案例
一名 5 岁男孩因不适及轻度发热 3 天前来就诊。患儿诉过去 24 小时口腔疼痛,手脚均产生水疱。发病前健康状况良好,无其他症状。其他家人健康状况良好。体格检查发现,患者体温 37.6°C(99.6°F),口腔多处小溃疡,双手手掌存在基底部发红的小椭圆形水疱。
其他表现
疾病还可表现为仅有口腔病变,或不伴发热。其他症状可包括腹痛和腹泻、上呼吸道症状(例如咽喉痛和咳嗽)、头痛、食欲不振、关节痛和易激惹。
在东亚和东南亚地区,例如中国台湾和马来西亚,肠病毒 71 (EV71) 引发了更严重的疾病导致了并发症,包括无菌性脑膜炎、脑炎、脑脊髓炎、肺水肿、肺出血、心肌炎和类脊髓灰质炎综合征。一些病例出现死亡(一次暴发期间的病死率为 8%)。[4]Chang LY, King CC, Hsu KH, et al. Risk factors of enterovirus 71 infection and associated hand, foot, and mouth disease/herpangina in children during an epidemic in Taiwan. Pediatrics. 2002;109:e88.http://pediatrics.aappublications.org/cgi/content/full/109/6/e88http://www.ncbi.nlm.nih.gov/pubmed/12042582?tool=bestpractice.com[5]Ishimaru Y, Nakano S, Yamaoka K, et al. Outbreaks of hand, foot, and mouth disease by enterovirus 71. High incidence of complication disorders of central nervous system. Arch Dis Child. 1980;55:583-588.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1627055/pdf/archdisch00778-0009.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/6254449?tool=bestpractice.com[9]Chang LY, Tsao KC, Hsia SH, et al. Transmission and clinical features of enterovirus 71 infections in household contacts in Taiwan. JAMA. 2004;291:222-227.http://jama.ama-assn.org/cgi/content/full/291/2/222http://www.ncbi.nlm.nih.gov/pubmed/14722149?tool=bestpractice.com[10]Chang LY, Huang LM, Gau SS, et al. Neurodevelopment and cognition in children after enterovirus 71 infection. N Engl J Med. 2007;356:1226-1234.http://www.nejm.org/doi/full/10.1056/NEJMoa065954#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/17377160?tool=bestpractice.com[11]Chang LY, Lin TY, Huang YC, et al. Comparison of enterovirus 71 and coxsackie-virus A16 clinical illnesses during the Taiwan enterovirus epidemic, 1998. Pediatr Infect Dis J. 1999;18:1092-1096.http://www.ncbi.nlm.nih.gov/pubmed/10608631?tool=bestpractice.com[12]Lee TC, Guo HR, Su HJ, et al. Diseases caused by enterovirus 71 infection. Pediatr Infect Dis J. 2009;28:904-910.http://www.ncbi.nlm.nih.gov/pubmed/20118685?tool=bestpractice.com 虽然患者会出现以上并发症的症状,但 EV71 感染在美国和欧洲并不常见。