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Comparison of clinical features between coxsackievirus A2 and enterovirus 71 during the enterovirus outbreak in Taiwan, 2008: a children's hospital experience.
J Microbiol Immunol Infect. 2010 Apr; 43(2):99-104.JM

Abstract

BACKGROUND/PURPOSE

Coxsackievirus A2 (Cox A2) was the predominant serotype in the enterovirus outbreak in Taiwan, 2008. However, detailed clinical features of Cox A2 infection have not been reported. In this study, we compared Cox A2 with enterovirus 71 (EV71) in terms of clinical manifestation and epidemiology during the 2008 enterovirus outbreak in Taiwan.

METHODS

A total of 280 hospitalized patients (97 with culture-proven EV71 infection and 183 with culture-proven Cox A2 infection) in 2008 at the Chang Gung Children's Medical Center were enrolled in this study. Epidemiologic data, clinical manifestations, and outcomes for these patients were collected and compared.

RESULTS

Both Cox A2 and EV71 serotypes peaked in June and declined soon afterwards. Seventy-one percent of the patients were younger than 3 years of age. Both groups had the same male-to-female ratio of 1.6:1. Patients with EV71 infection had a significantly longer hospitalization period (4.1 vs. 3.0 days, p< 0.001). Fever, fever for more than 3 days with a temperature above 39 degrees C, lethargy, poor activity, poor appetite and a myoclonic jerk were significantly associated with EV71 infection. Fever, or fever with a temperature above 39 degrees C, febrile seizure, elevated white cell counts, and elevated serum C-reactive protein concentrations were significantly associated with Cox A2 infection. Most patients with EV71 infection presented with hand-foot-mouth disease (78.3%), while most Cox A2-infected patients presented with herpangina (83.6%). Central nervous system complications were found in 18.6% of EV71-infected children, but only in 1.1% of Cox A2-infected children. All the patients with Cox A2 infection showed total recovery. One patient with EV71 infection died from encephalitis with cardiopulmonary failure, and 6.2% of EV71-infected children had neurologic sequelae.

CONCLUSION

Both Cox A2 and EV71 serotypes accounted for the enterovirus outbreak in Taiwanese children in 2008. Compared with those infected by EV71, the children with Cox A2 infection mostly presented with herpangina, had fewer central nervous system complications, and had better overall outcome.

Authors+Show Affiliations

Division of Infectious Diseases, Department of Pediatrics, Chang Gung Children's Medical Center, Taoyuan, Taiwan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20457425

Citation

Chen, Shih-Perng, et al. "Comparison of Clinical Features Between Coxsackievirus A2 and Enterovirus 71 During the Enterovirus Outbreak in Taiwan, 2008: a Children's Hospital Experience." Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi, vol. 43, no. 2, 2010, pp. 99-104.
Chen SP, Huang YC, Li WC, et al. Comparison of clinical features between coxsackievirus A2 and enterovirus 71 during the enterovirus outbreak in Taiwan, 2008: a children's hospital experience. J Microbiol Immunol Infect. 2010;43(2):99-104.
Chen, S. P., Huang, Y. C., Li, W. C., Chiu, C. H., Huang, C. G., Tsao, K. C., & Lin, T. Y. (2010). Comparison of clinical features between coxsackievirus A2 and enterovirus 71 during the enterovirus outbreak in Taiwan, 2008: a children's hospital experience. Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi, 43(2), 99-104. https://doi.org/10.1016/S1684-1182(10)60016-3
Chen SP, et al. Comparison of Clinical Features Between Coxsackievirus A2 and Enterovirus 71 During the Enterovirus Outbreak in Taiwan, 2008: a Children's Hospital Experience. J Microbiol Immunol Infect. 2010;43(2):99-104. PubMed PMID: 20457425.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of clinical features between coxsackievirus A2 and enterovirus 71 during the enterovirus outbreak in Taiwan, 2008: a children's hospital experience. AU - Chen,Shih-Perng, AU - Huang,Yhu-Chering, AU - Li,Wen-Chen, AU - Chiu,Cheng-Hsun, AU - Huang,Chung-Guei, AU - Tsao,Kuo-Chien, AU - Lin,Tzou-Yien, PY - 2009/04/28/received PY - 2009/06/01/revised PY - 2009/06/15/accepted PY - 2010/5/12/entrez PY - 2010/5/12/pubmed PY - 2010/9/16/medline SP - 99 EP - 104 JF - Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi JO - J Microbiol Immunol Infect VL - 43 IS - 2 N2 - BACKGROUND/PURPOSE: Coxsackievirus A2 (Cox A2) was the predominant serotype in the enterovirus outbreak in Taiwan, 2008. However, detailed clinical features of Cox A2 infection have not been reported. In this study, we compared Cox A2 with enterovirus 71 (EV71) in terms of clinical manifestation and epidemiology during the 2008 enterovirus outbreak in Taiwan. METHODS: A total of 280 hospitalized patients (97 with culture-proven EV71 infection and 183 with culture-proven Cox A2 infection) in 2008 at the Chang Gung Children's Medical Center were enrolled in this study. Epidemiologic data, clinical manifestations, and outcomes for these patients were collected and compared. RESULTS: Both Cox A2 and EV71 serotypes peaked in June and declined soon afterwards. Seventy-one percent of the patients were younger than 3 years of age. Both groups had the same male-to-female ratio of 1.6:1. Patients with EV71 infection had a significantly longer hospitalization period (4.1 vs. 3.0 days, p< 0.001). Fever, fever for more than 3 days with a temperature above 39 degrees C, lethargy, poor activity, poor appetite and a myoclonic jerk were significantly associated with EV71 infection. Fever, or fever with a temperature above 39 degrees C, febrile seizure, elevated white cell counts, and elevated serum C-reactive protein concentrations were significantly associated with Cox A2 infection. Most patients with EV71 infection presented with hand-foot-mouth disease (78.3%), while most Cox A2-infected patients presented with herpangina (83.6%). Central nervous system complications were found in 18.6% of EV71-infected children, but only in 1.1% of Cox A2-infected children. All the patients with Cox A2 infection showed total recovery. One patient with EV71 infection died from encephalitis with cardiopulmonary failure, and 6.2% of EV71-infected children had neurologic sequelae. CONCLUSION: Both Cox A2 and EV71 serotypes accounted for the enterovirus outbreak in Taiwanese children in 2008. Compared with those infected by EV71, the children with Cox A2 infection mostly presented with herpangina, had fewer central nervous system complications, and had better overall outcome. SN - 1995-9133 UR - https://www.unboundmedicine.com/medline/citation/20457425/Comparison_of_clinical_features_between_coxsackievirus_A2_and_enterovirus_71_during_the_enterovirus_outbreak_in_Taiwan_2008:_a_children's_hospital_experience_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1684-1182(10)60016-3 DB - PRIME DP - Unbound Medicine ER -