title: Enterovirus 71-associated hand, foot and mouth diseases with neurologic symptoms, a university hospital experience in Korea, 2009.
abstract: OBJECTIVE
  Hand-foot-mouth disease (HFMD) is a common viral illness in children, which is usually mild and self-limiting. However, in recent epidemics of HFMD in Asia, enterovirus 71 (EV71) has been recognized as a causative agent with severe neurological symptoms with or without cardiopulmonary involvement. HFMD was epidemic in Korea in the spring of 2009. Severe cases with complications including death have been reported. The clinical characteristics in children with neurologic manifestations of EV71 were studied in Ewha Womans University Mokdong Hospital.
  
  
  METHODS
  Examinations for EV71 were performed from the stools, respiratory secretion or CSF of children who presented neurologic symptoms associated with HFMD by realtime PCR. Clinical and radiologic data of the patients were collected and analyzed.
  
  
  RESULTS
  EV71 was isolated from the stool of 16 patients but not from respiratory secretion or CSF. Among the 16 patients, meningitis (n=10) was the most common manifestation, followed by Guillain-Barré syndrome (n=3), meningoencephalitis (n=2), poliomyelitis-like paralytic disease (n=1), and myoclonus (n=1). Gene analysis showed that most of them were caused by EV71 subgenotype C4a, which was prevalent in China in 2008.
  
  
  CONCLUSIONS
  Because EV71 causes severe complications and death in children, a surveillance system to predict upcoming outbreaks should be established and maintained and adequate public health measures are needed to control disease.
authors.affiliation: Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea.
authors.forename: Hye Kyung
authors.initials: HK
authors.lastname: Cho
authors.forename: Na Yong
authors.initials: NY
authors.lastname: Lee
authors.forename: Hyunju
authors.initials: H
authors.lastname: Lee
authors.forename: Hae Soon
authors.initials: HS
authors.lastname: Kim
authors.forename: Jeong Wan
authors.initials: JW
authors.lastname: Seo
authors.forename: Young Mi
authors.initials: YM
authors.lastname: Hong
authors.forename: Seung Joo
authors.initials: SJ
authors.lastname: Lee
authors.forename: Sun Wha
authors.initials: SW
authors.lastname: Lee
authors.forename: Doo Sung
authors.initials: DS
authors.lastname: Cheon
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Hong
authors.forename: Byung Hak
authors.initials: BH
authors.lastname: Kang
authors.forename: Jong-Hyun
authors.initials: JH
authors.lastname: Kim
authors.forename: Kyung-Hyo
authors.initials: KH
authors.lastname: Kim