Factors associated with severe neurologic complications in patients with either hand-foot-mouth disease or herpangina: A nationwide observational study in South Korea, 2009-2014.

Authors:
Bongyoung Kim
Bongyoung Kim
Korea Centers for Disease Control and Prevention
Shinje Moon
Shinje Moon
Korea Centers for Disease Control and Prevention
Atlanta | United States
Hyungmin Lee
Hyungmin Lee
Korea Centers for Disease Control and Prevention
Hyunjoo Pai
Hyunjoo Pai
Hanyang University College of Medicine
South Korea
Sung Hee Oh
Sung Hee Oh
College of Medicine
South Korea

PLoS One 2018 10;13(8):e0201726. Epub 2018 Aug 10.

Department of Pediatrics, Hanyang University College of Medicine, Seoul, South Korea.

Background: In 2009, a nationwide sentinel surveillance for hand-foot-mouth disease (HFMD) and herpangina (HA) with neurologic complications was initiated in South Korea. We used this surveillance system to investigate the clinical characteristics of patients with either HFMD or HA with neurologic complications, with the aim of determining risk factors for severe neurologic complications.

Methods: A retrospective review of medical records was conducted on all cases of HFMD and HA with neurologic complications that were reported in the national system between April 1, 2009 and December 31, 2014. A severe case was defined as having HFMD or HA with encephalitis, polio-like syndrome, or cardiopulmonary failure, and less-severe cases were defined as having HFMD or HA with aseptic meningitis.

Results: A total of 138 cases (less-severe: 90/138, 65.2%; severe: 48/138, 24.8%) were included from 28 hospitals; 28 ineligible cases were excluded. Of 48 severe cases, 27 (56.2%) had encephalitis; 14 (29.2%) had polio-like syndrome; and seven (14.6%) had cardiopulmonary syndrome. The median patient age was 36 months (IQR: 18-60) and 63 (45.7%) patients were female. Most patients completely recovered, except for seven cases that were fatal or resulted in long-term symptoms (5.1%, 3 patients with neurologic sequelae and 4 deaths). In a multivariable logistic regression analysis, lethargy (OR = 4.67, 95% CI: 1.37-15.96, P = 0.014), female sex (OR = 3.51, 95% CI: 1.17-10.50, P = 0.025), and enterovirus A71 (OR = 3.55, 95% CI: 1.09-11.57, P = 0.035) were significantly associated with severe neurologic complications in HFMD and HA patients.

Conclusion: In patients with HFMD and HA, lethargy, female, and enterovirus A71 may predict severe neurologic complications.

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Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0201726PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6086402PMC
February 2019
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