title: Enterovirus infections in Singaporean children: an assessment of neurological manifestations and clinical outcomes.
abstract: Enterovirus infections in childhood can be associated with significant neurological morbidity. This study aimed to describe the prevalence and range of neurological manifestations, determine the clinical characteristics and assess differences in clinical outcomes for Singaporean children diagnosed with enterovirus infections.
  
  
  
  In this single-centre, case-control study, clinical data was collected retrospectively from patients admitted to National University Hospital, Singapore, from August 2007 to October 2011 and diagnosed with enterovirus infection, based on the enterovirus polymerase chain reaction test, or cultures from throat and rectal swabs or cerebrospinal fluid samples. The occurrence of neurological manifestations was reviewed and clinical outcomes were assessed.
  
  
  
  A total of 48 patients (age range: six days-17.8 years) were included in the study. Neurological manifestations were seen in 75.0% of patients, 63.9% of whom presented with aseptic meningitis. Other neurological manifestations included encephalitis, acute cerebellitis, transverse myelitis and autonomic dysfunction. The incidence of neurological manifestations was significantly higher in patients aged > 1 year as compared to younger patients (p = 0.043). In patients without neurological manifestations, a significantly higher proportion presented with hand, foot and mouth disease and poor feeding. Long-term neurological sequelae were seen in 16.7% of patients with neurological manifestations.
  
  
  
  A wide spectrum of neurological manifestations resulting in a relatively low incidence of long-term neurological sequelae was observed in our study of Singaporean children with enterovirus infections. As some of these neurological morbidities were severe, careful evaluation of children with neurological involvement is therefore necessary.
authors.affiliation: Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.
authors.forename: Wen Yi
authors.initials: WY
authors.lastname: Thong
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Audrey
authors.initials: A
authors.lastname: Han
authors.affiliation: Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.
authors.forename: S J Furene
authors.initials: SJ
authors.lastname: Wang
authors.affiliation: Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Lin
authors.affiliation: Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.
authors.forename: Mas Suhaila
authors.initials: MS
authors.lastname: Isa
authors.affiliation: Laboratory Medicine, Molecular Diagnosis Centre, National University Health System, Singapore.
authors.forename: Evelyn Siew Chuan
authors.initials: ES
authors.lastname: Koay
authors.affiliation: Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.|Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Stacey Kiat-Hong
authors.initials: SK
authors.lastname: Tay
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D016022:Case-Control Studies; D002493:Central Nervous System Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000821:virology*; D002648:Child; D002675:Child, Preschool; D004770:Enterovirus / Q000302:isolation & purification; D004769:Enterovirus Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D012846:Singapore / Q000453:epidemiology
keywords: encephalitis; enterovirus infection; hand foot and mouth disease; meningitis