J Korean Med Sci.  2013 Jan;28(1):120-127. 10.3346/jkms.2013.28.1.120.

Risk Factors for Neurologic Complications of Hand, Foot and Mouth Disease in the Republic of Korea, 2009

• Kim SJ
• Kim JH
• Kang JH
• Kim DS
• Kim KH
• Kim KH
• Kim YH
• Chung JY
• Bin JH
• Jung DE
• Kim JH
• Kim HM
• Cheon DS
• Kang BH
• Seo SY
• The Enteroviruses Complications Working Group

• KMID: 2158011
• DOI: http://doi.org/10.3346/jkms.2013.28.1.120

Abstract

In 2009, the first outbreak of hand, foot and mouth disease (HFMD) or herpangina (HP) caused by enterovirus 71 occurred in the Republic of Korea. This study inquired into risk factors associated with complications of HFMD or HP. A retrospective medical records review was conducted on HFMD or HP patients for whom etiologic viruses had been verified in 2009. One hundred sixty-eight patients were examined for this investigation. Eighty patients were without complications while 88 were accompanied by complications, and 2 had expired. Enterovirus 71 subgenotype C4a was the most prevalent in number with 67 cases (54.9%). In the univariate analysis, the disease patterns of HFMD rather than HP, fever longer than 4 days, peak body temperature over 39degrees C, vomiting, headache, neurologic signs, serum glucose over 100 mg/dL, and having an enterovirus 71 as a causative virus were significant risk factors of the complications. After multiple logistic analysis, headache (Odds ratio [OR], 10.75; P < 0.001) and neurologic signs (OR, 42.76; P < 0.001) were found to be the most significant factors. Early detection and proper management of patients with aforementioned risk factors would be necessary in order to attain a better clinical outcome.

Keyword

Coxsackievirus; Hand, Foot and Mouth Disease; Herpangina; Enterovirus A, Human; Risk Factors

MeSH Terms

Adolescent
Adult
Blood Glucose/analysis
Body Temperature
Enterovirus A, Human/genetics/isolation & purification
Female
Fever/etiology
Genotype
Hand, Foot and Mouth Disease/*complications/virology
Headache/etiology
Herpangina/*complications/virology
Humans
Logistic Models
Male
Middle Aged
Odds Ratio
Republic of Korea
Retrospective Studies
Risk Factors
Vomiting/etiology
Young Adult
Blood Glucose

Figure

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  Fig. 1 The flow chart shows how we selected the study population in this study. EV, enterovirus; HFMD, hand, foot and mouth disease; HP, herpangina; KCDC, Korea Centers for Disease Control and Prevention.

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  Fig. 2 Number of hand, foot and mouth disease or herpangina in the Republic of Korea in 2009, by age group. mo, months; yr, years.

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  Fig. 3 Distribution of hand, foot and mouth disease or herpangina in the Republic of Korea in 2009, by date. The arrows indicate the dates of onset of the two fatal cases.

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  Fig. 4 Origins and numbers (percentage) of enterovirus positive samples on RT-PCR in the Republic of Korea in 2009. CSF, cerebrospinal fluid.

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