title: Comparison of clinical features between coxsackievirus A2 and enterovirus 71 during the enterovirus outbreak in Taiwan, 2008: a children's hospital experience.
abstract: OBJECTIVE
  Coxsackievirus A2 (Cox A2) was the predominant serotype in the enterovirus outbreak in Taiwan, 2008. However, detailed clinical features of Cox A2 infection have not been reported. In this study, we compared Cox A2 with enterovirus 71 (EV71) in terms of clinical manifestation and epidemiology during the 2008 enterovirus outbreak in Taiwan.
  
  
  METHODS
  A total of 280 hospitalized patients (97 with culture-proven EV71 infection and 183 with culture-proven Cox A2 infection) in 2008 at the Chang Gung Children's Medical Center were enrolled in this study. Epidemiologic data, clinical manifestations, and outcomes for these patients were collected and compared.
  
  
  RESULTS
  Both Cox A2 and EV71 serotypes peaked in June and declined soon afterwards. Seventy-one percent of the patients were younger than 3 years of age. Both groups had the same male-to-female ratio of 1.6:1. Patients with EV71 infection had a significantly longer hospitalization period (4.1 vs. 3.0 days, p< 0.001). Fever, fever for more than 3 days with a temperature above 39 degrees C, lethargy, poor activity, poor appetite and a myoclonic jerk were significantly associated with EV71 infection. Fever, or fever with a temperature above 39 degrees C, febrile seizure, elevated white cell counts, and elevated serum C-reactive protein concentrations were significantly associated with Cox A2 infection. Most patients with EV71 infection presented with hand-foot-mouth disease (78.3%), while most Cox A2-infected patients presented with herpangina (83.6%). Central nervous system complications were found in 18.6% of EV71-infected children, but only in 1.1% of Cox A2-infected children. All the patients with Cox A2 infection showed total recovery. One patient with EV71 infection died from encephalitis with cardiopulmonary failure, and 6.2% of EV71-infected children had neurologic sequelae.
  
  
  CONCLUSIONS
  Both Cox A2 and EV71 serotypes accounted for the enterovirus outbreak in Taiwanese children in 2008. Compared with those infected by EV71, the children with Cox A2 infection mostly presented with herpangina, had fewer central nervous system complications, and had better overall outcome.
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, Chang Gung Children's Medical Center, Taoyuan, Taiwan.
authors.forename: Shih-Perng
authors.initials: SP
authors.lastname: Chen
authors.forename: Yhu-Chering
authors.initials: YC
authors.lastname: Huang
authors.forename: Wen-Chen
authors.initials: WC
authors.lastname: Li
authors.forename: Cheng-Hsun
authors.initials: CH
authors.lastname: Chiu
authors.forename: Chung-Guei
authors.initials: CG
authors.lastname: Huang
authors.forename: Kuo-Chien
authors.initials: KC
authors.lastname: Tsao
authors.forename: Tzou-Yien
authors.initials: TY
authors.lastname: Lin
mesh_terms: D002493:Central Nervous System Diseases / Q000453:epidemiology / Q000821:virology; D002648:Child; D002675:Child, Preschool; D003384:Coxsackievirus Infections / Q000150:complications / Q000453:epidemiology* / Q000473:pathology* / Q000821:virology; D004196:Disease Outbreaks; D004770:Enterovirus / Q000302:isolation & purification*; D004769:Enterovirus Infections / Q000150:complications / Q000453:epidemiology* / Q000473:pathology* / Q000821:virology; D005260:Female; D006232:Hand, Foot and Mouth Disease / Q000453:epidemiology / Q000473:pathology / Q000821:virology; D006557:Herpangina / Q000453:epidemiology / Q000473:pathology / Q000821:virology; D006761:Hospitals; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D012621:Seasons; D012737:Sex Factors; D013624:Taiwan / Q000453:epidemiology