Elsevier

The Journal of Pediatrics

Volume 133, Issue 6, December 1998, Pages 795-798
The Journal of Pediatrics

Fatal enterovirus 71 encephalomyelitis,☆☆,

https://doi.org/10.1016/S0022-3476(98)70155-6Get rights and content

Abstract

During an outbreak of hand-foot-mouth disease caused by enterovirus 71 (EV-71) in 1997, 4 children presented with sudden cardiopulmonary collapse and minimal neurologic features. All children received cardiopulmonary resuscitation but died within a few hours of admission. Postmortem studies showed infection by EV-71 with extensive damage to the medulla and pons. We postulate an etiologic link between EV-71 and brainstem encephalomyelitis as the cause of pulmonary edema and death. (J Pediatr 1998;133:795-8)

Section snippets

ANTECEDENT ILLNESS

Four children, 3 male and 1 female between 15 months to 4 years old, were admitted to University Hospital Kuala Lumpur between July and October, 1997. Three children were seen at the emergency department in a state of pulmonary and cardiovascular instability. The history was fever of 3 to 5 days’ duration. Cases 1 and 3 had cough with sore throat. Case 3 had red spots on the hands and feet, and case 4 had oral ulcers. Case 4 had flaccid paralysis with hyporeflexia of the lower limbs. In the

RESULTS

All 4 cases showed similar pathologic findings. The main pathologic complications were in the brainstem and spinal cord, where severe and widespread inflammation was noted in the grey matter. Inflammatory changes consisted of perivascular cuffing by mononuclear cells predominantly and neutrophils occasionally. Clusters of neurons showed degeneration and necrosis with neuronophagia. Microglial nodules were prominent (Fig 2).

. Medulla: perivascular inflammation (thick arrow ) and microglial nodule (

DISCUSSION

The epidemic of HFMD in Peninsular Malaysia affected thousands of young children (Ministry of Health, Malaysia). Serious neurologic disease, the hallmark of EV-71 infections, was seen in 8 other fatal cases in other hospitals in Peninsular Malaysia. These cases, however, were investigated suboptimally. In our cases, although specific neurologic signs were present in only 1 case, all 4 cases showed severe involvement of the spinal cord and brainstem. A strong etiologic link between EV-71 and the

Acknowledgements

We thank the Virology Laboratory, Department of Pathology, Singapore General Hospital for its technical assistance.

References (19)

  • J Blomberg et al.

    New enterovirus type associated with epidemic of aseptic meningitis and/or hand, foot, and mouth disease [letter]

    Lancet

    (1974)
  • NJ Schmidt et al.

    An apparently new enterovirus isolated from patients with disease of the central nervous system

    J Infect Dis

    (1974)
  • R Deibel et al.

    Isolation of a new enterovirus

    Proc Soc Exp Biol Med

    (1975)
  • JC Hayward et al.

    Outbreak of poliomyelitis-like paralysis associated with enterovirus 71

    Pediatr Infect Dis J

    (1989)
  • ML Kennett et al.

    Enterovirus type 71 infection in Melbourne

    Bull WHO

    (1974)
  • M Chumakov et al.

    Enterovirus 71 isolated from cases of epidemic poliomyelitis-like disease in Bulgaria

    Arch Virol

    (1979)
  • JL Melnick et al.

    Identification of Bulgarian strain 258 of enterovirus 71

    Intervirology

    (1979)
  • G Nagy et al.

    Virological diagnosis of enterovirus type 71 infections: experiences gained during an epidemic of acute CNS diseases in Hungary in 1978

    Arch Virol

    (1982)
  • A Hagiwara et al.

    Epidemic of hand, foot and mouth disease associated with enterovirus 71 infection

    Intervirology

    (1978)
There are more references available in the full text version of this article.

Cited by (292)

  • Picornaviridae: Enterovirus

    2022, Encyclopedia of Infection and Immunity
  • Current status of hand-foot-and-mouth disease

    2023, Journal of Biomedical Science
View all citing articles on Scopus

From the Department of Pediatrics, the Department of Pathology, the Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

☆☆

Reprint requests: Lucy Chai-See Lum, MBBS, MRCP, Department of Pediatrics, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.

0022-3476/98/$5.00 + 0  9/22/94196

View full text