Objective To understand the trend of severe non-polio enteroviruses beyond neonatal period.

Methods Clinical manifestations of patients aged between 1 month to 18 years with culture-confirmed non-polio enteroviral infections were analyzed in a tertiary teaching hospital between January 2004 and March 2008.

Results There were 3,223 laboratory-confirmed enteroviruses during this period. A total of 26 patients were diagnosed severe non-polio enterovirus-associated diseases. Nine were female, and 17 were male. The median age was 3.6±2.4 years. The average days from onset to deterioration were 3.4 days (range 1–10 days). Among the 18 patients with encephalitis, most of them had myoclonic jerk (14/18), and most of the encephalitic patients with myoclonic jerk were EV 71-infected (13/14). Interestingly, less than half (12/26) had oral ulcers, and/or skin rashes, thus making earlier diagnosis difficult. Nineteen patients had EV 71 isolated either from throat or rectal swabs. Non-EV 71 isolates were 3 coxB3, 2 non-typable, 1 coxA16, and 1 echo 6 viruses. IVIG had been used in 12 patients, 2 of them receiving both IVIG and ECMO were expired (both had myocarditis), and the last fatality was with EV 71-associated encephalitis and pulmonary hemorrhage. Pulmonary edema/hemorrhage appeared to be strongly associated with EV 71 infections. Other patients remained alive and recovered except one patient who was ventilator-dependent.

Conclusions EV 71-associated encephalitis and pulmonary edema/hemorrhage are fatal diseases among children in Taiwan. Even in the absence of typical oral ulcers or skin rashes, pediatricians should be alert about myoclonic jerk and other neurological signs.