title: Neurological manifestations of enterovirus 71 infection in children during an outbreak of hand, foot, and mouth disease in Western Australia.
abstract: Enterovirus 71 (EV71) causes epidemics of hand, foot, and mouth disease associated with neurological complications in young children. We report an outbreak of EV71-associated neurological disease that occurred from February through September 1999 in Perth, Western Australia. Fourteen children with culture-proven, EV71-induced neurological disease were identified. Nine patients (64%) developed severe neurological disease; 4 of these patients developed long-term neurological sequelae. Neurological syndromes included aseptic meningitis, Guillain-Barré syndrome, acute transverse myelitis, acute cerebellar ataxia, opso-myoclonus syndrome, benign intracranial hypertension, and a febrile convulsion. Clinical and magnetic resonance imaging data indicated that immunopathology was a major factor in the pathogenesis of neurological disease in this outbreak. This finding is in contrast to reports of previous EV71 epidemics, in which virus-induced damage to gray matter was the most frequent cause of neurological disease.
authors.affiliation: Department of Microbiology, Princess Margaret Hospital for Children, Perth, WA, Australia. peter.mcminn@health.wa.gov.au
authors.forename: P
authors.initials: P
authors.lastname: McMinn
authors.forename: I
authors.initials: I
authors.lastname: Stratov
authors.forename: L
authors.initials: L
authors.lastname: Nagarajan
authors.forename: S
authors.initials: S
authors.lastname: Davis
mesh_terms: D000208:Acute Disease; D000914:Antibodies, Viral / Q000097:blood; D001315:Australia / Q000453:epidemiology; D002524:Cerebellar Ataxia / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D004770:Enterovirus / Q000276:immunology / Q000302:isolation & purification*; D004769:Enterovirus Infections / Q000097:blood / Q000453:epidemiology / Q000821:virology*; D005260:Female; D020275:Guillain-Barre Syndrome / Q000209:etiology; D006232:Hand, Foot and Mouth Disease / Q000097:blood / Q000453:epidemiology / Q000821:virology*; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008582:Meningitis, Aseptic / Q000209:etiology; D009188:Myelitis, Transverse / Q000209:etiology; D009422:Nervous System Diseases / Q000097:blood / Q000821:virology*; D020361:Paraneoplastic Syndromes, Nervous System / Q000209:etiology
chemical_list: D000914:Antibodies, Viral