Overview
Enterovirus 71 (EV71) infection primarily affects infants and young children, causing a spectrum of illnesses from mild hand-foot-and-mouth disease to severe neurological and respiratory complications, including encephalitis and cardiopulmonary failure 12.Diagnosis
Clinical presentation includes fever, rash, mouth ulcers, and neurological symptoms like myoclonus and ataxia 2.
Diagnostic confirmation through PCR testing of throat swabs, cerebrospinal fluid (CSF), or rectal swabs 2.
Imaging studies, particularly MRI, may show brainstem and spinal cord involvement in severe cases 2.Management
First-line treatments: Supportive care including respiratory support, fluid management, and antipyretics 12.
Adjunctive treatments: Extracorporeal life support (ECLS) for refractory cardiopulmonary failure 1.
Specific interventions: No specific antiviral therapy is mentioned; focus on managing complications like respiratory failure and neurological sequelae 12.Special Populations
Pediatrics: EV71 predominantly affects young children, with severe cases requiring prolonged respiratory and neurological support 12.
Neurological sequelae: Children often experience long-term effects such as dysphagia, central hypoventilation, limb weakness, and seizures, necessitating extended follow-up and rehabilitation 12.Key Recommendations
Initiate extracorporeal life support (ECLS) early for children with refractory cardiopulmonary failure due to EV71 infection (Evidence: Moderate 1).
Consider prolonged neurological follow-up for pediatric patients surviving severe EV71 infection due to potential long-term sequelae (Evidence: Moderate 12).
Utilize MRI to assess brainstem and spinal cord involvement in severe cases to guide management and predict need for tracheostomy or gastrostomy (Evidence: Moderate 2).References
1 Jan SL, Lin SJ, Fu YC, Chi CS, Wang CC, Wei HJ et al.. Extracorporeal life support for treatment of children with enterovirus 71 infection-related cardiopulmonary failure. Intensive care medicine 2010. link
2 Tsou YA, Cheng YK, Chung HK, Yeh YC, Lin CD, Tsai MH et al.. Upper aerodigestive tract sequelae in severe enterovirus 71 infection: predictors and outcome. International journal of pediatric otorhinolaryngology 2008. link