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 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, dyspnea 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 edema, respiratory failure and neurogenic shock
- pulmonary hemorrhage, 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