Article Text

  1. W C Li1,3,4,
  2. S R Shih2,3,
  3. S C Chang2,3,
  4. Y C Huang1,3,5,
  5. T Y Lin1,3,5
  1. 1Department of Pediatric Infectious Diseases, Chang Gung Children’s Hospital, Taoyuan, Taiwan, R.O.C
  2. 2Department of Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan, R.O.C
  3. 3Research Center for Emerging Viral Infections, Chang Gung University, Taoyuan, Taiwan, R.O.C
  4. 4Graduate Institue of Clinical Medical Sciences, Chang Gung University, Yaoyuan, Taiwan, R.O.C
  5. 5School of Medicine, College of Medicine, Chang Gung University, Yaoyuan, Taiwan, R.O.C


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.

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