Archives of Pediatrics (ISSN: 2575-825X)

research article

Enterovirus 71- and CoxsackievirusA16-Associated Hand-Foot-Mouth Disease in Guangdong, China: A Retrospective Clinical Study

Hong-Tao Zhou#, Yong-HuiGuo#, Bin Wang, Shao-Hua Tao, Qiong-Ling Peng, Min Guo, Yu-Xian Pan, Pei Tang, Lei Zeng, Man-Jun Chen, En-Zhong Che, Nan Yu* and Xiao-Yan Che 
Laboratory of Emerging Infectious Diseases and Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangdong, PR China
#Hong-Tao Zhou and Yong-HuiGuo contributed equally to this work
*Corresponding author: Nan Yu, Laboratory of Emerging Infectious Diseases and Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, No. 253 Gong-ye Avenue, Guangzhou, 510282, P.R. China Fax: +86 20 62783666, Tel: +86 20 62783662, Email:
Received Date: 01 August, 2016; Accepted Date: 16 August, 2016; Published Date: 22 August, 2016

Background: Since 1997, the Asia-Pacific region had experienced epidemics of Enterovirus 71 (EV71)-associated Hand-Foot-Mouth Disease (HFMD), with cases at risk for severe illness and even death.EV71 and coxsackie virus A group 16 (CA16) are both major causative agents of HFMD and have similar early symptoms. These similarities hamper early diagnosis, making it difficult to identify potentially severe cases without genotyping. EV71-VP1 gene sequence are related to the severity of disease remains controversial.

Method:We performed a retrospective study of clinical cases in Guangdong Province, China, from April 2009 to December 2012, using real-time RT-PCR to detect EV71/CA16/pan-enterovirus. Viral isolation followedVP1 genes sequencing were performed for molecular epidemiological analyses.

Result: 395 and 156 hospitalized patients were confirmed to be infected with EV71 and CA16, accounting for 51.6% and 20.4% of all inpatients with enterovirus infections, respectively. Hyperpyrexia (≥39 ºC, P<0.001), vomiting (P<0.001), headache (P=0.03), and neurological symptoms such as irritability (P<0.001), altered level of consciousness (P<0.001), tremors/trembling in the extremities (P<0.001), limb weakness/paralysis (P=0.007), and altered muscular tension (P=0.02) were significantly more common in EV71- than in CA16-infected patients. The incidence of neurological complications (62.8% VS 5.1%, P<0.001) and outcomes were significantly different in two infections. Logistic-regression analysis revealed four independent risk factors: chloride-ion concentration, LDH activity in the CSF, troponin I levels, and serum myoglobin. EV71 isolates were all C4a subgeno group, sharing high identity with each other (94.4%–100%). Amino acid sequences of three EV71 strains from severe cases were identical to those from mild cases.

Conclusion: A comparative study of the differences in the clinical presentations of EV71 and CA16 infections in China yielded in sights. Clinical features strongly associated with rapid progression and severe EV71 infections were identified. This retrospective study provides valuable information to primary-care doctors, permitting rapid intervention for high-risk patients. No difference in EV71-VP1 amino sequences were found between severe and mild cases.

Key Words: Coxsackie Virus A16, Clinical Features, Enterovirus 71, Hand-Foot-Mouth Disease, Molecular Epidemiology

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