Mirand A, Peigue-Lafeuille H
CHU Clermont-Ferrand, laboratoire de virologie, Centre national de référence des entérovirus et des parechovirus, laboratoire associé, 63003 Clermont-Ferrand cedex, France; Université Clermont-Auvergne, LMGE UMR CNRS 6023, équipe EPIE, épidémiologie et physiopathologie des infections à entérovirus, 63000 Clermont-Ferrand, France.
CHU Clermont-Ferrand, laboratoire de virologie, Centre national de référence des entérovirus et des parechovirus, laboratoire associé, 63003 Clermont-Ferrand cedex, France; Université Clermont-Auvergne, LMGE UMR CNRS 6023, équipe EPIE, épidémiologie et physiopathologie des infections à entérovirus, 63000 Clermont-Ferrand, France.
Arch Pediatr. 2017 Oct;24(10):1036-1046. doi: 10.1016/j.arcped.2017.08.001.
Hand, foot and mouth disease (HFMD) and herpangina (HA) are common childhood diseases mostly associated with human enteroviruses (EV). Although usually benign illnesses, neurological complications may be observed during large epidemics when enterovirus A71 (EV-A71) is involved, as observed in the Asia Pacific Region and in China since the late 1990s. The occurrence of these complications warrants reinforcing the surveillance of the emergence of EV-A71 infections in France and Europe. Monitoring EV infections associated with HFMD can be considered as an effective tool to detect an upsurge of EV-A71 infections in a timely manner. In 2014, a national sentinel surveillance system for HFMD/HA was set up in France through a network of volunteer pediatricians and coordinated by the National Reference Center for Enteroviruses and Parechoviruses. Although classical manifestations of HFMD/HA can be easily recognized, there are several atypical presentations of the disease that can be confused with other skin conditions. Delayed cutaneous manifestations, such as onychomadesis and acral desquamation, may also occur and should prompt consideration of HFMD in the preceding weeks. Severe complications following HFMD include neurological manifestations (mainly rhombencephalitis) or less frequently cardiopulmonary failure and can sometimes be fatal. In China, the case severity rate has been estimated at 1%, with a case fatality rate at 0.03%. EV-A71 was involved in more than 90% of the fatal cases. Diagnosis of EV infections associated with severe neurological manifestations is based on the molecular detection of the EV genome in vesicles, cerebrospinal fluid (CSF), throat and stool given that EV-A71 is rarely recovered from the CSF. Positive EV genome detection should be followed by EV genotyping to identify the type of the EV. In temperate-climate countries, outbreaks of HFMD occur mostly but not exclusively during summer and autumn months. Adults may also present with HFMD. In 2016, an upsurge of severe neurological manifestations was reported in France; EV-A71 accounted for 50% of the cases. No specific treatment is available, but two inactivated EV-A71 vaccines are currently available in China.
手足口病（HFMD）和疱疹性咽峡炎（HA）是常见的儿童疾病，大多与人类肠道病毒（EV）有关。虽然通常为良性疾病，但在大规模流行期间，当涉及肠道病毒A71（EV-A71）时，可能会出现神经系统并发症，自20世纪90年代末以来在亚太地区和中国都有观察到这种情况。这些并发症的出现促使法国和欧洲加强对EV-A71感染出现情况的监测。监测与手足口病相关的肠道病毒感染可被视为及时发现EV-A71感染激增的有效工具。2014年，法国通过志愿儿科医生网络建立了一个全国性的手足口病/疱疹性咽峡炎哨点监测系统，并由肠道病毒和帕里病毒国家参考中心协调。虽然手足口病/疱疹性咽峡炎的典型表现很容易识别，但该疾病有几种非典型表现可能会与其他皮肤疾病混淆。延迟性皮肤表现，如甲脱落和肢端脱皮，也可能发生，在前几周应考虑到手足口病。手足口病后的严重并发症包括神经系统表现（主要是脑干脑炎），或较少见的心肺衰竭，有时可能致命。在中国，病例严重率估计为1%，病死率为0.03%。超过90%的死亡病例与EV-A71有关。鉴于很少能从脑脊液中分离出EV-A71，与严重神经系统表现相关的肠道病毒感染的诊断基于在水疱、脑脊液（CSF）、咽喉和粪便中对肠道病毒基因组的分子检测。肠道病毒基因组检测呈阳性后，应进行肠道病毒基因分型以确定肠道病毒的类型。在温带气候国家，手足口病疫情大多（但并非全部）发生在夏季和秋季。成人也可能患手足口病。2016年，法国报告了严重神经系统表现的激增；EV-A71占病例的50%。目前尚无特效治疗方法，但中国目前有两种灭活EV-A71疫苗。
