Risk Factors for Severe Enteroviral Infections in Children
Somchai Owatanapanich MD*, Rochana Wutthanarungsan MD, MPH*,
Wipaporn Jaksupa MSc*, Usa Thisyakorn MD**
Affiliation :
* King Narai Hospital, Lopburi, Thailand
** Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Objective : To study the risk factors associated with severe enterovirus infection among hospitalized pediatric patients with
hand, foot, and mouth disease (HFMD) at King Narai Hospital, Lopburi, Thailand.
Material and Method: We reviewed all of the suspected enterovirus infection cases aged less than 15 years admitted to
King Narai Hospital between 2011 and 2013. Cases were classified into mild and severe enterovirus infection. Risk factors
for severe enterovirus infection were analyzed using univariate and multivariate logistic regressions.
Results : During the study period, 156 patients met the case definition for further analysis. Of those 156 patients, 131 (84.0%)
were classified as mild cases, and 25 (16.0%) as severe cases with five (3.2%) deaths. The most common manifestations
among the severe cases were seizures, pneumonia, meningoencephalitis, meningitis, and hyperglycemia. Of the 31 identifiable
cases, 12 were caused by enterovirus 71 (EV71), 12 by coxsackievirus A16 (CA16), four by both, and three by other enterovirus.
The clinical manifestations that were significantly related to severe enterovirus infection in univariate analysis were age of
less than one year, highest body temperature greater than 39.0°C, duration of fever greater than three days, absence of skin
lesions, diarrhea, dyspnea, and hyperglycemia. The clinical manifestations that were significantly related to severe enterovirus
infection by both univariate and multivariate analyses were absence of oral lesions, seizures, and drowsiness/lethargy.
Conclusion : The major pathogens of severe disease were EV71 and CA16. High-risk factors significantly related to severe
enterovirus infection in both univariate and multivariate analyses were absence of oral lesions, seizures, and drowsiness/
lethargy. Early recognition of children at risk and prompt treatment is important to mitigate the deterioration of patients
with enterovirus infection.
Keywords : Enterovirus infection, Severe
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