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
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
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DOI：
10.1371/journal.pone.0201726
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发表时间：
2018-08-10
期刊：
影响因子：
3.7
通讯作者：
Oh, Sung Hee
中科院分区：
文献类型：
--
作者：
Kim, Bongyoung;Moon, Shinje;Oh, Sung Hee
背景2009年，韩国启动了全国范围内的手足口病（HFMD）和伴有神经系统并发症的疱疹性咽峡炎（HA）哨点监测。我们利用该监测系统调查手足口病或HA伴神经系统并发症患者的临床特征，旨在确定严重神经系统并发症的危险因素。方法对2009年4月1日至2014年12月31日国家系统报告的所有手足口病和HA伴神经系统并发症病例的病历进行回顾性分析。重症病例定义为手足口病或HA合并脑炎、脊髓灰质炎样综合征或心肺衰竭，较轻病例定义为手足口病或HA合并无菌性脑膜炎。 结果共纳入28家医院的138例（轻度：90/138，65.2％；重型：48/138，24.8％）；排除28例不符合条件的病例。 48例重症病例中，27例（56.2%）患有脑炎； 14 人（29.2%）患有脊髓灰质炎样综合征；七名（14.6%）患有心肺综合征。患者中位年龄为 36 个月（IQR：18-60），63 名患者（45.7%）为女性。大多数患者完全康复，只有 7 例死亡或导致长期症状（5.1%，3 例出现神经系统后遗症，4 例死亡）。在多变量逻辑回归分析中，嗜睡（OR = 4.67，95% CI：1.37-15.96，P = 0.014）、女性（OR = 3.51，95% CI：1.17-10.50，P = 0.025）和肠道病毒 A71（OR = 3.55，95% CI： 1.09-11.57，P = 0.035）与手足口病和HA患者的严重神经系统并发症显着相关。结论在手足口病和HA患者中，嗜睡、女性和肠道病毒A71可能预测严重神经系统并发症。
BackgroundIn 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.MethodsA 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.ResultsA 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.ConclusionIn patients with HFMD and HA, lethargy, female, and enterovirus A71 may predict severe neurologic complications.