Xing Jingjun, Wang Ke, Wei Hua, Wei Dengming
Zhejiang Key Laboratory of Pathophysiology, Department of Pathology and Pathogen Biology, Medical School of Ningbo University.
The Affiliated Hospital of Medical School of Ningbo University, Ningbo, Zhejiang Province, China.
Medicine (Baltimore). 2018 Nov;97(48):e13447. doi: 10.1097/MD.0000000000013447.
Enterovirus 71 (EV71) is identified as the primary cause of hand, foot, and mouth disease (HFMD) and mainly infects the young infants. Though some fatal cases have been reported, the underlying mechanisms of EV71 infection remain elusive and more further pathologic and molecular studies of EV71 infection are needed.
A 26-month-old girl with a history of fever and lethargy for 3 days and intermittent seizures for 2 hours associated with rash on 4 limbs was brought to a hospital.
The autopsy was performed to identify the cause of death for a medical dispute. The results of histologic examination, immunohistochemistry (IHC), nested reverse transcription polymerase chain reaction (RT-PCR), and viral isolation confirmed that this patient died of EV71 infection.
The patient was transferred to neonatal intensive care unit and was intubated and mechanically ventilated. The other treatment included cardiopulmonary resuscitation and intravenous injection of adrenaline.
The patient presented persistent coma and intermittent seizures and suddenly developed respiratory arrest and died 16 hours after admission.
Our results suggest that EV71 might invade into the central nervous system (CNS) through peripheral nerves which control the digestive tract in the early stage of infection. In addition, we successfully isolated one EV71 strain. Phylogenetic analysis showed that the isolated strain clustered in the C4a of C4 subgenotype. This case also highlights that rapid deterioration in HFMD cases is still a challenge to physicians and they must pay special attention to the infants with HFMD symptoms, particularly in EV71 epidemic areas for early diagnosis and treatment.
肠道病毒71型（EV71）被确定为手足口病（HFMD）的主要病因，主要感染幼儿。尽管已有一些致命病例报道，但EV71感染的潜在机制仍不清楚，需要对EV71感染进行更多的病理学和分子研究。
一名26个月大的女童，有3天发热、嗜睡病史，伴有四肢皮疹2小时间歇性惊厥，被送至医院。
为医疗纠纷进行尸检以确定死因。组织学检查、免疫组化（IHC）、巢式逆转录聚合酶链反应（RT-PCR）和病毒分离结果证实该患者死于EV71感染。
患者被转至新生儿重症监护病房，进行气管插管和机械通气。其他治疗包括心肺复苏和静脉注射肾上腺素。
患者持续昏迷、间歇性惊厥，入院16小时后突然呼吸骤停死亡。
我们的结果表明，EV71可能在感染早期通过控制消化道的外周神经侵入中枢神经系统（CNS）。此外，我们成功分离出一株EV71毒株。系统发育分析表明，分离株聚集在C4亚型的C4a中。该病例还凸显出手足口病病例的快速恶化对医生来说仍是一项挑战，他们必须特别关注有手足口病症状的婴儿，尤其是在EV71流行地区，以便早期诊断和治疗。
