Carl Gustav Carus Faculty of Medicine, Institute for Medical Microbiology and Virology, TU Dresden, Dresden, Germany.
Carl Gustav Carus Faculty of Medicine, Department of Paediatric Neurology, TU Dresden, Dresden, Germany.
J Med Case Rep. 2023 Jul 19;17(1):310. doi: 10.1186/s13256-023-04041-6.
Enterovirus A71 is one of the causative agents of hand, foot, and mouth disease, which is usually a self-limiting disease. Complications of enterovirus infection are also very rare. However, when such complications occur, they can lead to serious neurological diseases or even death.
In this report, we describe a case of enterovirus A71-associated acute flaccid paralysis in a 13-month-old Caucasian girl that was managed in our hospital. The patient presented with sudden onset of left arm paresis that could not be attributed to any other cause. Establishing a diagnosis was furthermore complicated by negative virological investigations of cerebrospinal fluid and non-pathological radiological findings. A polymerase chain reaction test of the child's stool sample however tested positive for enterovirus and sequencing results revealed the presence of enterovirus A71. A previous history of febrile gastroenteritis just before the paresis started also supported the suspected diagnosis of enterovirus-associated acute flaccid paralysis. Following this, the child was treated with intravenous immunoglobulin over 5 days and a remarkable improvement was observed in the child's paresis.
This case report describes a possible complication of enterovirus A71 infection in a child. It also highlights the prolonged detection of enterovirus in the child's stool sample as compared with cerebrospinal fluid weeks after the primary infection occurred. Finally, it shows the need for increased clinical and diagnostic awareness especially in the management of sudden and unknown causes of paresis or paralysis in children.
肠道病毒 A71 是手足口病的病原体之一，通常为自限性疾病。肠道病毒感染的并发症也非常罕见。然而，当发生此类并发症时，可导致严重的神经系统疾病甚至死亡。
本报告描述了 1 例在我院治疗的 13 月龄白人女孩肠道病毒 A71 相关急性弛缓性麻痹病例。患儿以左侧手臂无力起病，无法归因于其他原因。脑脊液病毒学检测阴性且影像学未见明显异常，进一步明确诊断存在困难。患儿粪便的聚合酶链反应检测结果为肠道病毒阳性，测序结果显示存在肠道病毒 A71。起病前有发热性胃肠炎病史，也支持肠道病毒相关急性弛缓性麻痹的疑似诊断。随后，患儿接受了 5 天的静脉注射免疫球蛋白治疗，麻痹症状明显改善。
本病例报告描述了儿童肠道病毒 A71 感染的一种可能并发症。此外，还重点强调了与初次感染后数周相比，肠道病毒在患儿粪便样本中的持续检出时间较脑脊液长。最后，该病例提示需要提高临床和诊断意识，尤其是在管理儿童突发和不明原因的麻痹或瘫痪时。
