Infection with enterovirus 71 predominantly results in a vesicular rash of the hands and feet that follows a prodrome of symptoms including fever, vomiting and oral mucosal ulceration.
In most cases, the initial infection wanes and symptoms and signs resolve. However in rare cases, it may be followed a by severe neurological infection resulting in aseptic meningitis, brainstem encephalitis and even acute flaccid paralysis akin to paralytic poliomyelitis.
Stages of disease
Shen et al. 2 described 5 symptomatic stages:
- fever, anorexia, erythema and skin manifestations;
- resolution within a week for most patients
- fever, restlessness, vomiting, headache and abdominal pain;
- most patients recover, some progress to grade 3 (those less than 2 years old may progress directly to grade 4)
- akin to grade 2 symptoms but with tachycardia and brainstem symptoms like cranial nerve palsy (6, 7, 9 - 12), auditory hallucinations, ocular disturbance, dyspnoea and ataxia;
- improvement in 3 - 4 days with recovery in 1 - 2 weeks (aside from those less than 2 years who tended to progress to grade 4)
- hypothermia, pulmonary oedema, respiratory failure and neurogenic shock
- pulmonary haemorrhage, respiratory distress syndrome, circulatory collapse and death
- 1. Huang CC, Liu CC, Chang YC et-al. Neurologic complications in children with enterovirus 71 infection. N. Engl. J. Med. 1999;341 (13): 936-42. doi:10.1056/NEJM199909233411302 - Pubmed citation
- 2. Shen WC, Chiu HH, Chow KC et-al. MR imaging findings of enteroviral encephaloymelitis: an outbreak in Taiwan. AJNR Am J Neuroradiol. 1999;20 (10): 1889-95. AJNR Am J Neuroradiol (full text) - Pubmed citation
- 3. Hayward JC, Gillespie SM, Kaplan KM et-al. Outbreak of poliomyelitis-like paralysis associated with enterovirus 71. Pediatr. Infect. Dis. J. 1989;8 (9): 611-6. Pubmed citation
- 4. Li L, He Y, Yang H et-al. Genetic characteristics of human enterovirus 71 and coxsackievirus A16 circulating from 1999 to 2004 in Shenzhen, People's Republic of China. J. Clin. Microbiol. 2005;43 (8): 3835-9. doi:10.1128/JCM.43.8.3835-3839.2005 - Free text at pubmed - Pubmed citation