.47?10/L,severe group white blood cell count was?13.91�4.59?10/L,mean percentage of neutrophil in general group was?55.15�18.30?%,mean percentage of neutrophil in severe group was?63.45�16.69?%,general group blood platelet count was?296.24�93.43?10¹²/L,severe group blood platelet count was?342.91�118.39?10¹²/L;general group blood glucose count was?5.10�0.89?mmol/L,severe group blood glucose count was?8.32�2.14?mmol/L;general group CRP count was?9.22�14.61?mg/L,severe group CRP count was?6.12�9.37?mg/L;Severe group in white blood cell count,mean percentage of neutrophil,platelet,,blood sugar is higher than general group,difference has statistical significance?P<0.05?,and CRP was no statistically significant difference with general group?P>0.05?.?4?Pathogen detection:pharynx,airway secretions,herpes fluid,feces specimens of isolated intestinal virus or specificity of the viral nucleic acid detection within the early period.In the general group,89 cases?71%?were positive for HFMD virus,57 cases?39%?were negative for virus infection,125 cases?84.5%?were positive for virus infection in severe group,and 23 cases?15.5%?were negative for virus infection,the comparison chi-square=20.493,P=0.000,difference has statistical significance?P<0.05?.29 cases were detected only positive EV71,including 13 cases of general group?8.9%?and 16 cases of severe group?10.8%?,15 cases were detected only positive PE,including 6 cases of general group?4.1%?and 9 cases of severe group?6.1%?.9 cases were detected only positive CoxA16 positive,including 3cases of general group?2%?and 6 cases of severe group?4.0%?.53 cases were detected positive EV71 merger PE,including 3 cases of general group?2.0%?and 50 cases of severe group?33.8%?.32 cases were detected positive EV71 merger CoxA16,including 5 cases of general illness group?3.4%?and 27 cases of severe illness group?18.2%?.13 cases were detected positive PE merger CoxA16,including2 cases of general illness group?2.0%?and 11 cases of severe illness group?7.4%?.There were 22 cases?15.1%?in general group and 94 cases?63.5%?in severe group of multiple virus serotype positive.There were 124 cases?84.9%?in general group and 54 cases?36.5%?in the severe group of single virus serotype positive,the comparison chi-square=72.354,P=0.000,difference has statistical significance?P<0.05?.?5?Auxiliary examination:Abnormal ECG in severe group was 69/148?46.6%?,the main manifestations are sinus arrhythmia,nodal tachycardia,ST-T alter,right ventricular conduction delay,left axis deviation,right axis deviation,QT prolongation.Abnormal chest X ray was20/148?13.5%?,the main manifestations are thick lung,two lungs or a single side field with visible patches.Abnormal EEG was 38/148?25.7%?,the main manifestations are diffuse slow waves,spinous slow waves.Abnormal head MRI was 50/148?33.8%?,the main manifestations are abnormal signal changes in brain stem,anterior spinal cord injury,cerebellar damage can be combined.Single factor analysis results show that the number of hospitalized patients with severe HFMD,thermal spike,thermal range,blood pressure?systolic and diastolic pressure?,RR,HR,blood sugar,WBC,N,L,M,PLT,virus serotype positive compare gengral HFMD,the difference was statistically significant;but the difference with CRP,in these two groups was not statistically significant.The multi-factors Logistic analysis showed that the high risk factors key to the translation from the severe illness cases to the critical illness cases may be as follows:Early onset infection of multiple virus serotype positive?OR=1.445,95%CI:1.021².045?,high fever?OR=1.269,95%CI:1.150¹.461?,thermal range?OR=1.188,95%CI:1.065¹.326?and blood glucose?OR=8.893,95%CI:3.146²5.141?.Conclusion?1?Hand,foot and mouth disease has no difference between the male and female,mainly occurrs to children of age with less than 3 years old,the rural regions has a higher incidence than the city regions;?2?The common clinical manifestations of severe children were similar to those insevere cases before vaccination;Severe illness the intestinal virus is mostly mixed infection,which is not consisitent with EV71 before inoculation.?3?Weakness,with vomiting,convulsions,somnolence,limb tremor,limb weakness was early symptoms and physical signs of severe hand,foot and mouth disease.?4?Early onset infection of multiple virus serotype positive,high fever,long thermal range and increase in blood sugar were four factors for the development of risk factors for severe hand,foot and mouth disease.