Outcome of enterovirus 71 infections with or without stage-based management: 1998 to 2002.
BACKGROUND
Enterovirus 71 (EV71) infection may progress through four stages, one of which is cardiopulmonary failure. In Taiwan in 1998 almost all the EV71 patients with cardiopulmonary failure died. To improve clinical outcome of EV71 patients, we developed a stage-based management program in 2000.


METHODS
The medical records of 196 EV71 patients who did not have stage-based management (1998 to 1999) and of 331 EV71 patients who did (2000 to 2002) at Chang Gung Children's Hospital were reviewed for demographic characteristics, clinical syndromes, case-fatality rates and sequelae. We compared and analyzed the results for the 2 groups.


RESULTS
Of the patients who did not receive stage-based management, 83% (15 of 18) of cases with both central nervous system (CNS) involvement and cardiopulmonary failure died during the acute stage of the infection. Two patients died at convalescence, and 1 had sequelae of dysphagia and limb weakness. By contrast of the patients who received stage-based management, 33% (12 of 36) of patients with CNS and cardiopulmonary failure died during the acute stage, 8% (3 of 36) died at convalescence, 14% (5 of 36) recovered and 43% (16 of 36) had severe sequelae of central hypoventilation, dysphagia and limb weakness (P < 0.001). For cases with CNS and cardiopulmonary failure, multivariate analysis showed that age older than 2 years and cerebro-spinal fluid white blood cell count >100/microl were associated with a increase in acute mortality [95% confidence interval (CI) 1.9 to 105.3, P = 0.001; 95% CI 1.1 to 66.6, P = 0.04, respectively], but stage-based management was significantly associated with a reduction in acute mortality (95% CI 0.007 to 0.24; P = 0.0004). Stage-based management did not affect the outcome of cases with CNS involvement alone.


CONCLUSIONS
Stage-based management reduced the case fatality rate of EV71-related cardiopulmonary failure, but two-thirds of the survivors had severe sequelae.
Chang
Luan-Yin
LY
Divisions of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, 5 Fu-Hsing Street, Kweishan, Taoyuan, Taiwan.
Hsia
Shao-Hsuan
SH
Wu
Chang-Teng
CT
Huang
Yhu-Chering
YC
Lin
Kuang-Lin
KL
Fang
Tsui-Yen
TY
Lin
Tzou-Yien
TY
D016022:Case-Control Studies; D002423:Cause of Death; D020805:Central Nervous System Viral Diseases / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D018450:Disease Progression; D029821:Enterovirus A, Human / Q000145:classification*; D004769:Enterovirus Infections / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006232:Hand, Foot and Mouth Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D006557:Herpangina / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011336:Probability; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D013624:Taiwan; D016896:Treatment Outcome