Clinical features for 89 deaths of hand, foot and mouth disease in Guangxi, China, 2014

- There may be two clinical subtypes (pulmonary edema and non- pulmonary edema) in patients with severe HFMD.
- Non-pulmonary edema (non-PE) is poorly documented and their clinical manifestations in detail were described.
- Non-PE cases of HFMD and cases in stage 1 or stage 2 can also increase in severity.
- CRP and CK-MB as a reference index for HFMD needs further study.
- An increased WBC count and EV71 positivity are associated with a severe course of HFMD.

ObjectivesThe aim of this study is to summarize the risk factors of severe Hand, foot and mouth disease (HFMD) and explore the clinical characteristics of pulmonary edema (PE) and non-PE in the deceased patients with HFMD.MethodsWe identified 89 HFMD deaths which were separated into the PE group or non-PE group. Next, patients were divided based on their initial admission to hospitals as stage 1, 2, 3, or 4; at this point, their clinical manifestations were compared.ResultsThere were 87 cases in the PE group, and 2 cases in the non-PE group. In the PE group, the difference in median time for patients at different stages from onset to symptoms, showed no significant difference (p > 0.05). The etiology was detected as a positive rate for enterovirus 71 (EV71) of 89.19%, which showed a more severe course than other etiologies. The white blood cell (WBC) counts, lymphocyte (LYM) counts and creatine kinase MB (CK-MB) counts of patients admitted in different stages increased significantly with severity (p < 0.05).ConclusionsThere may be two clinical subtypes, mostly PE and rarely non-PE, in the deceased patients with HMFD. EV71 and risk factors such as an increased WBC count are associated with a severe course of HMFD.