Clinical Features Of Hand,foot And Mouth Disease With Atypical Rash

Objective:To analyze the clinical features of hand,foot,and mouth disease?HFMD?with atypical rash,include the analysis of risk factors of severe cases,it provides reference for early clinical identification and prevention and control of HFMD with atypical rash.Method:The data of 306 children with HFMD who were hospitalized in our hospital from January 2017 to December 2018 were collected,which include epidemiology,rash features,clinical symptoms,laboratory examination,pathogen detection results etc.According to the characteristics of the rash,the children with no rash,single site rash or multiple sites rash except hand,foot,mouth and hip but no herpes were classified as atypical group I.Multiple sites rash except hand,foot,mouth and hip with blisters as atypical type II.Papules,macules,and herpes were concentrated in the hand,foot,mouth and hip as typical group.Data were analyzed using SPSS 22.0 software,by comparing the differences of clinical characteristics among three groups,and the clinical features of HFMD with atypical rash and risk factors in severe cases were studied.Results:1.Among 306 hospitalized children with HFMD,98 cases in the atypical type I group?32.03%?,46 cases in the atypical type II group?15.03%?,and 162 cases in the typical rash group?52.94%?.Spring and summer?March to June?were the peak season of atypical type I group,winter and spring?January to March?were the peak season of atypical rashes type II.Children under 3 years old were more common in the atypical I group?55/98,56.12%?and the atypical II group?34/46,73.91%?,while children in the diaspora were the majority in the atypical I group?68/98,69.39%?and the atypical II group?36/46,78.26%?,among which the age of onset of atypical type II was relatively younger,with a median age of 2.16 years(P₂₅^P₇₅:1.66².68)?P<0.01?.2.All children had rashes.In the atypical type I group,the rash was still more common in the hands,feet,mouth,buttock parts and a few of them were in the trunk?16/98,16.32%?,face?12/98,12.24%?and other parts of the limbs,maculopapule were more common?89/98,90.82%?,the sites of macular eruption were less or even single,the incidence of ecchymosis/petechiae?26/98,26.53%?and eruption?2 sites?46/98,46.94%?were the highest of the three groups?P<0.01?;the rash in atypical type II were widely distributed and varied in morphology,except for the typical parts,the incidence of the rash involving the elbow?24/46,52.17%?,knee?29/46,63.04%?,trunk?30/46,65.21%?,4 rash sites?17/46,36.96%?and?5 sites?25/46,54.34%?were the highest of the three groups?P<0.01?,the incidence of maculopapules?37/46,80.43%?,blisters?46/46,80.100%?,pustules?26/46,56.52%?,scabs?38/46,82.61%?and more than 3rash forms?40/46,86.96%?was higher than that of the other two groups?P<0.01?.3.Fever was common in two atypical groups,and the incidence of peak fever?39.0?and the proportion of increased white blood cell count in two atypical groups were higher than that in the typical group?P<0.01?,among which the proportion of increased white blood cell count and CRP?38/46,82.60%?and PCT?39/46,84.78%?in atypical type II were the highest of the three groups?P<0.01?,with a median of14.56*109/L(P₂₅^P₇₅:12.94¹6.86));there was no statistical significance in ALT and CK-MB elevation among the three groups?P>0.05?.4.In the atypical I group,the detection rate of EV71?54/98,55.10%?was the highest,followed by CA16?21/98,21.44%?,and the detection rates of other enterovirus?16/98,16.32%?and CA6?7/98,7.14%?were lower,showed no statistical difference from the typical group?P>,0.05?.The detection rate of CA6?26/46,56.52%?was the highest in the atypical II group,which was statistically different from the other two groups?P<0.01?,followed by other enterovirus?10/46,21.74%?,EV71?6/46,13.04%?and CA16?4/46,8.70%?.5.91 patients met the diagnostic criteria for severe HFMD?91/306,29.74%?.The incidence of severe HFMD in the atypical type I group?47/98,47.96%?was higher than that in the other two groups?P<0.01?,and was more prone to vomiting?47/98,47.96%?,shock?44/98,44.90%?,limb shaking?42/98,42.86%?,and convulsions?8/98,8.16%??P<0.01?.The incidence of severe disease?4/46,8.70%?,shock?3/46,6.52%?,limb shaking?3/46,6.52%?and other symptoms of nervous system involvement in the atypical II group was lower than that in the other two groups?P<0.01?.6.Multivariate logistic regression analysis shows that the age of onset is under three years old?OR=1.569,95%CI:1.102⁴.251?,peak fever is greater than or equal to39.0??OR=2.327,95%CI:1.542⁸.529?,EV71 infection?OR=2.171,95%CI:1.043⁵.346?were risk factors for severe cases.Conclusions:1.The rash in HFMD with atypical rash:One is eruption is few,maculopapules are dominant.Another kind gives rash range wide,can involve limb and trunk and other parts,the visible maculopapule,blister,pustules,scab can coexist,and the rash presents a variety of changes.2.The HFMD with atypical rash is most common in children under 3 years old and scattered children.The HFMD with the site of eruption is few and with maculopapules are dominant mainly occurs in spring and summer.The HFMD with a wide range of rashes and a variety of rashes mainly occurs in winter and spring,has a relatively younger onset age.3.High fever and leukocyte elevation are common in HFMD with atypical rash.The neurological symptoms of the HFMD with the site of eruption is few with maculopapules are dominant are more common and the rate of severe disease is highest,the main pathogen is EV71.The neurological symptoms of the HFMD with a wide range of rashes and a variety of rashes are rare and the rate of severe disease is low,which is mainly caused by CA6 infection.4.The age of onset is under three years old,peak fever is greater than or equal to39.0?,EV71 infection are risk factors for severe cases of HFMD with the site of eruption is few and maculopapules are dominant.Clinical monitoring of the condition of such children should be strengthened to prevent and control the occurrence and development of severe cases.