title: Enterovirus-related diarrhoea in Guangdong, China: clinical features and implications in hand, foot and mouth disease and herpangina.
abstract: BACKGROUND
  A series of complications caused by enteroviruses, including meningitis, encephalitis, acute flaccid paralysis, acute cardiopulmonary failure, respiratory infection, and myocardial injury have been reported in hand, foot and mouth disease/herpangina (HFMD/HA). However, the complication of diarrhoea caused by enteroviruses has been neglected, and a summary of its clinical features and impact on HFMD/HA is unavailable.
  
  
  METHODS
  We included inpatients with HFMD/HA admitted to the Paediatric Department of Zhujiang Hospital during 2009-2012. We summarised and compared clinical data for cases with and without diarrhoea, and determined enterovirus serotypes by reverse transcriptase polymerase chain reaction and genotyping based on a partial-length fragment of viral protein 1 or the 5'-untranslated region.
  
  
  RESULTS
  There were 804 inpatients with HFMD/HA and 28 (3.5%) presented with diarrhoea. Gastrointestinal symptoms were mild in most cases of diarrhoea (82.1%), with high prevalence of no dehydration (82.1%), short duration of diarrhoea (78.6%) and watery stools (75.0%). The prevalence of multi-organ dysfunction syndrome (10.7 vs 0.40%) (p = 0.001), hepatic injury (14.3 vs 3.4%) (p = 0.019), myocardial injury (21.4 vs 6.1%) (p = 0.002) and convulsion (21.4 vs 7.2%) (p = 0.016) was significantly higher in the diarrhoea than no diarrhoea group. There was no significant difference between the two groups regarding prevalence of death, altered consciousness, paralysis, central nervous system involvement, or acute respiratory infection.
  
  
  CONCLUSIONS
  Most patients with diarrhoea caused by enteroviruses circulating in Guangdong Province in 2009-2012 had mild or moderate gastrointestinal symptoms. Although enterovirus-related diarrhoea caused additional multi-organ dysfunction syndrome, hepatic injury and myocardial injury in children with HFMD/HA, timely intervention efficiently reduced disease severity and improved outcome.
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, China. apollo_zhou@126.com.|Department of Clinical Laboratory, Hainan Provincial People's Hospital, No. 19 Xiuhua Road,, Haikou, 570311, China. apollo_zhou@126.com.
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, China.
authors.forename: Hai-Su
authors.initials: HS
authors.lastname: Yi
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, 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, China.
authors.forename: Yu-Xian
authors.initials: YX
authors.lastname: Pan
authors.affiliation: Department of Pediatrics, Zhujiang Hospital, Southern Medical University, Guangdong, 510282, China.
authors.forename: Shao-Hua
authors.initials: SH
authors.lastname: Tao
authors.affiliation: Department of Pediatrics, Zhujiang Hospital, Southern Medical University, Guangdong, 510282, 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, China.
authors.forename: Man-Jun
authors.initials: MJ
authors.lastname: Chen
authors.affiliation: Department of Infectious Diseases, Zhujiang Hospital, Southern Medical University, Guangdong, 510282, China.
authors.forename: Mei
authors.initials: M
authors.lastname: Yang
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, China. yunanzhujiang@163.com.
authors.forename: Nan
authors.initials: N
authors.lastname: Yu
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D003967:Diarrhea / Q000453:epidemiology / Q000821:virology; D004770:Enterovirus / Q000302:isolation & purification*; D004769:Enterovirus Infections / Q000453:epidemiology* / Q000821:virology; D005260:Female; D005838:Genotype; D006232:Hand, Foot and Mouth Disease / Q000453:epidemiology* / Q000821:virology; D006557:Herpangina / Q000453:epidemiology / Q000821:virology; D006801:Humans; D008297:Male; D015995:Prevalence
keywords: Clinical features; Diarrhoea; Enterovirus; Foot and mouth disease; Hand; Herpangina