Huang Y-F, Chiu P-C, Chen C-C, Chen Y-Y, Hsieh K-S, Liu Y-C, Lai P-H, Chang H-W
Department of Pediatrics, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung, Taiwan.
J Infect. 2003 May;46(4):238-43. doi: 10.1053/jinf.2002.1117.
A major outbreak of enterovirus 71 (EV71) in Taiwan in 1998 caused many severe cases and 78 deaths. Our purpose was to find reliable markers and early indicators of fatal EV71 central nervous system (CNS) infection.
From June 2000 to November 2001, 21 patients with hand foot mouth disease or herpangina with CNS infection were admitted to Kaohsiung Veterans General Hospital. All 21 had culture-confirmed EV71 infection or were EV71 IgM positive. Patients were divided into two groups: group I included the five fatalities at our institution and group II, the 16 surviving patients.
Of the 21 infants and children with EV71 infection with CNS involvement, MR imaging studies were completed on 17, and 15 showed hyperintensity in the posterior portions of brain stem. All patients received intravenous immunoglobulin (IVIG) 1 g/day for two days and supportive care. Five patients rapidly deteriorated owing to irreversible hypotension and died. The other 16 patients recovered completely without sequel. In group I patients, the decrease of cardiac ejection function is significant and laboratory findings showed lower platelet count (P=0.0192). The mean of initial cTnI level for groups I and II was 10.6+/-11.6 and 0.48+/-0.55 ng/dl, respectively, higher in group I than in II (P=0.0019).
We hypothesized that like patients with severe burns, those with severe EV-71 CNS meningoencephalitis have varying degrees of non-ischemic cardiac injury, manifesting as leakage of cTnI from myocytes into the circulation. EV-71 CNS meningoencephalitis likely to die with an early myocardial involvement evidenced by reduced ejection fraction and release of cTnI. We conclude that fatal EV71 CNS infection quickly leads to death due to severe encephalopathy associated with cardiomyopathy.
1998年台湾地区发生肠道病毒71型（EV71）大爆发，导致许多严重病例和78人死亡。我们的目的是寻找致命性EV71中枢神经系统（CNS）感染的可靠标志物和早期指标。
2000年6月至2001年11月，21例患有手足口病或疱疹性咽峡炎并伴有CNS感染的患者入住高雄荣民总医院。所有21例患者均经培养确诊为EV71感染或EV71 IgM阳性。患者分为两组：第一组包括在本院死亡的5例患者，第二组为16例存活患者。
在21例患有EV71感染并累及CNS的婴幼儿中，17例完成了磁共振成像检查，其中15例显示脑干后部高信号。所有患者均接受静脉注射免疫球蛋白（IVIG）1 g/天，共2天，并给予支持治疗。5例患者因不可逆性低血压迅速恶化并死亡。其他16例患者完全康复，无后遗症。在第一组患者中，心脏射血功能下降显著，实验室检查结果显示血小板计数较低（P = 0.0192）。第一组和第二组的初始肌钙蛋白I（cTnI）水平平均值分别为10.6±11.6和0.48±0.55 ng/dl，第一组高于第二组（P = 0.0019）。
我们推测，与严重烧伤患者一样，患有严重EV - 71 CNS脑膜脑炎的患者存在不同程度的非缺血性心脏损伤，表现为cTnI从心肌细胞渗漏到循环中。伴有早期心肌受累的EV - 71 CNS脑膜脑炎患者可能死亡，表现为射血分数降低和cTnI释放。我们得出结论，致命性EV71 CNS感染由于与心肌病相关的严重脑病而迅速导致死亡。
