Hand, foot, and mouth syndrome in an immunocompetent adult: a case report

Hand, Foot and Mouth Disease in Immunocompetent Adult with Severe Oral Manifestation

Hand-foot-mouth Disease (HFMD) is an acute, self-limited, and highly contagious disease caused by a virus and generally affects children under 10 years old. The etiology of this disease is enterovirus 71 or coxsackievirus A16 which usually causes symptomatic infection or mild disease. Immunocompetent adults are rarely affected. However, recently the incidence of HFMD in immunocompetent adults has increased. We report a 41-year-old woman with severe oral lesions and painful papulovesicular eruption on the palms of her hands and feet.

Pseudomembranous conjunctivitis with hand, foot and mouth disease in a pregnant woman : a case report

Background

Hand, foot, and mouth disease (HFMD) is a common systemic infection that is caused by an enterovirus, normally Coxsackie A16. Generally, it affects children or immunocompromised adults. Only a few reports have described pseudomembranous conjunctivitis associated with HFMD. We aim to describe the clinical outcomes and ocular findings of a 37-year-old female with HFMD and concurrent severe pseudomembranous conjunctivitis, who was 28 weeks pregnant.

Case presentation

A female patient who was 28-weeks pregnant was referred for an ophthalmological review due to pain and injection in both eyes. The patient was hospitalized under obstetrics and gynecology and evaluated for Behcet’s disease with oral and perineal ulcers. In an ophthalmic examination, both eyes were observed to have a conjunctival injection. Behcet’s disease-associated conjunctivitis was diagnosed. Topical steroids and antibiotics were administered every 6 h. Two days after her presentation, a maculopapular eruption occurred on her palms. Enterovirus type 71 was detected in a serum virus antibody test, and the patient was diagnosed with HFMD. After 7 days, severe pseudomembranous conjunctivitis and corneal epithelial defects occurred in both eyes. Topical steroids were administered every 3 h, and the pseudomembrane was removed every 2 to 3 days. The pseudomembrane did not occur after 3 weeks, but corneal erosion persisted. After 3 months, the corneal erosion had completely resolved.

Conclusions

HFMD-associated conjunctivitis is a rare complication in adults, however it can appear as a severe pseudomembranous conjunctivitis. In this case, the removal of the pseudomembrane and topical steroids helped improve the symptoms.

Application of the Effect of Latitude on the Starting of Hand, Foot, and Mouth Disease Epidemic on Early Warning in Dalian, Liaoning Province, China

Hand, foot, and mouth disease (HFMD) is a common infectious gastrointestinal disease in children under the age of 5. Many studies have documented that meteorological variables, especially temperature, are associated with HFMD. Since the general climate patterns occur as latitude increases, so latitude may indirectly influence the peak time of HFMD. The objective of this study was to explore the effect of latitude on the starting of an HFMD epidemic in Dalian, which can help in the development of an early warning model of HFMD in difference latitude districts. Spearman's rank correlation coefficient was used to analyze the tendency of HFMD incidence rate over the year. A circular distribution method was used to calculate the gold standard of beginning of the HFMD epidemic. A negative binomial regression model was used to establish the early warning of the starting of the HFMD epidemic. The annualized crude incidence rate of HFMD disease in Dalian, Liaoning Province, China as a whole was 169.14 per 100,000 from 2009 to 2013.The incidence rate of HFMD varied considerably by district during the study period, but there was no significant declining or rising trend in disease incidence over the years by district of Dalian. The circular statistical analysis results showed that there was latitudinal gradient in the starting of the HFMD epidemic except for region B; the starting time of HFMD epidemic of Region A was earlier than other regions range 9 days to 18 days. The starting time of the HFMD epidemic differs from region to region with different latitudes in Dalian, Liaoning Province, China. This result can provide a scientific basis for early warning of HFMD.

Using a Negative Binomial Regression Model for Early Warning at the Start of a Hand Foot Mouth Disease Epidemic in Dalian, Liaoning Province, China

Background

The hand foot and mouth disease (HFMD) is a human syndrome caused by intestinal viruses like that coxsackie A virus 16, enterovirus 71 and easily developed into outbreak in kindergarten and school. Scientifically and accurately early detection of the start time of HFMD epidemic is a key principle in planning of control measures and minimizing the impact of HFMD. The objective of this study was to establish a reliable early detection model for start timing of hand foot mouth disease epidemic in Dalian and to evaluate the performance of model by analyzing the sensitivity in detectability.

Methods

The negative binomial regression model was used to estimate the weekly baseline case number of HFMD and identified the optimal alerting threshold between tested difference threshold values during the epidemic and non-epidemic year. Circular distribution method was used to calculate the gold standard of start timing of HFMD epidemic.

Results

From 2009 to 2014, a total of 62022 HFMD cases were reported (36879 males and 25143 females) in Dalian, Liaoning Province, China, including 15 fatal cases. The median age of the patients was 3 years. The incidence rate of epidemic year ranged from 137.54 per 100,000 population to 231.44 per 100,000population, the incidence rate of non-epidemic year was lower than 112 per 100,000 population. The negative binomial regression model with AIC value 147.28 was finally selected to construct the baseline level. The threshold value was 100 for the epidemic year and 50 for the non- epidemic year had the highest sensitivity(100%) both in retrospective and prospective early warning and the detection time-consuming was 2 weeks before the actual starting of HFMD epidemic.

Conclusions

The negative binomial regression model could early warning the start of a HFMD epidemic with good sensitivity and appropriate detection time in Dalian.

New-Onset Myocarditis in an Immunocompetent Adult with Acute Metapneumovirus Infection

Introduction. A number of viruses have been implicated in viral myocarditis; however, there has been no previous report of human metapneumovirus (hMPV) causing this condition. Discovered in 2001, hMPV is typically associated with upper respiratory illness, mainly affecting children. Case Presentation. We report the case of a 25-year-old man with acute systolic heart failure from viral myocarditis secondary to the hMPV. The patient was initially admitted to the general medical ward but developed increasing oxygen requirements resulting in transfer to the cardiac intensive care unit. Cardiac magnetic resonance imaging was used to help confirm the diagnosis. He was treated with intravenous diuretics, and afterload and preload agents, and he was subsequently discharged home after seven days of hospitalization. Discussion. hMPV is typically a respiratory pathogen; however, it was associated with in myocarditis in our patient. Due to the recent ability to detect this virus, we may see more cases of this, particularly during peak months of infection. Conclusion. This is the first case description of myocarditis associated with hMPV infection.