Enterovirus 71: epidemiology, pathogenesis and management.
Enterovirus 71 (EV71) has emerged as a major cause of neurological threat in the world following the eradication of poliovirus. Most EV71 infections commonly result in hand-foot-mouth disease or herpangina, and some cases are associated with brainstem encephalitis and acute flaccid paralysis. Mortality was high in EV71 brainstem encephalitis complicated with pulmonary edema, particularly in children below 5 years of age. Destruction of vasomotor in the brainstem by EV71 produces autonomic nervous system dysregulation prior to the pulmonary edema. The pulmonary edema is the result of increased pulmonary vascular permeability caused by the direct brainstem lesions and/or a systemic inflammatory response syndrome produced by the release of cytokines and chemokines. There is currently no specific antiviral agent to treat or vaccine to prevent EV71 diseases. Treating severe EV71 brainstem encephalitis patients with intravenous IgG and milrinone is associated with significantly decreased mortality by attenuated sympathetic activity and cytokine production.
Wang
Shih-Min
SM
Department of Emergency Medicine, College of Medicine, National Cheng Kung University and Hospital, 138 Sheng Li Road, Tainan, 70428, Taiwan. pedwang@mail.ncku.edu.tw
Liu
Ching-Chuan
CC
D000328:Adult; D001933:Brain Stem / Q000821:virology; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D018792:Encephalitis, Viral / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology / Q000821:virology; D029821:Enterovirus A, Human / Q000472:pathogenicity*; D004769:Enterovirus Infections / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology / Q000821:virology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000627:therapeutic use; D007155:Immunologic Factors / Q000008:administration & dosage / Q000627:therapeutic use; D007223:Infant; D020105:Milrinone / Q000008:administration & dosage / Q000627:therapeutic use; D010264:Paraplegia / Q000628:therapy / Q000821:virology; D011654:Pulmonary Edema / Q000628:therapy / Q000821:virology; D013624:Taiwan / Q000453:epidemiology; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use
D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D014665:Vasodilator Agents; D020105:Milrinone