title: The absence of exanthema is related with death and illness severity in acute enterovirus infection.
abstract: OBJECTIVE
  To clarify whether exanthema is related to illness severity in acute enterovirus infection in children.
  
  
  METHODS
  The data of pediatric inpatients at Zhujiang Hospital during 2009-2012 with an acute enterovirus infection were reviewed retrospectively. Enterovirus infection was determined by real-time reverse transcription PCR. Clinical data were summarized and compared between cases with and without exanthema.
  
  
  RESULTS
  A total of 780 pediatric inpatients with an acute enterovirus infection were included in this study, of whom 83 (10.6%) presented no exanthema. The percentage of deaths in the group of patients without exanthema was significantly higher than that in the group with exanthema (7.2% vs. 1.1%; p = 0.002). Central nervous system involvement (41.0% vs. 30.0%; p = 0.041), severe central nervous system (CNS) involvement (21.7% vs. 11.0%; p = 0.005), severe CNS involvement with cardiopulmonary failure (9.6% vs. 2.3%; p = 0.002), an altered level of consciousness (15.7% vs. 7.6%; p = 0.013), and convulsions (14.4% vs. 6.3%; p = 0.007) occurred significantly more frequently in the group without exanthema.
  
  
  CONCLUSIONS
  A considerable proportion of children with an acute enterovirus infection in Guangdong Province, China during 2009-2012 presented no exanthema, and the absence of exanthema was found to be related to death and illness severity for these acute enterovirus infections. Clinicians in China should consider enterovirus as the possible pathogen when treating children with an acute pathogen infection without exanthema.
authors.affiliation: Laboratory of Emerging Infectious Diseases and Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, No. 253 Gong ye da dao zhong, Guangzhou, 510282, PR China.
authors.forename: Hong-Tao
authors.initials: HT
authors.lastname: Zhou
authors.affiliation: Laboratory of Emerging Infectious Diseases and Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, No. 253 Gong ye da dao zhong, Guangzhou, 510282, PR China.
authors.forename: Yong-Hui
authors.initials: YH
authors.lastname: Guo
authors.affiliation: Laboratory of Emerging Infectious Diseases and Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, No. 253 Gong ye da dao zhong, Guangzhou, 510282, PR China.
authors.forename: Pei
authors.initials: P
authors.lastname: Tang
authors.affiliation: Laboratory of Emerging Infectious Diseases and Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, No. 253 Gong ye da dao zhong, Guangzhou, 510282, PR China.
authors.forename: Lei
authors.initials: L
authors.lastname: Zeng
authors.affiliation: Laboratory of Emerging Infectious Diseases and Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, No. 253 Gong ye da dao zhong, Guangzhou, 510282, PR China.
authors.forename: Yu-Xian
authors.initials: YX
authors.lastname: Pan
authors.affiliation: Laboratory of Emerging Infectious Diseases and Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, No. 253 Gong ye da dao zhong, Guangzhou, 510282, PR China.
authors.forename: Xi-Xia
authors.initials: XX
authors.lastname: Ding
authors.affiliation: Laboratory of Emerging Infectious Diseases and Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, No. 253 Gong ye da dao zhong, Guangzhou, 510282, PR China.
authors.forename: Kun
authors.initials: K
authors.lastname: Wen
authors.affiliation: Department of Pediatrics, Zhujiang Hospital, Southern Medical University, Guangdong, PR China.
authors.forename: Shao-Hua
authors.initials: SH
authors.lastname: Tao
authors.affiliation: Laboratory of Emerging Infectious Diseases and Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, No. 253 Gong ye da dao zhong, Guangzhou, 510282, PR China.
authors.forename: Man-Jun
authors.initials: MJ
authors.lastname: Chen
authors.affiliation: Department of Pediatrics, Zhujiang Hospital, Southern Medical University, Guangdong, PR China.
authors.forename: Bin
authors.initials: B
authors.lastname: Wang
authors.affiliation: Laboratory of Emerging Infectious Diseases and Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, No. 253 Gong ye da dao zhong, Guangzhou, 510282, PR China. Electronic address: yunanzhujiang@163.com.
authors.forename: Nan
authors.initials: N
authors.lastname: Yu
authors.affiliation: Laboratory of Emerging Infectious Diseases and Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, No. 253 Gong ye da dao zhong, Guangzhou, 510282, PR China; Department of Pediatrics, Zhujiang Hospital, Southern Medical University, Guangdong, PR China. Electronic address: chexiaoyan@126.com.
authors.forename: Xiao-Yan
authors.initials: XY
authors.lastname: Che
mesh_terms: D000208:Acute Disease; D002675:Child, Preschool; D002681:China; D004769:Enterovirus Infections / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D005076:Exanthema / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies
keywords: Death; Enterovirus; Exanthema; Illness; Severity