The clinical stages and prognostic factors of children with enterovirus type 71 infection developing pulmonary edema and hemorrhage

Pulmonary edema/hemorrhage was the most severe complications of EV 71 associated hand–foot–mouth disease and usually led to cardiopulmonary failure. The mortality rate was 92% in the 1998 outbreak (11/12). During 2000 and 2001 outbreaks, the mortality rate had been reduced to 33% (8/24). This report was an observation of the clinical stages, risk factors and outcomes. There were 24 children brought to our PICU from May 2000 to June 2001. There were 10 females and 14 males. The age ranged from 5 to 93 months old (mean = 19.8).

The EV 71 infections were confirmed by either positive virus isolation (71%, 17/24) or elevated serum neutralization antibody (> 1:8, 96%, 23/24). We found most of the patients (58%, 14/24) presented five clinical stages: (1) hand–foot–mouth disease; (2) meningoencephalitis; (3) cardiopulmonary failure; and (4) convalescence stage. The third stage was divided into two substages, (3A) hypertension stage and (3B) hypotension stage.

The risk factors associated with mortality/morbidity were age, CSF leukocytosis, increased troponin I, episodes of cardiac arrest, decreased ejection fraction, need of high dosage inotropes support, lack of hypertension stage which might mean delayed hospital visit, initial very high serum glucose and very low worst PaO₂-FiO₂ ratio. Fifty percent of survivors (8/16) had moderate to severe neurological sequelae and needed long-term respiratory care.