title: Pathologic Studies of Fatal Encephalomyelitis in Children Caused by Enterovirus 71.
abstract: OBJECTIVE
  Enterovirus 71 (EV71) is the major pathogen of hand, foot, and mouth disease and can cause death; however, its pathogenesis remains elusive.
  
  
  METHODS
  We performed a detailed systematic histopathologic examination and molecular studies on six autopsy cases of EV71 infection using H&E, immunohistochemistry, double immunofluorescence staining, and nested reverse transcription polymerase chain reaction.
  
  
  RESULTS
  Characteristic features of acute encephalomyelitis were observed. Viral antigens were mainly detected in neuronal cytoplasm and processes in the different brainstem nuclei and spinal cord, including the anterior and posterior horn cells. Viral antigens were also positive in the nerve roots of spinal cord and autonomic ganglia of intestines.
  
  
  CONCLUSIONS
  Our study revealed direct pathologic evidence supporting viral entry into the central nervous system (CNS) through peripheral nerves. In addition to the major motor pathway, EV71 can also enter the CNS via peripheral sensory and autonomic pathways in retrograde axonal transport.
authors.affiliation: From the Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Jingjun
authors.initials: J
authors.lastname: Xing
authors.affiliation: Department of Pathology, Medical College, Wuhan University of Science and Technology, Wuhan, China.
authors.forename: Dan
authors.initials: D
authors.lastname: Liu
authors.affiliation: State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, China.
authors.forename: Shu
authors.initials: S
authors.lastname: Shen
authors.affiliation: State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, China.
authors.forename: Zhengyuan
authors.initials: Z
authors.lastname: Su
authors.affiliation: From the Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Zhang
authors.affiliation: From the Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Yijie
authors.initials: Y
authors.lastname: Duan
authors.affiliation: From the Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Tong
authors.affiliation: From the Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Yue
authors.initials: Y
authors.lastname: Liang
authors.affiliation: State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, China.
authors.forename: Hualin
authors.initials: H
authors.lastname: Wang
authors.affiliation: State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Deng
authors.affiliation: State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, China.
authors.forename: Zhihong
authors.initials: Z
authors.lastname: Hu
authors.affiliation: From the Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China zhouyiwu@outlook.com huzh@wh.iov.cn.
authors.forename: Yiwu
authors.initials: Y
authors.lastname: Zhou
mesh_terms: D000328:Adult; D001344:Autopsy; D002648:Child; D002675:Child, Preschool; D018792:Encephalitis, Viral / Q000473:pathology*; D004679:Encephalomyelitis / Q000473:pathology* / Q000821:virology*; D029821:Enterovirus A, Human; D004769:Enterovirus Infections / Q000473:pathology*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D016133:Polymerase Chain Reaction; D013116:Spinal Cord / Q000473:pathology; D055815:Young Adult
keywords: Encephalomyelitis; Enterovirus 71; Immunohistochemistry; Viral transmission