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Clinical Stages of Lin et al for Infection with Enterovirus 71

Description

Enterovirus 71 can cause a spectrum of infection in children, ranging from mild to life-threatening conditions. Lin et al recognized a series of stages that patients progressed through during an epidemic outbreak. Early recognitions of patients with potentially serious infections can result in hospitalization and appropriate clinical interventions.


Stage

Clinical Features

1

hand-foot-mouth disease (HFMD) or herpangina

2

encephalomyelitis, with drowsiness, limb weakness, seizures and/or flaccid paralysis

3

cardiopulmonary failure

3A

with hypertension, pulmonary edema and respiratory failure; patients may show cold sweating, hypoglycemia, myoclonic jerks.

3B

with hypotension, improved respiratory function but with deterioration in neurologic and cardiovascular condition, with coma and/or shock

4

convalescence, with almost complete recovery of cardiopulmonary function

 

where:

• Stage 0 could be used to identify subclinical cases with seroconversion or virus isolation.

• In Stage 3 patients may vacillate between hypertension and hypotension.

 

Most symptomatic patients have Stage 1 disease and recover without residua in about 1 week. A small subset progresses to Stage 2 disease, with a smaller subset progressing to Stage 3 disease.

 

Criteria for hospitalization - any sign of CNS involvement:

(1) vomiting

(2) limb weakness or paralysis

(3) drowsiness

(4) myoclonic jerks or seizures

 

Criteria for admission to the ICU:

(1) tachypnea or apnea

(2) hypertension or hypotension

(3) increased intracranial pressure

(4) hyperglycemia

 


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