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Nguyet LA, Thanh TT, Nhan LNT, Hong NTT, Nhu LNT, Van HMT, Ny NTH, Anh NT, Han DDK, Tuan HM, Huy VQ, Viet HL, Cuong HQ, Thao NTT, Viet DC, Khanh TH, Thwaites L, Clapham H, Hung NT, Chau NVV, Thwaites G, Ha DQ, van Doorn HR, Tan LV. Neutralizing Antibodies against Enteroviruses in Patients with Hand, Foot and Mouth Disease. Emerg Infect Dis 2021; 26:298-306. [PMID: 31961293 PMCID: PMC6986819 DOI: 10.3201/eid2602.190721] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Hand, foot and mouth disease (HFMD) is an emerging infection with pandemic potential. Knowledge of neutralizing antibody responses among its pathogens is essential to inform vaccine development and epidemiologic research. We used 120 paired-plasma samples collected at enrollment and >7 days after the onset of illness from HFMD patients infected with enterovirus A71 (EV-A71), coxsackievirus A (CVA) 6, CVA10, and CVA16 to study cross neutralization. For homotypic viruses, seropositivity increased from <60% at enrollment to 97%-100% at follow-up, corresponding to seroconversion rates of 57%-93%. Seroconversion for heterotypic viruses was recorded in only 3%-23% of patients. All plasma samples from patients infected with EV-A71 subgenogroup B5 could neutralize the emerging EV-A71 subgenogroup C4. Collectively, our results support previous reports about the potential benefit of EV-A71 vaccine but highlight the necessity of multivalent vaccines to control HFMD.
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Liu J, Lu XC, Zhou WD. Elevated circulating miR-494 in plasma of children with enterovirus 71 induced hand, foot, and mouth disease and its potential diagnostic value. Acta Virol 2020; 64:338-343. [PMID: 32985212 DOI: 10.4149/av_2020_311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hand, foot, and mouth disease (HFMD) is a common pediatric disease, whose outcome depends of the enterovirus genotype infecting the patient. The present study is focused on the potential diagnostic value and the role of circulating microRNA-494 (miR-494) in enterovirus 71-induced more severe form of HFMD. We included 102 children with enterovirus 71 (EV71)-induced HFMD, 42 coxsackievirus A16 (CA16)-induced HFMD and 102 healthy controls. The plasma and serum samples were collected. The expression level of circulating miR-494 was determined by RT-PCR method. Moreover, ROC curve has been drawn to evaluate the sensitivity and specificity of circulating miR-494 for the diagnosis of EV71-induced HFMD. Furthermore, the correlation between the circulating miR-494 and the levels of interleukin 6 (IL-6), interleukin 4 (IL-4) and interferon γ (IFN-γ) in the serum of patients were analyzed. Circulating miR-494 was significantly increased in plasma of children with EV71-induced HFMD compared with the healthy children or CA16-induced HFMD, and level of miR-494 in the EV71 severe group was significantly higher than the EV71 mild group. Moreover, results of ROC analysis suggested that miR-494 is a sensitive biomarker to distinguish EV71 patients from healthy controls and CA16 patients. Furthermore, IL-6 and IFN-γ were elevated in serum of patients with EV71-induced HFMD and the level of circulating miR-494 in patients with EV71-induced HFMD was positively correlated with the serum levels of both IL-6 and IFN-γ, respectively. Circulating miR-494 was abnormally up-regulated in plasma of the children with EV71-induced HFMD, and miR-494 may serve as potential biomarker for the diagnosis and treatment of the disease. Keywords: miR-494; HFMD; biomarker; enterovirus 71; inflammation.
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Qin L, Dang D, Wang X, Zhang R, Feng H, Ren J, Chen S, Zhou G, Huang P, Wang B, Xi Y, Wu W, Jin Y, Duan G. Identification of immune and metabolic predictors of severe hand-foot-mouth disease. PLoS One 2019; 14:e0216993. [PMID: 31120941 PMCID: PMC6532886 DOI: 10.1371/journal.pone.0216993] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 05/02/2019] [Indexed: 01/15/2023] Open
Abstract
Hand, foot and mouth disease (HFMD) is an infectious disease that affects mostly children. The children with HFMD also have other immune and metabolic disorders. However, the association of these disorders with the severity of HFMD has not yet been determined. In this study, we used a case-control study design to examine the correlation of immune and metabolic disorders with HFMD development in children. 406 mild and severe patients were recruited and divided into different subgroups based on the number of days from the initial onset time to hospitalization (1, 2, 3, 4, and ≥5 days). Logistic regression model was used to define the predictors of severe HFMD. We found that the patients from rural area (OR = 1.76, 95% CI [1.19~2.63], P = 0.005) or with body temperature of >39°C (OR = 2.14, 95% CI [1.12~4.12], P = 0.022) exhibited higher risk for severe symptoms. In addition, the risk increased with the rise of body temperature by using a Chis-quare trend test (P = 0.01). We also found that a decreased number of eosinophils was an predictor of severe HFMD at 1, 2, 3,and 4 days post infection (dpi). Decreased levels of Na+, Cl-, and creatine kinase were also predictors at 1 and ≥5 dpi. On the other hand, elevated level of globulin was a predictor for severe HFMD at 4 dpi and ≥5 dpi, and the increased number of neutrophils or increased level of alkaline phosphatase posed risk for severe HFMD at 3 and ≥5 dpi. Our results suggested that rural living, hyperpyrexia, changes in the immune system that include the numbers of eosinophils and neutrophils and the levels of IgG and globulin, and metabolic alterations, such as the levels of alkaline phosphatase, Na+, Cl-, and creatine kinase in peripheral blood are predictors of severe HFMD.
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Affiliation(s)
- Luwei Qin
- School of Public Health, Xinxiang Medical University, Xinxiang, China
| | - Dejian Dang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xinhong Wang
- Department of Infectious Disease, The Children's Hospital of Zhengzhou City, Zhengzhou, China
| | - Rongguang Zhang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Huifen Feng
- Department of Gastroenterology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingchao Ren
- School of Public Health, Xinxiang Medical University, Xinxiang, China
| | - Shuaiyin Chen
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Guangyuan Zhou
- School of Public Health, Xinxiang Medical University, Xinxiang, China
| | - Ping Huang
- Department of Gastroenterology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bin Wang
- Department of Gastroenterology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuanlin Xi
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Weidong Wu
- School of Public Health, Xinxiang Medical University, Xinxiang, China
| | - Yuefei Jin
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
- * E-mail: (GD); (YJ)
| | - Guangcai Duan
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
- * E-mail: (GD); (YJ)
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Kuo KC, Yeh YC, Huang YH, Chen IL, Lee CH. Understanding physician antibiotic prescribing behavior for children with enterovirus infection. PLoS One 2018; 13:e0202316. [PMID: 30192893 PMCID: PMC6128467 DOI: 10.1371/journal.pone.0202316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 08/01/2018] [Indexed: 11/22/2022] Open
Abstract
Background Our previous study demonstrated that pediatricians prescribe antibiotics without proper clinical justification to patients with enterovirus infection, although antibiotics are not effective in treating the infections caused by these viruses. To improve the quality of healthcare, we aim to evaluate the association of clinical and demographic characteristics of patients and further to identify the determining factors for prescribing antibiotics to children experiencing enterovirus infection. Methods We retrospectively reviewed the medical records of children who were hospitalized between January 2008 and December 2016 with a diagnosis of herpangina or hand-foot-mouth disease (HFMD). We identified those children who were prescribed antibiotics for at least 24 hours during admission. We conducted a retrospective descriptive study to analyze data in order to determine the factors associated with pediatrician antibiotics prescribing for enterovirus infection. Results In the nine years of study period, the rate of antibiotics use was about 13% in these patients. A total of 3659 patients were enrolled during 2008~2012 and analyzed in detail. Elevated levels of C-reactive protein (CRP) and presence of leukocytosis in blood (WBC) were both significantly associated with pediatrician antibiotic prescribing for enterovirus infection (p<0.001). Between different specialistic devisions, there was significantly different proportion of antibiotics utilization for patients. In further analysis of antibiotics prescribing by Receiver operating characteristic (ROC) curve method, the level of CRP significantly had more the area under curve (0.708) compared with the count of WBC (p<0.05). Conclusions The present study indicates that higher serum level of CRP is strongly associated with pediatricians prescribing antibiotics for children experiencing herpangina or HFMD. Antibiotic prescribing is a complex process. Pediatricians should be more judicious in decision-making time by their specialistics. Our findings would shed new light on process and allay the concern about inappropriate antibiotics.
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Affiliation(s)
- Kuang-Che Kuo
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Chun Yeh
- Department of Psychiatry, Kaohsiung Medical University Hospital, Department of Psychiatry, Faculty of Medicine, Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ying-Hsien Huang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - I-Ling Chen
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chen-Hsiang Lee
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- * E-mail:
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Li S, Xiao Z, Li L, Hu B, Zhou Z, Yi S, Luo J, Xie L, Nie B, Mo L, Wang S. Establishment of normal reference values of NT-proBNP and its application in diagnosing acute heart failure in children with severe hand foot and mouth disease [corrected]. Medicine (Baltimore) 2018; 97:e12218. [PMID: 30200140 PMCID: PMC6133461 DOI: 10.1097/md.0000000000012218] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Hand, foot, and mouth disease (HFMD), caused by enteroviruses, is an acute contagious disease in children. Some severe infections caused by human enterovirus 71 (HEV71) lead to rapid death in children with acute heart failure (HF). N-terminal probrain natriuretic peptide (NT-proBNP) is an important indicator of HF; however, its normal reference values in children and role in HFMD remain unclear.This study aimed to investigate the correlation between NT-proBNP and heart function and establish normal reference values of NT-proBNP in children with HFMD aged 0 to 18 years.In this study, 95% normal reference values were established in 1031 healthy children aged 0 to 18 years. The correlation between NT-proBNP and left ventricular ejection (LVEF) was analyzed in 392 children with HFMD using Spearman correlation and receiver operating characteristic analysis.NT-proBNP levels were negatively correlated with LVEF in 392 children with HFMD. The median NT-proBNP level was 921 pg/mL in the early cardiorespiratory failure group, but only 55 pg/mL in the nervous system involvement group. Serum NT-proBNP levels were negatively correlated with age. The normal reference value in the neonatal period (0 to <1 month) and adolescence (13-18 years) was 250.0 to 3987.0 pg/mL and 20.0 to 145.0 pg/mL, respectively.NT-proBNP levels can reflect the severity of HFMD and discriminate the second stage from the third stage of HFMD effectively. NT-proBNP is a useful biomarker to predict the early stage of severe HFMD in children with HF. Different ages fit with different normal reference values of NT-proBNP in children.
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Affiliation(s)
- Sai Li
- School Of Basic Medical Science, Central South University
- Clinical Laboratory
| | | | | | | | | | | | - Junming Luo
- Department of Infections, Hunan Children's Hospital, Changsha, China
| | | | | | | | - Shiping Wang
- School Of Basic Medical Science, Central South University
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Pan YZ, Song CL, Guo YJ, Wang LL, Cui YJ, Ren YF. [Effects of L-carnitine on serum levels of brain natriuretic peptide and N-terminal pro-brain natriuretic peptide and cardiac function in children with severe hand-foot-mouth disease]. Zhongguo Dang Dai Er Ke Za Zhi 2018; 20:635-640. [PMID: 30111472 PMCID: PMC7389759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/11/2018] [Indexed: 11/04/2023]
Abstract
OBJECTIVE To observe the effects of L-carnitine treatment on serum levels of brain natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) and cardiac function in children with heart dysfunction and severe hand-foot-mouth disease (HFMD). METHODS A total of 120 children with severe HFMD were enrolled and randomly and equally divided into routine treatment group and L-carnitine treatment group. Thirty healthy children served as the control group. HFMD patients were given anti-fever and antiviral treatment as the basic treatment, while the patients in the L-carnitine treatment group were given L-carnitine as an adjuvant treatment to the basic treatment. Treatment outcomes were observed in the two groups. For all the subjects, serum levels of BNP and NT-proBNP and cardiac function parameters including left ventricular ejection fraction (LVEF), fractional shortening (FS), and cardiac index (CI) were measured at different time points before and after treatment. RESULTS Before treatment, HFMD patients had significantly higher serum levels of BNP and NT-proBNP and heart rate but significantly lower LVEF, FS, and CI compared with the control group (P<0.05). After treatment, the L-carnitine treatment group had a significantly higher response rate than the routine treatment group (P<0.05). After 3 days of treatment, the serum levels of BNP and NT-proBNP, LVEF, FS, and CI were significantly reduced in the L-carnitine group (P<0.05); the L-carnitine group had significantly lower serum levels of BNP and NT-proBNP, LVEF, FS, and CI than the routine treatment group (P<0.05); there were no significant differences in the serum levels of BNP and NT-proBNP, LVEF, FS, or CI between the L-carnitine treatment and control groups (P>0.05). After 5 days of treatment, there were no significant differences in the serum levels of BNP and NT-proBNP, LVEF, FS, or CI between the L-carnitine treatment and routine treatment groups (P>0.05). Heart rate recovery was significantly slower in the routine treatment group than in the L-carnitine treatment group (P<0.05). CONCLUSIONS As an adjuvant therapy for severe HFMD, L-carnitine treatment has satisfactory short-term efficacy in reducing the serum levels of BNP and NT-proBNP and improving cardiac function, thus improving clinical outcomes.
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Affiliation(s)
- Yan-Zhu Pan
- Department of Emergency and Critical Medicine, Children's Hospital of Zhengzhou University/Children's Hospital of Henan Province/Zhengzhou Children's Hospital/Zhengzhou Children's Key Laboratory of Critical Care Medicine, Zhengzhou 450003, China.
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Pan YZ, Song CL, Guo YJ, Wang LL, Cui YJ, Ren YF. [Effects of L-carnitine on serum levels of brain natriuretic peptide and N-terminal pro-brain natriuretic peptide and cardiac function in children with severe hand-foot-mouth disease]. Zhongguo Dang Dai Er Ke Za Zhi 2018; 20:635-640. [PMID: 30111472 PMCID: PMC7389759 DOI: 10.7499/j.issn.1008-8830.2018.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/11/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To observe the effects of L-carnitine treatment on serum levels of brain natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) and cardiac function in children with heart dysfunction and severe hand-foot-mouth disease (HFMD). METHODS A total of 120 children with severe HFMD were enrolled and randomly and equally divided into routine treatment group and L-carnitine treatment group. Thirty healthy children served as the control group. HFMD patients were given anti-fever and antiviral treatment as the basic treatment, while the patients in the L-carnitine treatment group were given L-carnitine as an adjuvant treatment to the basic treatment. Treatment outcomes were observed in the two groups. For all the subjects, serum levels of BNP and NT-proBNP and cardiac function parameters including left ventricular ejection fraction (LVEF), fractional shortening (FS), and cardiac index (CI) were measured at different time points before and after treatment. RESULTS Before treatment, HFMD patients had significantly higher serum levels of BNP and NT-proBNP and heart rate but significantly lower LVEF, FS, and CI compared with the control group (P<0.05). After treatment, the L-carnitine treatment group had a significantly higher response rate than the routine treatment group (P<0.05). After 3 days of treatment, the serum levels of BNP and NT-proBNP, LVEF, FS, and CI were significantly reduced in the L-carnitine group (P<0.05); the L-carnitine group had significantly lower serum levels of BNP and NT-proBNP, LVEF, FS, and CI than the routine treatment group (P<0.05); there were no significant differences in the serum levels of BNP and NT-proBNP, LVEF, FS, or CI between the L-carnitine treatment and control groups (P>0.05). After 5 days of treatment, there were no significant differences in the serum levels of BNP and NT-proBNP, LVEF, FS, or CI between the L-carnitine treatment and routine treatment groups (P>0.05). Heart rate recovery was significantly slower in the routine treatment group than in the L-carnitine treatment group (P<0.05). CONCLUSIONS As an adjuvant therapy for severe HFMD, L-carnitine treatment has satisfactory short-term efficacy in reducing the serum levels of BNP and NT-proBNP and improving cardiac function, thus improving clinical outcomes.
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Affiliation(s)
- Yan-Zhu Pan
- Department of Emergency and Critical Medicine, Children's Hospital of Zhengzhou University/Children's Hospital of Henan Province/Zhengzhou Children's Hospital/Zhengzhou Children's Key Laboratory of Critical Care Medicine, Zhengzhou 450003, China.
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8
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Lin YL, Chow YH, Huang LM, Hsieh SM, Cheng PY, Hu KC, Chiang BL. A CpG-adjuvanted intranasal enterovirus 71 vaccine elicits mucosal and systemic immune responses and protects human SCARB2-transgenic mice against lethal challenge. Sci Rep 2018; 8:10713. [PMID: 30013088 PMCID: PMC6048030 DOI: 10.1038/s41598-018-28281-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 05/15/2018] [Indexed: 12/11/2022] Open
Abstract
Enterovirus 71 (EV71) is an aetiological agent responsible for seasonal epidemics of hand-foot-and-mouth disease, which causes considerable mortality among young children. Mucosal vaccines can efficiently induce secretory IgA at mucosal surfaces and thereby prevent or limit infection at the site of virus entry. CpG oligodeoxynucleotides (ODNs), which resemble bacterial DNA, can induce the innate immune response through activation of Toll-like receptor 9. Here, we used CpG ODNs as adjuvants to investigate an EV71 mucosal vaccine in mice. In the EV71 + CpG group, the EV71-specific IgG and IgA titres in the serum, nasal wash, bronchoalveolar lavage fluid, and faeces were substantially higher than those in the EV71- and phosphate-buffered saline-treated groups. Moreover, the number of EV71-specific IgG- and IgA-producing cells was also higher in the EV71 + CpG group. Furthermore, T-cell proliferative responses and interleukin-17 secretion were markedly increased when CpG-adjuvanted EV71 was delivered intranasally. More importantly, the induced antibodies neutralised infection by EV71 of the C2 genotype and crossneutralised infection by EV71 of the B4 and B5 genotypes. Lastly, human scavenger receptor class B, member 2-transgenic mice intranasally immunised with the CpG-adjuvanted EV71 vaccine resisted a subsequent lethal challenge with EV71, indicating that CpG was an effective intranasal adjuvant for EV71 mucosal-vaccine development.
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MESH Headings
- Adjuvants, Immunologic/administration & dosage
- Administration, Intranasal
- Animals
- Antibodies, Viral/blood
- Antibodies, Viral/immunology
- Bronchoalveolar Lavage Fluid/immunology
- Disease Models, Animal
- Enterovirus A, Human/immunology
- Enterovirus A, Human/pathogenicity
- Female
- Hand, Foot and Mouth Disease/blood
- Hand, Foot and Mouth Disease/immunology
- Hand, Foot and Mouth Disease/prevention & control
- Hand, Foot and Mouth Disease/virology
- Humans
- Immunity, Mucosal
- Immunogenicity, Vaccine
- Lysosomal Membrane Proteins/genetics
- Mice
- Mice, Inbred BALB C
- Mice, Transgenic
- Oligodeoxyribonucleotides/administration & dosage
- Oligodeoxyribonucleotides/immunology
- Receptors, Scavenger/genetics
- Treatment Outcome
- Vaccines, Inactivated
- Viral Vaccines/administration & dosage
- Viral Vaccines/immunology
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Affiliation(s)
- Yu-Li Lin
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Hung Chow
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan Town, Miaoli County, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Li-Min Huang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Szu-Min Hsieh
- Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Yun Cheng
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Kai-Chieh Hu
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan Town, Miaoli County, Taiwan
| | - Bor-Luen Chiang
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
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Zhu L, Qian T, Zhang XW, Huang W, Li WH. Using changes in pro-brain natriuretic peptide of plasma amino-terminal and norepinephrine levels as prognostic and diagnostic factors in hand-foot-and-mouth disease. Eur Rev Med Pharmacol Sci 2018; 22:4224-4227. [PMID: 30024611 DOI: 10.26355/eurrev_201807_15416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE We explored the possibility of using the variations in the pro-brain natriuretic peptide (NT-proBNP) of serum amino-terminal and norepinephrine (NE) levels as prognostic as well as diagnostic factors in children suffering from severe hand-foot-and-mouth disease (HFMD). PATIENTS AND METHODS From February 2014 to February 2015, 102 HFMD patients were enrolled in this study. They were divided into the common group (n=55) and the severe group (n=47). During the same period, 30 healthy children were enrolled in the control group. NT-proBNP and NE levels were evaluated in all patients. RESULTS Our results revealed that NT-proBNP and NE levels in the common group were not evidently different compared with those of the control group. However, these levels in the severe group were significantly higher than other groups. After treatment, NT-proBNP and NE levels in the severe group were lower than those measured before treatment. CONCLUSIONS We suggest that serum level of NT-proBNP can be used as a valuable index to judge the severity of HFMD and to predict the prognosis. We believe that NT-proBNP and NE levels can be added to other HFMD diagnostic tools.
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Affiliation(s)
- L Zhu
- Intensive Care Unit, Xuzhou Children's Hospital, Xuzhou, Jiangsu, P.R. China.
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Zhang H, Song Z, Yu H, Zhang X, Xu S, Li Z, Li J, Xu H, Yuan Z, Ma H, Yi Z, Hu Y. Genome-wide linear B-cell epitopes of enterovirus 71 in a hand, foot and mouth disease (HFMD) population. J Clin Virol 2018; 105:41-48. [PMID: 29886372 DOI: 10.1016/j.jcv.2018.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/31/2018] [Accepted: 06/01/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Enteroviruses cause hand, foot and mouth disease (HFMD). The host B-cells recognize the viral proteins and provoke humoral responses. Deciphering the B-cell responses to the viral epitopes helps diagnosis and vaccine development. OBJECTIVES The objective of the present study was to investigate for the first time the landscape of genome-wide linear B-cell epitopes of enterovirus 71 in HFMD population. STUDY DESIGN The peptides encompassing the entire coding region of EV71 were chemically synthesized and displayed on a microarray. The peptide microarray was used to screen serum samples from an HFMD population, including EV71-, CAV10-, CAV16- and CAV6-infected patients. We identified the dominant epitope-containing-peptides (DECPs) that react with the sera of more than 20% of the HFMD population and the common DECPs that cross-react with the sera from other enteroviruses-infected population. RESULTS Ten DECPs reacting with IgM and 9 DECPs reacting with IgG antibodies were identified, of which, 6 IgM and 5 IgG common DECPs cross-reacted with the sera from other enteroviruses. Some DECPs preferentially reacted with IgG or IgM antibodies and some epitope-antibody interactions correlated with the severity of HFMD. CONCLUSIONS We uncovered the DECPs and the common DECPs among a group of enteroviruses in HFMD population and found that some epitope-antibody reactions were associated with the outcome of HFMD. These data may guide developing vaccines against the enteroviruses and help the diagnosis and prognosis of HFMD.
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Affiliation(s)
- Huiying Zhang
- Department of pathogen diagnosis and biosafety, Shanghai public health clinical center, Fudan University, Shanghai, 201508, PR China.
| | - Zhigang Song
- Department of pathogen diagnosis and biosafety, Shanghai public health clinical center, Fudan University, Shanghai, 201508, PR China.
| | - Huiju Yu
- Department of pediatrics infectious disease, Xinhua hospital affiliated to Shanghai Jiao Tong University School of medicine, Shanghai, 201508, PR China.
| | - Xiaoling Zhang
- Department of pathogen diagnosis and biosafety, Shanghai public health clinical center, Fudan University, Shanghai, 201508, PR China.
| | - Shanshan Xu
- Department of pediatrics infectious disease, Xinhua hospital affiliated to Shanghai Jiao Tong University School of medicine, Shanghai, 201508, PR China.
| | - Zhong Li
- Nano-Bio-Med department, Suzhou Institute of Nano-Tech and Nano-Bionics, Chinese Academy of Sciences, Suzhou, 215123, PR China.
| | - Jingzhi Li
- Nano-Bio-Med department, Suzhou Institute of Nano-Tech and Nano-Bionics, Chinese Academy of Sciences, Suzhou, 215123, PR China.
| | - Hongke Xu
- Nano-Bio-Med department, Suzhou Institute of Nano-Tech and Nano-Bionics, Chinese Academy of Sciences, Suzhou, 215123, PR China.
| | - Zhenghong Yuan
- Key Laboratory of medical molecular virology and department of medical microbiology, School of basic medical sciences, Shanghai medical college of Fudan University, Shanghai, 20003, PR China.
| | - Hongwei Ma
- Nano-Bio-Med department, Suzhou Institute of Nano-Tech and Nano-Bionics, Chinese Academy of Sciences, Suzhou, 215123, PR China.
| | - Zhigang Yi
- Department of pathogen diagnosis and biosafety, Shanghai public health clinical center, Fudan University, Shanghai, 201508, PR China; Key Laboratory of medical molecular virology and department of medical microbiology, School of basic medical sciences, Shanghai medical college of Fudan University, Shanghai, 20003, PR China.
| | - Yunwen Hu
- Department of pathogen diagnosis and biosafety, Shanghai public health clinical center, Fudan University, Shanghai, 201508, PR China.
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Dang HX, Liu CJ, Li J, Chen SJ, Xu F. Clinical Significance and Prognostic Effect of Serum 25-hydroxyvitamin D Concentrations in Critical and Severe Hand, Foot and Mouth Disease. Nutrients 2017; 9:nu9050478. [PMID: 28489032 PMCID: PMC5452208 DOI: 10.3390/nu9050478] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/06/2017] [Accepted: 05/08/2017] [Indexed: 12/13/2022] Open
Abstract
Objective: To examine the association of serum 25-hydroxyvitamin D [25(OH)D] concentrations with critical and severe hand, foot and mouth disease (HFMD) and assess the clinical significance and prognostic effect of 25(OH)D concentrations in children with HFMD. Methods: This is a prospective observational study. The 138 children with HFMD were divided into common (49 cases), severe (52 cases), and critical (37 cases) HFMD groups. Another 59 healthy children undergoing outpatient medical examinations during the same period were chosen as the control group. Serum 25(OH)D concentrations were measured in all the subjects, and each group was subdivided by serum 25(OH)D concentration into 25(OH)D normal (≥30 ng/mL); insufficiency (20–29.9 ng/mL), and deficiency (<20 ng/mL) groups. The pediatric critical illness score (PCIS) was recorded for the critical and severe HFMD group upon admission to the pediatric intensive care unit (PICU). Children with critical and severe HFMD were also monitored for blood lactate (LAC), serum calcium ions (Ca++), D-dimer (DD), lactate dehydrogenase (LDH), and creatine kinase-MB (CK-MB) levels; the incidences of brainstem encephalitis, neurogenic pulmonary edema, and circulatory failure; and the 14-day mortality rate. Results: Serum 25(OH)D concentrations were generally low in all groups. The critical HFMD group showed a significantly lower serum 25(OH)D mean concentration (20.0 ± 8.4 ng/mL) and a higher proportion of deficiency (18%) compared with the control group (28.1 ± 6.6 ng/mL, 8%), common (29.5 ± 8.1 ng/mL, 10%) and severe (31.9 ± 9.7 ng/mL, 8%) HFMD groups (p < 0.05). In the critical and severe HFMD groups, the 25(OH)D deficiency group had lower PCISs than the 25(OH)D normal and insufficiency groups (p < 0.05); and had higher values than the latter two groups for LAC, LDH, CK-MB and DD; and the incidences of brainstem encephalitis, neurogenic pulmonary edema, circulatory failure, and mortality (p < 0.05). The death group showed significantly lower serum 25(OH)D concentrations and PCISs than the survival group (p < 0.05) and had higher LAC, LDH, CK-MB and DD levels and higher incidences of brainstem encephalitis, neurogenic pulmonary edema, and circulatory failure (p < 0.05). Logistic regression analysis revealed that the serum 25(OH)D concentration was an independent factor that influenced mortality in children with critical and severe HFMD. Conclusions: In this study, we find the serum 25(OH)D concentrations are substantially reduced in children with critical and severe HFMD and are associated with the severity of HFMD. The serum 25(OH)D concentrations may have clinical value for determining the progression of critical HFMD and predicting the risk of death. Further evidence is needed before it can be stated that 25(OH)D concentrations have clinical value in HMFD diagnosis.
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Affiliation(s)
- Hong-Xing Dang
- Department of PICU, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China.
- China International Science and Technology Cooperation base of Child development and Critical Disorders, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China.
- Chongqing Engineering Research Center of Stem Cell Therapy, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China.
| | - Cheng-Jun Liu
- Department of PICU, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China.
- China International Science and Technology Cooperation base of Child development and Critical Disorders, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China.
- Chongqing Engineering Research Center of Stem Cell Therapy, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China.
| | - Jing Li
- Department of PICU, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China.
- China International Science and Technology Cooperation base of Child development and Critical Disorders, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China.
- Chongqing Engineering Research Center of Stem Cell Therapy, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China.
| | - Shi-Jiao Chen
- Department of PICU, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China.
- China International Science and Technology Cooperation base of Child development and Critical Disorders, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China.
- Chongqing Engineering Research Center of Stem Cell Therapy, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China.
| | - Feng Xu
- Department of PICU, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China.
- China International Science and Technology Cooperation base of Child development and Critical Disorders, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China.
- Chongqing Engineering Research Center of Stem Cell Therapy, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China.
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Zheng W, Shi H, Chen Y, Xu Z, Chen J, Jin L. Alteration of serum high-mobility group protein 1 (HMGB1) levels in children with enterovirus 71-induced hand, foot, and mouth disease. Medicine (Baltimore) 2017; 96:e6764. [PMID: 28445307 PMCID: PMC5413272 DOI: 10.1097/md.0000000000006764] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Hand, foot, and mouth disease (HFMD) is a common pediatric disease caused by enterovirus infection. It typically presents as a fever along with flat, discolored spots and bumps on the hands, feet, and mouth. Compared with other viruses, enterovirus 71 (EV71)-induced HFMD is more prone to cause severe complications in children, such as brainstem encephalitis, cardiopulmonary disorders, and even death. More in-depth studies are still necessary to understand the characteristics of EV71-induced HFMD, although some related research has been reported so far. High-mobility group box 1 (HMGB1) is an inflammatory cytokine that can upregulate other inflammatory factors through its receptors, such as Toll-like receptors and the receptor for advanced glycation endproducts.We prospectively investigated the alteration of serum HMGB1, interleukin (IL)-6, and tumor necrosis factor (TNF)-α levels before and after treatment in 82 children with HFMD.We found that the serum HMGB1, IL-6, and TNF-α levels were significantly increased in EV71-induced HFMD, and that these changes were more serious in the severe and critical HMFD groups; however, there was no significant difference in the HMGB1 level between the normal control and mild HMFD groups. Moreover, the serum HMGB1 level was positively correlated with the alteration of serum IL-6 and TNF-α concentrations.These results suggest that HMGB1 is involved in the inflammatory pathogenesis of EV71-induced HFMD and that the serum level of HMGB1 could be applied as a clinical indicator for the severity of HFMD, and also a sign for the recovery prognosis of HFMD.
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Zhou JF, Chen ZY, Yang SM, Chen JZ, Zhou LY, Wang YF, Wang G, Yu XJ, Zhang WH. Clinical Features and Peripheral Blood T Lymphocyte Subsets in Hand, Foot, and Mouth Disease According to Different Pathogens. Indian J Pediatr 2017; 84:124-127. [PMID: 27465820 DOI: 10.1007/s12098-016-2198-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 07/07/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the changes in lymphocyte subsets that are caused by infection with different pathogens in children with hand, foot, and mouth disease. METHODS T lymphocyte subsets were measured in the patients' peripheral blood, and serum, throat swab, and fecal samples were tested for enterovirus. RESULTS Fecal and throat swab samples exhibited similar positive detection rates, and were significantly more likely to be positive, compared to serum samples (P < 0.01). The EV71-positive group exhibited significantly lower CD4 + TM cell counts (QR: 1.058), compared to the CD4 + TM cell counts in the CoxA16-positive group (QR: 1.391; P < 0.05). CONCLUSIONS Throat swab and fecal samples exhibited significantly higher positive detection rates, compared to serum samples. In addition, EV71-infected children exhibited significantly lower CD4+ T-cell counts, compared to CoxA16-infected children, which suggests that EV71 infection may be associated with a poorer prognosis.
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Affiliation(s)
- Jian-Fang Zhou
- Department of Infectious Diseases, Fenghua People's Hospital, Fenghua, Zhejiang Province, 315500, China.
| | - Zhi-Yong Chen
- Department of Infectious Diseases, The Affiliated Huashan Hospital of Fudan University, Shanghai, China
| | - Shan-Ming Yang
- Department of Infectious Diseases, Fenghua People's Hospital, Fenghua, Zhejiang Province, 315500, China
| | - Jia-Zhen Chen
- Department of Infectious Diseases, Fenghua People's Hospital, Fenghua, Zhejiang Province, 315500, China
| | - Ling-Ye Zhou
- Department of Infectious Diseases, Fenghua People's Hospital, Fenghua, Zhejiang Province, 315500, China
| | - Ya-Fen Wang
- Department of Infectious Diseases, Fenghua People's Hospital, Fenghua, Zhejiang Province, 315500, China
| | - Gang Wang
- Department of Infectious Diseases, Fenghua People's Hospital, Fenghua, Zhejiang Province, 315500, China
| | - Xia-Jian Yu
- Department of Infectious Diseases, Fenghua People's Hospital, Fenghua, Zhejiang Province, 315500, China
| | - Wen-Hong Zhang
- Department of Infectious Diseases, The Affiliated Huashan Hospital of Fudan University, Shanghai, China
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Li J, Liu RH, Shan RB. [Value of serum S100B protein and neuron-specific enolase levels in predicting the severity of hand, foot and mouth disease]. Zhongguo Dang Dai Er Ke Za Zhi 2017; 19:182-187. [PMID: 28202117 PMCID: PMC7389472 DOI: 10.7499/j.issn.1008-8830.2017.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 10/09/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To study the value of serum S100B protein and neuron-specific enolase (NSE) levels in predicting the severity of hand, foot and mouth disease (HFMD). METHODS Ninety children with HFMD were classified into three groups: common type, severe type, and critical type (n=30 each). Thirty healthy children were randomly selected as the control group. ELISA was used to measure serum levels of S100B protein and NSE before and at 7 days after treatment. The receiver operating characteristic (ROC) curve was used to evaluate the prediction efficiency of S100B protein and NSE for the severity of HFMD. RESULTS The critical type group had significant increases in the serum levels of S100B protein and NSE compared with the other three groups (P<0.01). The severe type group had significant increases in serum levels of S100B protein and NSE compared with the common type and control groups (P<0.01). The critical type and severe type groups had significant reductions in serum levels of S100B protein and NSE after treatment (P<0.05). Serum S100B protein had the highest Youden value of 0.611 at the cut-off value of 0.445 μg/L, with a sensitivity of 61% and a specificity of 100%, in the prediction of serious HFMD (including severe type and critical type HFMD). Serum NSE had the highest Youden value of 0.533 at the cut-off value of 5.905 μg/L, with a sensitivity of 80% and a specificity of 73%, in the prediction of serious HFMD. Combined measurements of these two parameters had a sensitivity of 86% and a specificity of 73% and had the highest predictive value for serious HFMD. CONCLUSIONS The serum levels of S100B protein and NSE help to predict the severity and treatment outcomes of HFMD. Combined measurements of these two parameters has a higher predictive value for serious HFMD.
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Affiliation(s)
- Jing Li
- Department of Pediatric Intensive Care Unit, Qingdao Women and Children's Hospital, Qingdao, Shandong 266000, China.
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Li J, Liu RH, Shan RB. [Value of serum S100B protein and neuron-specific enolase levels in predicting the severity of hand, foot and mouth disease]. Zhongguo Dang Dai Er Ke Za Zhi 2017; 19:182-187. [PMID: 28202117 PMCID: PMC7389472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 10/09/2016] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To study the value of serum S100B protein and neuron-specific enolase (NSE) levels in predicting the severity of hand, foot and mouth disease (HFMD). METHODS Ninety children with HFMD were classified into three groups: common type, severe type, and critical type (n=30 each). Thirty healthy children were randomly selected as the control group. ELISA was used to measure serum levels of S100B protein and NSE before and at 7 days after treatment. The receiver operating characteristic (ROC) curve was used to evaluate the prediction efficiency of S100B protein and NSE for the severity of HFMD. RESULTS The critical type group had significant increases in the serum levels of S100B protein and NSE compared with the other three groups (P<0.01). The severe type group had significant increases in serum levels of S100B protein and NSE compared with the common type and control groups (P<0.01). The critical type and severe type groups had significant reductions in serum levels of S100B protein and NSE after treatment (P<0.05). Serum S100B protein had the highest Youden value of 0.611 at the cut-off value of 0.445 μg/L, with a sensitivity of 61% and a specificity of 100%, in the prediction of serious HFMD (including severe type and critical type HFMD). Serum NSE had the highest Youden value of 0.533 at the cut-off value of 5.905 μg/L, with a sensitivity of 80% and a specificity of 73%, in the prediction of serious HFMD. Combined measurements of these two parameters had a sensitivity of 86% and a specificity of 73% and had the highest predictive value for serious HFMD. CONCLUSIONS The serum levels of S100B protein and NSE help to predict the severity and treatment outcomes of HFMD. Combined measurements of these two parameters has a higher predictive value for serious HFMD.
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Affiliation(s)
- Jing Li
- Department of Pediatric Intensive Care Unit, Qingdao Women and Children's Hospital, Qingdao, Shandong 266000, China.
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Zhu L, Qi BX, Fang DH, Qi GJ, Gao K, Hu BL. [Application of esmolol in severe hand, foot, and mouth disease]. Zhongguo Dang Dai Er Ke Za Zhi 2017; 19:44-48. [PMID: 28100321 PMCID: PMC7390115 DOI: 10.7499/j.issn.1008-8830.2017.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 10/26/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To study the clinical effect and mechanism of action of esmolol in the treatment of severe hand, foot, and mouth disease (HFMD). METHODS A prospective randomized controlled trial was performed. A total of 102 children with severe HFMD were enrolled in the study and were randomly divided into conventional treatment and esmolol treatment groups (n=51 each). The children in the conventional treatment group were given conventional treatment according to the guidelines for the diagnosis and treatment of HFMD. Those in the esmolol treatment group were given esmolol in addition to the conventional treatment. The heart rate (HR), systolic blood pressure (SBP), and respiratory rate (RR) were continuously monitored for all children. Blood samples were collected from all children before treatment and 1, 3, and 5 days after treatment to measure the levels of norepinephrine (NE), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and nuclear factor-kappa B (NF-κB) p65 in mononuclear cells. Serum levels of myocardial enzymes and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured before treatment and after 5 days of treatment. RESULTS There were no significant differences in HR, SBP, RR, NE, TNF-α, IL-6, NF-κB p65, serum myocardial enzymes, and NT-proBNP before treatment between the conventional treatment and esmolol treatment groups. Both groups had significant reductions in these parameters at each time point (P<0.05). Compared with the conventional treatment group, the esmolol treatment group had significant improvements in the above parameters after 1 and 3 days of treatment (P<0.05). After 5 days of treatment, the esmolol treatment group had significant improvements in serum levels of myocardial enzymes and NT-proBNP compared with the conventional treatment group (P<0.05). CONCLUSIONS Early application of esmolol can effectively stabilize the vital signs of the children with severe HFMD. Its mechanism of action may be related to reducing serum catecholamine concentration, alleviating myocardial damage, improving cardiac function, and reducing inflammatory response.
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Affiliation(s)
- Lei Zhu
- Department of Intensive Care Unit, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221006, China.
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NikNadia NMN, Sam IC, Rampal S, WanNorAmalina WMZ, NurAtifah G, Verasahib K, Ong CC, MohdAdib M, Chan YF. Cyclical Patterns of Hand, Foot and Mouth Disease Caused by Enterovirus A71 in Malaysia. PLoS Negl Trop Dis 2016; 10:e0004562. [PMID: 27010319 PMCID: PMC4806993 DOI: 10.1371/journal.pntd.0004562] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 02/29/2016] [Indexed: 11/18/2022] Open
Abstract
Enterovirus A71 (EV-A71) is an important emerging pathogen causing large epidemics of hand, foot and mouth disease (HFMD) in children. In Malaysia, since the first EV-A71 epidemic in 1997, recurrent cyclical epidemics have occurred every 2–3 years for reasons that remain unclear. We hypothesize that this cyclical pattern is due to changes in population immunity in children (measured as seroprevalence). Neutralizing antibody titers against EV-A71 were measured in 2,141 residual serum samples collected from children ≤12 years old between 1995 and 2012 to determine the seroprevalence of EV-A71. Reported national HFMD incidence was highest in children <2 years, and decreased with age; in support of this, EV-A71 seroprevalence was significantly associated with age, indicating greater susceptibility in younger children. EV-A71 epidemics are also characterized by peaks of increased genetic diversity, often with genotype changes. Cross-sectional time series analysis was used to model the association between EV-A71 epidemic periods and EV-A71 seroprevalence adjusting for age and climatic variables (temperature, rainfall, rain days and ultraviolet radiance). A 10% increase in absolute monthly EV-A71 seroprevalence was associated with a 45% higher odds of an epidemic (adjusted odds ratio, aOR1.45; 95% CI 1.24–1.69; P<0.001). Every 10% decrease in seroprevalence between preceding and current months was associated with a 16% higher odds of an epidemic (aOR = 1.16; CI 1.01–1.34 P<0.034). In summary, the 2–3 year cyclical pattern of EV-A71 epidemics in Malaysia is mainly due to the fall of population immunity accompanying the accumulation of susceptible children between epidemics. This study will impact the future planning, timing and target populations for vaccine programs. Enterovirus A71 (EV-A71) is a major cause of hand, foot, and mouth disease (HFMD) in children. Since the first outbreak in Malaysia in 1997, EV-A71 epidemics have occurred every 2–3 years, in 2000, 2003, 2006, 2008/2009, and 2012. As the reasons for this cyclical pattern are not known, we hypothesize that it is due to changes in population immunity in children. In this study, we measured the EV-A71 neutralizing antibody prevalence in serum collected from children ≤12 years old between 1995 and 2012, covering 18 years and 6 epidemics. HFMD incidence was highest in children <2 years, and seroprevalence increased with age, and was higher during epidemics compared to non-epidemic periods. Peaks in EV-A71 genetic diversity coincided with reported EV-A71 epidemics. Decreases in EV-A71 seroprevalence over time were significantly associated with subsequent epidemic periods. This suggests that epidemics lead to high levels of population seroprevalence; but during the 2–3 years between epidemics, the population of young children with no immunity is replenished and increases, making it more likely that a new epidemic will occur. This is the first study to show that the cyclical pattern of EV-A71 epidemics is associated with changes in EV-A71 seroprevalence.
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Affiliation(s)
- NMN NikNadia
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Malaysia
| | - I-Ching Sam
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Malaysia
| | - Sanjay Rampal
- Department of Social and Preventive Medicine, Julius Centre University of Malaya, Faculty of Medicine, University of Malaya, Malaysia
| | - WMZ WanNorAmalina
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Malaysia
| | - Ghazali NurAtifah
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Malaysia
| | - Khebir Verasahib
- National Public Health Laboratory, Ministry of Health, Selangor, Malaysia
| | - Chia Ching Ong
- Kepong Health Office, Ministry of Health, Kuala Lumpur, Malaysia
| | | | - Yoke Fun Chan
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Malaysia
- * E-mail: ;
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Liu RH, Li J, Qu XF, Xu YJ, Qu NY, Feng XC. [Clinical characteristics and prognostic factors of children with critical hand-foot-mouth disease treated with mechanical ventilation]. Zhongguo Dang Dai Er Ke Za Zhi 2015; 17:249-253. [PMID: 25815494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the clinical characteristics of children with critical hand-foot-mouth disease (HFMD) who were treated with mechanical ventilation and to explore the risk factors for poor prognosis. METHODS The clinical data of 63 children with critical HFMD who were admitted to the pediatric intensive care unit between April 2012 and September 2013 and needed mechanical ventilation were retrospectively analyzed. RESULTS Among the 63 children, 43 were boys and 20 were girls, and their mean age was 25 ± 18 months, with 81% under 3 years old. The four death cases were all under three years old. Compared with the cured cases, the death cases had a significantly lower mean age (8 ± 3 months vs 25 ± 18 months; P<0.05). Poor peripheral circulation above the elbow or knee joint, pulmonary edema involving at least two thirds of the lung field, and pulmonary hemorrhage were all closely related to death (P<0.01). The death cases and cured cases had significantly different peripheral white blood cell counts, blood lactic acid, and blood glucose (24 ± 11× 10⁹/L vs 12 ± 5×10⁹/L; 6.6 ± 1.8 mmol/L vs 3.6 ± 1.7 mmol/L; 16.4 ± 2.5 mmol/L vs 10.0 ± 3.0 mmol/L). The cases with critical illness score <90 had a significantly higher death risk (P<0.01). CONCLUSIONS Children with critical HFMD are mainly under 3 years old. The children face extremely high risk of death when they suffer from poor peripheral circulation above the elbow or knee joint, pulmonary edema involving at least two thirds of the lung field, and pulmonary hemorrhage. Significant increases in peripheral white blood cell counts, blood lactic acid, and blood glucose are risk factors for poor prognosis. Critical illness score is also related to poor prognosis.
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Affiliation(s)
- Rui-Hai Liu
- Intensive Care Units, Qingdao Hospital for Women and Children, Qingdao, Shandong 266034, China.
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Duan G, Yang H, Shi L, Sun W, Sui M, Zhang R, Wang X, Wang F, Zhang W, Xi Y, Fan Q. Serum inflammatory cytokine levels correlate with hand-foot-mouth disease severity: a nested serial case-control study. PLoS One 2014; 9:e112676. [PMID: 25391156 PMCID: PMC4229228 DOI: 10.1371/journal.pone.0112676] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 10/10/2014] [Indexed: 11/18/2022] Open
Abstract
Background Hand-food-mouth disease (HFMD) cases can be fatal. These cases develop rapidly, and it is important to predict the severity of HFMD from mild to fatal and to identify risk factors for mild HFMD. The objective of this study was to correlate the levels of serum inflammatory cytokines with HFMD severity. Methods This study was designed as a nested serial case-control study. The data collected included general information, clinical symptoms and signs, laboratory findings and serum cytokine levels. Results The levels of IL-4, IL-6, IL-10, TNF-α and IFN-γ in patients with severe HFMD were significantly higher than in mild patients during the 2nd to 5th day after disease onset. The levels of IL-4, IL-6, IL-10 and IFN-γ increased from the 2nd day to the 4th day and later decreased. The levels of TNF-α were high on the first two days and subsequently decreased. The changes of IL-10, TNF-α and IFN-γ in the controls were similar for all cases. The levels of IL-4, IL-6 and IL-17 in the controls were not significantly different with the progression of HFMD. Conclusions Our findings indicate that the IL-4, IL-6, IL-10, TNF-α and IFN-γ levels correlate with HFMD severity.
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Affiliation(s)
- Guangcai Duan
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
- Henan Innovation Center of Molecular Diagnosis and Laboratory Medicine, Xinxiang Medical University, Xinxiang, Henan, China
- * E-mail:
| | - Haiyan Yang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Lubin Shi
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
- Henan Center for Disease Control and Prevention, Zhengzhou, Henan, China
| | - Wumei Sun
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Meili Sui
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Rongguang Zhang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Xinhong Wang
- Children's Hospital of Zhengzhou City, Zhengzhou, Henan, China
| | - Fang Wang
- Children's Hospital of Zhengzhou City, Zhengzhou, Henan, China
| | - Weidong Zhang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Yuanlin Xi
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Qingtang Fan
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
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Song CL, Cheng YB, Chen D, Gu X, Li HB, Yan XQ. [Risk factors for death in children with severe hand, foot and mouth disease]. Zhongguo Dang Dai Er Ke Za Zhi 2014; 16:1033-1036. [PMID: 25344186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To study the death risk factors in children with severe hand, foot and mouth disease (HFMD). METHODS A total of 164 children with severe HFMD between May 2010 and September 2012 were recruited and classified into death and survival groups according to their prognosis. The differences in general information, clinical signs and symptoms and laboratory examinations were compared between the two groups. The multivariate logistic regression analysis was used to identify death risk factors in children with severe HFMD. RESULTS There were significant differences in the incidences of atypical rash, persistent fever, dyspnea, pulmonary hemorrhage, heart rate increase, blood pressure abnormalities, cold sweat, capillary refill time>3 seconds and frequent seizures, and blood glucose, serum creatine kinase and serum lactate levels between the death and the survival groups (P<0.05). The multivariate logistic regression analysis showed three independent death risk factors for children with severe HFMD: pulmonary hemorrhage (OR=9.466, 95%CI: 1.786-21.256), abnormal blood pressure (OR=5.224, 95%CI: 1.012-28.985) and elevated serum lactate level (OR=2.154, 95%CI: 1.020-8.253). CONCLUSIONS Pulmonary hemorrhage, abnormal blood pressure and elevated serum lactate are major death risk factors for children with severe HFMD.
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Affiliation(s)
- Chun-Lan Song
- Department of Intensive Care Unit II, Zhengzhou Children′s Hospital, Zhengzhou 450003, China.
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Zhang H, An D, Liu W, Mao Q, Jin J, Xu L, Sun S, Jiang L, Li X, Shao J, Ma H, Huang X, Guo S, Chen H, Cheng T, Yang L, Su W, Kong W, Liang Z, Jiang C. Analysis of cross-reactive neutralizing antibodies in human HFMD serum with an EV71 pseudovirus-based assay. PLoS One 2014; 9:e100545. [PMID: 24964084 PMCID: PMC4070950 DOI: 10.1371/journal.pone.0100545] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 05/28/2014] [Indexed: 01/11/2023] Open
Abstract
Hand, foot and mouth disease, associated with enterovirus 71 (EV71) infections, has recently become an important public health issue throughout the world. Serum neutralizing antibodies are major indicators of EV71 infection and protective immunity. However, the potential for cross-reactivity of neutralizing antibodies for different EV71 genotypes and subgenotypes is unclear. Here we measured the cross-reactive neutralizing antibody titers against EV71 of different genotypes or subgenotypes in sera collected from EV71-infected children and vaccine-inoculated children in a phase III clinical trial (ClinicalTrials.gov Identifier: NCT01636245) using a new pseudovirus-based neutralization assay. Antibodies induced by EV71-C4a were cross-reactive for different EV71 genotypes, demonstrating that C4a is a good candidate strain for an EV71 vaccine. Our study also demonstrated that this new assay is practical for analyses of clinical samples from epidemiological and vaccine studies.
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Affiliation(s)
- Huafei Zhang
- School of Life Sciences, Jilin University, Changchun, P. R. China
- National Engineering Laboratory for AIDS Vaccine, Jilin University, Changchun, P. R. China
| | - Dong An
- School of Life Sciences, Jilin University, Changchun, P. R. China
- National Engineering Laboratory for AIDS Vaccine, Jilin University, Changchun, P. R. China
| | - Wei Liu
- School of Life Sciences, Jilin University, Changchun, P. R. China
- National Engineering Laboratory for AIDS Vaccine, Jilin University, Changchun, P. R. China
| | - Qunying Mao
- National Institutes for Food and Drug Control, Beijing, P. R. China
| | - Jun Jin
- School of Life Sciences, Jilin University, Changchun, P. R. China
- National Engineering Laboratory for AIDS Vaccine, Jilin University, Changchun, P. R. China
| | - Lin Xu
- School of Life Sciences, Jilin University, Changchun, P. R. China
- National Engineering Laboratory for AIDS Vaccine, Jilin University, Changchun, P. R. China
| | - Shiyang Sun
- School of Life Sciences, Jilin University, Changchun, P. R. China
- National Engineering Laboratory for AIDS Vaccine, Jilin University, Changchun, P. R. China
| | - Liping Jiang
- School of Life Sciences, Jilin University, Changchun, P. R. China
- National Engineering Laboratory for AIDS Vaccine, Jilin University, Changchun, P. R. China
| | - Xiaojun Li
- School of Life Sciences, Jilin University, Changchun, P. R. China
- National Engineering Laboratory for AIDS Vaccine, Jilin University, Changchun, P. R. China
| | - Jie Shao
- National Institutes for Food and Drug Control, Beijing, P. R. China
| | - Hongxia Ma
- Henan Provincial Center for Disease Control and Prevention, Zhengzhou, P. R. China
| | - Xueyong Huang
- Henan Provincial Center for Disease Control and Prevention, Zhengzhou, P. R. China
| | - Shijie Guo
- Department of Pediatrics, the First Hospital of Jilin University, Changchun, P. R. China
| | - Haiying Chen
- Department of Pediatrics, the First Hospital of Jilin University, Changchun, P. R. China
| | - Tong Cheng
- National Institute of Diagnostics and Vaccine Development in Infectious Disease, School of Life Science, Xiamen University, Xiamen, P. R. China
| | - Lisheng Yang
- National Institute of Diagnostics and Vaccine Development in Infectious Disease, School of Life Science, Xiamen University, Xiamen, P. R. China
| | - Weiheng Su
- School of Life Sciences, Jilin University, Changchun, P. R. China
- National Engineering Laboratory for AIDS Vaccine, Jilin University, Changchun, P. R. China
- Key Laboratory for Molecular Enzymology & Engineering, Ministry of Education, Jilin University, Changchun, P. R. China
| | - Wei Kong
- School of Life Sciences, Jilin University, Changchun, P. R. China
- National Engineering Laboratory for AIDS Vaccine, Jilin University, Changchun, P. R. China
- Key Laboratory for Molecular Enzymology & Engineering, Ministry of Education, Jilin University, Changchun, P. R. China
| | - Zhenglun Liang
- National Institutes for Food and Drug Control, Beijing, P. R. China
- * E-mail: (ZL); (CJ)
| | - Chunlai Jiang
- School of Life Sciences, Jilin University, Changchun, P. R. China
- National Engineering Laboratory for AIDS Vaccine, Jilin University, Changchun, P. R. China
- Key Laboratory for Molecular Enzymology & Engineering, Ministry of Education, Jilin University, Changchun, P. R. China
- * E-mail: (ZL); (CJ)
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Li W, Teng G, Tong H, Jiao Y, Zhang T, Chen H, Wu H. Study on risk factors for severe hand, foot and mouth disease in China. PLoS One 2014; 9:e87603. [PMID: 24489943 PMCID: PMC3906182 DOI: 10.1371/journal.pone.0087603] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 12/23/2013] [Indexed: 11/26/2022] Open
Abstract
Background Epidemics of HFMD are elevated every year globally, especially in mainland China. The disease now presents as an increasing threat to public health worldwide. Methods Five hundred and seventy-one EV71-infected HFMD patients in Beijing You'an Hospital were grouped by disease severity: Mild (no severe complication) (n = 221), and Severe group (complicated with brainstem encephalitis (BE), and/or pulmonary edema (PE) (n = 350)). Clinical and laboratory findings and levels of 7 serum cytokines were analyzed. Results Univariate analysis showed that (RR)>26/min (p<0.001), age<4 yo (p = 0.001), GLU>8.3 mmol/L (p = 0.008), CL<98 mmol/L (p = 0.026), and WBC>1.2×109/L (p = 0.040) were associated with severe cases. Results of multivariate analysis indicated five independent risk factors (RR>26/min (p<0.001), Age<4 yo (p<0.001), GLU>8.3 mmol/L (p = 0.011), LYM>40% (p = 0.010), and ALT>40 U/L (p = 0.045)). In addition to single-factor analysis, we further analyzed the use of different combinations of risk factors. “GLU>8.3 and CL<98 and RR>26” (confidence ration (CR) = 100%) is the top indicator, followed by “ALT>40 and LYM>40% and RR>26 and Age<4 yo” (CR = 92.9%). Serum levels of IL-2, IL-4, IL-10, IFNγ, GM-CSF, and TNFα were higher in severe cases than in mild cases. A new evaluation scoring system by scoring each risk factor 1 and independent risk factor 2 was developed for early identification of severe HFMD cases. Conclusions Five independent risk factors, along with indicative combinations of risk factors, for severe cases were identified, and a scoring system was created to facilitate the use of indicators for early medical intervention.
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Affiliation(s)
- Wei Li
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Guangju Teng
- Department of Non-Infectious Liver Disorders, 302 Military Hospital of China, Beijing, China
| | - Hongfei Tong
- Department of General Surgery, Second Affiliated Hospital of Wenzhou Medical College, Wenzhou, Zhejiang, China
| | - Yanmei Jiao
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Tong Zhang
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Hui Chen
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- * E-mail: (HW); (HC)
| | - Hao Wu
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
- * E-mail: (HW); (HC)
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Li W, Yi L, Su J, Lu J, Ke C, Zeng H, Guan D, Ma C, Zhang W, Xiao H, Li H, Lin J, Zhang Y. Seroprevalence of human enterovirus 71 and coxsackievirus A16 in Guangdong, China, in pre- and post-2010 HFMD epidemic period. PLoS One 2013; 8:e80515. [PMID: 24324604 PMCID: PMC3850913 DOI: 10.1371/journal.pone.0080515] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 10/04/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Human Enterovirus 71 and Coxsackie A16 have caused many outbreaks in the last decade in mainland China, resulting in thousands of fatal cases. Seroepidemiology which provides important information to document population immunity is rare in China. METHODOLOGY/PRINCIPAL FINDINGS A cross sectional study of Enterovirus 71 (EV71) and Coxsackie A16 (CA16) seroprevalence was carried out in Guangdong, China, pre- and post- the 2010 hand, foot and mouth disease (HFMD) epidemic period. The levels of EV71 and CA16 specific antibodies were evaluated by a microneutralization test and the geometric mean titer (GMT) was calculated and compared. Our results indicated frequent infection by EV71 and CA16 in Guangdong before the 2010 epidemic. Only EV71 neutralizing antibody but not CA16 seroprevalence was significantly increased after the 2010 HFMD epidemic. Children less than 3 years old especially those aged 2 years showed the lowest positive rates for EV71 and CA16 NA before epidemic and the most significantly increased EV71 seroprevalence after epidemic. CA16 GMT values declined after the 2010 epidemic. CONCLUSIONS These results indicate EV71 was the major pathogen of HFMD in Guangdong during the 2010 epidemic. The infection occurs largely in children less than 3 years, who should have first priority to receive an EV71 vaccine.
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Affiliation(s)
- Wei Li
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
| | - Lina Yi
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Juan Su
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
| | - Jing Lu
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Changwen Ke
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
| | - Hanri Zeng
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
| | - Dawei Guan
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
| | - Cong Ma
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
| | - Wanly Zhang
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
| | - Hong Xiao
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
| | - Hui Li
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
| | - Jinyan Lin
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
| | - Yonghui Zhang
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
- * E-mail:
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24
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Zhang SL, Song CF. [Dynamic changes in plasma D-dimer level and its prognostic value in children with severe hand-foot- mouth disease]. Zhongguo Dang Dai Er Ke Za Zhi 2013; 15:1119-1122. [PMID: 24342212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To study the dynamic changes in plasma D-dimer and its prognostic value in children with severe hand-foot-mouth disease (HFMD). METHODS A total of 95 children who suffered from HFMD between May 2010 and September 2012, including 65 cases of severe HFMD (observation group) and 30 cases of non-severe HFMD (control group), were enrolled in the study. Plasma D-dimer levels of the observation group on days 1, 2, 3, 4 and 5 were compared with plasma D-dimer levels of the control group on day 1 after admission. In the observation group, plasma D-dimer levels on days 1, 2, 3, 4 and 5 were compared. The prognostic value of plasma D-dimer was analyzed using the receiver operating characteristic (ROC) curve. RESULTS Of the 65 cases in the observation group, 15 died, and 50 survived. All the 30 cases in the control group survived. Plasma D-dimer levels in the observation group on days 1, 2, 3, 4 and 5 were significantly higher than in the control group on day 1 after admission (P<0.05). In the observation group, there were significant differences between plasma D-dimer levels on days 1, 2, 3, 4 and 5 (P<0.01), and plasma D-dimer level was the highest on day 1 after admission and second highest on the next day. Of the patients in the observation group, those who died had significantly higher plasma D-dimer levels on day 1 after admission than those who survived (P<0.05). In the observation group, plasma D-dimer levels on day 1 after onset had an area under the ROC curve of 0.877 (95% confidence interval: 0.785-0.969) and an optimal cut-off value of 582.10 μg/L (80% sensitivity and 78% specificity) for predicting mortality. CONCLUSIONS Children with severe HFMD have significantly increased plasma D-dimer levels, and the severer the condition, the higher the value. Plasma D-dimer levels can be used as one of the important indices for assessing the severity and prognosis of severe HFMD.
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Affiliation(s)
- Shui-Lu Zhang
- Department of Pediatrics, People's Hospital of Lincheng County, Lincheng, Hebei 054300, China.
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Premanand B, Prabakaran M, Kiener TK, Kwang J. Recombinant baculovirus associated with bilosomes as an oral vaccine candidate against HEV71 infection in mice. PLoS One 2013; 8:e55536. [PMID: 23390538 PMCID: PMC3563597 DOI: 10.1371/journal.pone.0055536] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 12/29/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Human enterovirus 71 (HEV71) is one of the major pathogen responsible for hand, foot and mouth disease (HFMD). Currently no effective vaccine or antiviral drugs are available. Like poliovirus, EV71 is transmitted mainly by the feco-oral route. To date the majority of the studied EV71 vaccine candidates are administered parenterally. Injectable vaccines induce good systemic immunity but mucosal responses are often unsatisfactory, whereas mucosal vaccines provide both systemic and mucosal immunity. Therefore, oral immunization appears to be an attractive alternative to parenteral immunization. METHODOLOGY/PRINCIPAL FINDINGS In this report, we studied the efficacy of an orally administered vaccine candidate developed using recombinant baculovirus displaying VP1 (Bac-VP1) in a murine model. Gastrointestinal delivery of Bac-VP1 significantly induced VP1-specific humoral (IgG) and mucosal (IgA) immune responses. Further, we studied the efficacy of the Bac-VP1 associated with bilosomes and observed that the Bac-VP1 associated with bilosomes elicited significantly higher immune responses compared to bilosomes non-associated with Bac-VP1. However, mice immunized subcutaneously with live Bac-VP1 had significantly enhanced VP1 specific serum IgG levels and higher neutralizing antibody titers compared with mice orally immunized with live Bac-VP1 alone or associated with bilosomes. CONCLUSION Bilosomes have been shown to possess inherent adjuvant properties when associated with antigen. Therefore Bac-VP1 with bilosomes could be a promising oral vaccine candidate against EV71 infections. Thus, Bac-VP1 loaded bilosomes may provide a needle free, painless approach for immunization against EV71, thereby increasing patient compliance and consequently increasing vaccination coverage.
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MESH Headings
- Administration, Oral
- Animals
- Antibodies, Viral/blood
- Antibodies, Viral/immunology
- Baculoviridae/genetics
- Baculoviridae/immunology
- Enterovirus A, Human/drug effects
- Enterovirus A, Human/immunology
- Female
- Hand, Foot and Mouth Disease/blood
- Hand, Foot and Mouth Disease/immunology
- Hand, Foot and Mouth Disease/prevention & control
- Humans
- Immunity, Humoral/drug effects
- Immunity, Mucosal/drug effects
- Immunization
- Liposomes/administration & dosage
- Liposomes/chemistry
- Liposomes/immunology
- Mice
- Mice, Inbred BALB C
- Vaccines, Synthetic
- Viral Structural Proteins/genetics
- Viral Structural Proteins/immunology
- Viral Vaccines/administration & dosage
- Viral Vaccines/genetics
- Viral Vaccines/immunology
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Affiliation(s)
- Balraj Premanand
- Animal Health Biotechnology, Temasek Life Sciences Laboratory, National University of Singapore, Singapore, Singapore
| | - Mookkan Prabakaran
- Animal Health Biotechnology, Temasek Life Sciences Laboratory, National University of Singapore, Singapore, Singapore
| | - Tanja K. Kiener
- Animal Health Biotechnology, Temasek Life Sciences Laboratory, National University of Singapore, Singapore, Singapore
| | - Jimmy Kwang
- Animal Health Biotechnology, Temasek Life Sciences Laboratory, National University of Singapore, Singapore, Singapore
- Department of Microbiology, Faculty of Medicine, National University of Singapore, Singapore, Singapore
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Feng BF, Zhu KR. [Serum levels of ferritin and neuron-specific enolase in children with hand-foot-mouth disease complicated by acute viral encephalitis]. Zhongguo Dang Dai Er Ke Za Zhi 2012; 14:515-517. [PMID: 22809604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To study serum ferritin and neuron-specific enolase (NSE) levels in children with hand-foot-mouth disease (HFMD) complicated by acute viral encephalitis and their clinical significance. METHODS Serum levels of ferritin and NSE were measured using ELISA and electrochemical luminescence in 20 children with HFMD complicated by viral encephalitis (encephalitis group), 20 children with HFMD only (simple HFMD group) and 20 healthy children (control group). RESULTS Serum levels of ferritin in the encephalitis group (212 ± 71 μg/L) were significantly higher than in the simple HFMD group (85 ± 18 μg/L) and control group (70 ± 15 μg/L) (P<0.01). Serum levels of NSE in the encephalitis group (8.6 ± 2.6 μg/L) were also significantly higher than in the simple HFMD group (6.0 ± 1.3 μg/L) and control group (5.6 ± 1.8 μg/L) (P<0.01). Significantly decreased serum ferritin (126 ± 37 μg/L) and NSE levels (6.8 ± 1.9 μg/L) were found in the encephalitis group (P<0.01) after treatment. CONCLUSIONS Serum levels of ferritin and NSE in children with HFMD complicated by acute viral encephalitis increase, suggesting that serum ferritin and NSE measurement is useful in the early diagnosis of HFMD complicated by acute viral encephalitis.
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Affiliation(s)
- Bing-Feng Feng
- Departments of Pediatrics, Maternity and Child Care Centers of Linyi, Linyi, Shandong 276001, China.
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Li Y, Zhu R, Qian Y, Deng J. The characteristics of blood glucose and WBC counts in peripheral blood of cases of hand foot and mouth disease in China: a systematic review. PLoS One 2012; 7:e29003. [PMID: 22235257 PMCID: PMC3250408 DOI: 10.1371/journal.pone.0029003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2011] [Accepted: 11/18/2011] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Outbreaks of Hand Foot and Mouth Disease (HFMD) have occurred in many parts of the world especially in China. We aimed to summarize the characteristics of the levels of blood glucose and white blood cell (WBC) counts in cases of HFMD in Mainland China and Taiwan, using meta-analysis based on systematic review of published articles. METHODS We systematically reviewed published studies, from the MEDLINE and WANFANG Data, about the levels of blood glucose and WBC counts in cases of HFMD until 15(th) June 2011, and quantitatively summarized the characteristics of them using meta-analysis. RESULTS In total, 37 studies were included in this review. In Mainland China and Taiwan, generally, the average level of blood glucose, the prevalence of hyperglycemia, WBC counts and the prevalence of leukocytosis increased with the severity of the illness. There was no significant difference in the prevalence of leukocytosis between ANS (autonomic nervous system dysregulation)/PE (pulmonary edema) group and CNS (central nervous system) group, and in the average level of blood glucose between healthy controls and mild cases of HFMD. WBC counts in cases infected by EV71 were less than those in cases infected by CA16. CONCLUSIONS our analyses indicated that blood glucose and WBC counts increased with the severity of HFMD disease, which would help doctors to manage patients efficiently.
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Affiliation(s)
- Yuyun Li
- Laboratory of Virology, Capital Institute of Pediatrics, Beijing, China
| | - Runan Zhu
- Laboratory of Virology, Capital Institute of Pediatrics, Beijing, China
| | - Yuan Qian
- Laboratory of Virology, Capital Institute of Pediatrics, Beijing, China
- * E-mail:
| | - Jie Deng
- Laboratory of Virology, Capital Institute of Pediatrics, Beijing, China
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Zhao ZX, Lu JH, Mei ZQ, Pan SY, Chen D, Liu YZ, Xia WY, Dai EH. [The level of peripheral circular DNA in patients with hand foot and mouth disease]. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi 2011; 25:483-485. [PMID: 22734243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To determine the circular DNA level of patients with hand foot and mouth disease (HFMD) and evaluate its potential clinical value. METHODS Venous blood in 30 healthy children and 78 patients with HFMD within 3 days of onset of illness and convalescent period was collected. The level of plasma circular DNA was detected by duplex real-time polymerase chain reaction assay. Blood sugar, high-sensitive CRP(hs-CRP) and leucocyte were also detected. RESULTS The level of circular DNA in control group was (6.57 +/- 4.67) ng/ml. The level of circular DNA in ordinary and severe HFMD patients was (11.51 +/- 7.75) ng/ml and (20.59 +/- 10.67) ng/ml before treatment, respectively. The levels of circular DNA in ordinary and severe HFMD patients were significantly higher than that in control group (P = 0.021; 0.000); the level of circular DNA in severe HFMD patients was significantly higher than that in ordinary HFMD patients (P = 0.011). The level of circular DNA in severe HFMD patients after treatment were significantly lower than that before treatment (P = 0.033). The level of circular DNA before treatment and after treatment in ordinary HFMD patients had no significant difference. The levels of blood sugar and hs-CRP in severe HFMD patients were higher than those in ordinary before treatment (P = 0.045; 0.011). The levels of blood sugar and hs-CRP before treatment and after treatment in ordinary HFMD patients had no significant change. There was significantly positive correlation between the level of circular DNA and that of hs-CRP in HFMD patient (P = 0.021), but there was no correlation between the level of circular DNA and that of blood sugar and leucocyte. CONCLUSIONS The level of circular DNA not only become an early identification marker of severe HFMD patients, but also become monitoring marker of effect of treatment.
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Affiliation(s)
- Zhao-Xia Zhao
- Department of Laboratory Medicine, Fifth Hospital of Shijiazhuang, Shijiazhuang 050021, China
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Fu J, Cui XD, Sun CR, Wang TY. [A pathogen analysis within 174 cases of hand-foot-mouth disease in the summer of 2009]. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi 2011; 25:377-380. [PMID: 22338230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To analyze the pathogen and characteristics of the serum types of enterovirus of hand-foot-and-mouth disease (HFMD) in the summer, 2009. METHODS Both throat swab and herpes fluids were taken respectively from 174 children with HFMD in the outpatient infection during April to September, 2009. Anti-Cox A16 and anti-EV71 IgMs in the serum were detected with ELISA. And RNA were extracted from each sample followed with real-time fluorescence quantitative RT-PCR kits with three reagents: universal enterovirus primer, Coxsackievirus A16 (CA16) primer and enterovirus 71 (EV71) primer. Parts of positive samples were sequenced and analyzed. RESULTS (1) EV genes were detected from 167 cases, of which ,112 cases were positive for CA16 and 46 were positive for EV71. CA16: EV71 was 2.43: 1. (2) There were 51 cases with CA16 IgM positive and 25 cases with EV71 IgM positive in the early collected sera, and in the later samples, 98 cases with CA16 IgM positive and 32 cases with EV71 IgM positive. (3)The nucleotide homologies were 88.7%-98.5% of VP1 gene among CA16. The nucleotide homologies were 94.9% - 99.7% of VP1 gene among EV71, and were 92.1% - 95.3% with C4 subtype. CONCLUSION The mainly pathogen causing HFMD in children in the summer, 2009 were CA16 and EV71. EV71 infection, mainly C4 subtype, was highly elevated according to the earlier reported. Real-time RT-PCR is more appropriate than the serological test.
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Affiliation(s)
- Jin Fu
- Capital Institute of Pediatrics, Beijing 100020, China
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Liu YX, Xie JJ, He YX, Liu WL, Zhang MX, Le XH, Fu D, Chen XC, Yang GL, Cao DZ, Zhang HM, Xu LM, Zhu XY, Tan Y, Yang QT, Zhou BP. [Study of the clinical and laboratory features of hand-foot-mouth disease]. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi 2008; 22:475-477. [PMID: 19544650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To study the clinical and laboratory features of the mild and severe hand-foot-mouth diseases (HFMD) in Shenzhen in 2008. METHODS 145 cases were observed in East-Lake Hospital and Shenzhen Children's Hospital. Of the 145 cases, 124 mild cases and 21 severe cases were involved.All the clinical data and laboratory findings were collected and summarized. After collection of the acute and convalescent consecutive stools and peripheral bloods from the patients with HFMDI, EV71 genes were amplified from these samples by RT-PCR. Enterovirus 71 were cultured and isolated using Vero cell line and R&D cell line. RESULTS The WBC counts and blood glucose levels of the severe cases were significantly elevated, but the ages of the severe ones significantly decreased compared with those of the mild cases (P < 0.05). EV71 genes could be detected by RT-PCR with 35% positive rate in mild cases and 67% in severe cases. The EV71 gene detection rate of the severe cases was significantly increased in contrast to that of the mild ones. The EV71 were isolated and cultured from the stools of 9 patients, one specimens from the dead's stool. Two severe cases died of neurogenic pulmonary edema and brain-stem encephalitis. CONCLUSIONS EV71 mainly contributes to HFMD and is responsible for death of some severe cases. High fever, less rash, elevated white blood cell counts and blood glucose concentrations as well as age less than 4 years old should be used for prediction of severe cases.
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Affiliation(s)
- Ying-xia Liu
- Shenzhen East-Lake Hospital, Children's Hospital, Shenzhen 518020, China
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Wang CL, Wu YT, Liu CA, Lin MW, Lee CJ, Huang LT, Yang KD. Expression of CD40 ligand on CD4+ T-cells and platelets correlated to the coronary artery lesion and disease progress in Kawasaki disease. Pediatrics 2003; 111:E140-7. [PMID: 12563087 DOI: 10.1542/peds.111.2.e140] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Kawasaki disease (KD) is an acute febrile vasculitic syndrome in children. CD40 ligand (CD40L) has been implicated in certain types of vasculitis. We proposed that CD40L expression might be correlated with coronary artery lesions in KD. METHODS Blood samples were collected from 43 patients with KD before intravenous immunoglobulin (IVIG) treatment and 3 days afterward. Forty-three age-matched febrile children with various diseases were studied in parallel as controls. CD40L expression on T-cells and platelets were detected by flow cytometry, and soluble CD40L (sCD40L) levels were measured by enzyme-linked immunosorbent assay. RESULTS We found that CD40L expression on CD4(+) T-cells was significantly higher in patients with KD than in the febrile control (FC) group (28.69 +/- 1.17% vs 4.37 +/- 0.36%). CD40L expression decreased significantly 3 days after IVIG administration (28.69 +/- 1.17% vs 13.53 +/- 0.55%). CD40L expression on platelets from patients with KD was also significantly higher than in the FC group (8.20 +/- 0.41% vs 1.26 +/- 0.12%) and decreased after IVIG therapy. sCD40L levels were also significantly higher in KD patients with those of FC (9.69 +/- 0.45 ng/mL vs 2.25 +/- 0.19 ng/mL) but were not affected by IVIG treatment 3 days afterward (9.69 +/- 0.45 ng/mL vs 9.03 +/- 0.32 ng/mL). More interesting, we found that in KD patients, CD40L expression on CD4(+) T-cells and platelets but not on CD8(+) T-cells or sCD40L was correlated with the occurrence of coronary artery lesions. CONCLUSIONS CD40L might play a role in the immunopathogenesis of KD. IVIG therapy might downregulate CD40L expression, resulting in decrease of CD40L-mediated vascular damage in KD. This implicates that modulation of CD40L expression may benefit to treat KD vasculitis.
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Affiliation(s)
- Chih-Lu Wang
- Division of Allergy and Immunology, Chang-Gung Children's Hospital at Kaohsiung, Chang-Gung University, Niau-Sung, Kaohsiung, Taiwan
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McMinn P, Stratov I, Nagarajan L, Davis S. Neurological manifestations of enterovirus 71 infection in children during an outbreak of hand, foot, and mouth disease in Western Australia. Clin Infect Dis 2001; 32:236-42. [PMID: 11170913 DOI: 10.1086/318454] [Citation(s) in RCA: 331] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2000] [Revised: 06/12/2000] [Indexed: 12/17/2022] Open
Abstract
Enterovirus 71 (EV71) causes epidemics of hand, foot, and mouth disease associated with neurological complications in young children. We report an outbreak of EV71-associated neurological disease that occurred from February through September 1999 in Perth, Western Australia. Fourteen children with culture-proven, EV71-induced neurological disease were identified. Nine patients (64%) developed severe neurological disease; 4 of these patients developed long-term neurological sequelae. Neurological syndromes included aseptic meningitis, Guillain-Barré syndrome, acute transverse myelitis, acute cerebellar ataxia, opso-myoclonus syndrome, benign intracranial hypertension, and a febrile convulsion. Clinical and magnetic resonance imaging data indicated that immunopathology was a major factor in the pathogenesis of neurological disease in this outbreak. This finding is in contrast to reports of previous EV71 epidemics, in which virus-induced damage to gray matter was the most frequent cause of neurological disease.
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Affiliation(s)
- P McMinn
- Department of Microbiology, Princess Margaret Hospital for Children, Perth, WA, Australia.
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