title: Risk factors for severe hand foot mouth disease in Singapore: a case control study.
abstract: BACKGROUND
  Hand foot mouth disease (HFMD) is a common childhood infection that can potentially lead to serious complications. The aim of this study is to identify risk factors of acquiring severe HFMD in our population.
  
  
  METHODS
  We performed a case control study using patients admitted to our hospital from August 2004 to July 2014. Cases were patients with severe HFMD disease while controls were age-matched patients obtained from the same year, in a 2:1 ratio. Data comprising demographic characteristics, clinical symptoms and signs, and lab findings were collected. Conditional univariable logistic regression was performed to determine risk factors for severe disease.
  
  
  RESULTS
  A total of 24 cases of severe HFMD were identified and matched with 48 controls. Seventeen (70.8%) cases had central nervous system complications. Seven (29.2%) had cardiovascular complications without evidence of myocarditis. One patient died of encephalitis. The overall mortality of severe disease is 4%. Evidence of hypoperfusion, seizure, altered mentation, meningeal irritation, tachycardia, tachypnea, raised absolute neutrophil count and EV-A71 (Enterovirus A71) positivity were significantly associated with a severe course of HFMD.
  
  
  CONCLUSIONS
  In managing children with HFMD, physicians should consider these factors to help identify patients at risk for severe disease.
authors.affiliation: Department of Emergency Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. Chew.so-phia@kkh.com.sg.
authors.forename: So-Phia
authors.initials: SP
authors.lastname: Chew
authors.affiliation: Department of Emergency Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. Chong.shu-ling@kkh.com.sg.
authors.forename: Shu-Ling
authors.initials: SL
authors.lastname: Chong
authors.affiliation: Centre for Quantitative Medicine, DUKE-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore. Sylvaine.barbier@gmail.com.
authors.forename: Sylvaine
authors.initials: S
authors.lastname: Barbier
authors.affiliation: Department of Emergency Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. Ajigm99@yahoo.com.
authors.forename: Aji
authors.initials: A
authors.lastname: Matthew
authors.affiliation: Department of Children's Intensive Care, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. Lee.jan.hau@kkh.com.sg.
authors.forename: Jan Hau
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Children's Intensive Care, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. Chan.yoke.hwee@kkh.com.sg.
authors.forename: Yoke Hwee
authors.initials: YH
authors.lastname: Chan
mesh_terms: D016022:Case-Control Studies; D002493:Central Nervous System Diseases / Q000209:etiology / Q000821:virology; D002648:Child; D002675:Child, Preschool; D004770:Enterovirus / Q000472:pathogenicity; D004769:Enterovirus Infections / Q000150:complications / Q000453:epidemiology; D005260:Female; D006232:Hand, Foot and Mouth Disease / Q000150:complications / Q000453:epidemiology* / Q000821:virology*; D006331:Heart Diseases / Q000209:etiology / Q000821:virology; D006760:Hospitalization; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D015996:Survival Rate