Abstract
Introduction: The Hand-Foot-Mouth Disease (HFMD) is caused by the members of the genus Enterovirus of the P icornaviridae family; predominantly coxsackievirus A16 (CVA16) and enterovirus 71 (EV71). It is often observed among young children under five years of age, typically benign and self-limiting. However, HFMD caused by EV71 is often more severe than CVA16 in which severe complications may occur including encephalitis, myocarditis, neurogenic pulmonary edema and death. The EV71-related infection is considered endemic in South-East Asian in which a cyclical pattern of outbreaks was often observed every 2 to 3 years. In 2018, nearly 38,000 HFMD cases were recorded in Malaysia in between January to July with three reported deaths. Until 28 May, 65,535 HFMD cases were reported throughout the year 2022. We reported a sporadic case of EV71 HFMD complicated with meningoencephalitis and myocarditis in Kelantan, Malaysia.
Case Presentation: In April 2022, a previously healthy four-year-old Malay girl, residing in Pasir Puteh, Kelantan, presented with fever associated with mouth ulcer, vesicular lesions over palm and soles along with tachycardia, followed by alteration of consciousness, vomiting and seizure. The throat swab specimen was negative but EV71 was detected from the rectal swab by PCR test. She was diagnosed with severe HFMD complicated with myocarditis and brainstem meningoencephalitis with anterior spinal cord syndrome, requiring prolonged mechanical ventilation in the Pediatric Intensive Care Unit (PICU). The source of infection for this case was unclear. However, she had history of visiting public places particularly hypermarket and shops during incubation. Shortly after, another five cases of EV71 were identified in the state with no clear epidemiological link found between the cases; suggesting the spreading of EV71 infection in the communities, making control a challenge. Only two of these cases were associated with outbreaks at different nurseries and four of them were from Pasir Puteh district. At the time of diagnosis, the estimated incidence of HFMD in Kelantan for 2022 was 122/100,000 in general population; highest among children aged four-year-old and below (545.4/100,000). The increment of cases could be attributed to increasing non-immune population during the COVID-19 pandemic, among other factors. In response, investigation and contact tracing were conducted early within 48 hours by the district health offices. Other public health interventions involving multiple agencies carried out including dissemination of HFMD alert to healthcare facilities, and widespread health education activities among communities, educational institution and business premises. The enteroviral surveillance was also intensified among sporadic cases in hospital and selected clinics. Due to limited resources, risk stratification were used to facilitate the preventive measures. Conclusion: Although the vast majority of HFMD cases were self-limiting, EV71 infection could be life threatening. In the absence of effective vaccine or antiviral for EV71, early case detection and health educations to prevent secondary spread appear to be the most effective public health measure to limit the transmission. Public health surveillance and preventive measures for HFMD needs to be continued and strengthen to prevent the occurrence of such complications associated with EV71 infection.
Links
- https://apcph.cphm.my/wp-content/uploads/2022/07/APCPH2022-P-9.pdf
- https://apcph.cphm.my/wp-content/uploads/wpforms/1176-1e04940bb5d885bf8711ed1909[...]
BibTeX (Download)
@proceedings{APCPH2022-P-9a,
title = {A Severe Case of Enterovirus 71 Hand-Foot-Mouth Disease With Prolonged Stay in The Intensive Care Unit: A Case Report in Kelantan},
author = {Nik Mohd Hafiz Mohd Fuzi and Hazlienor Mohd Hatta and Zawiyah Dollah},
url = {https://apcph.cphm.my/wp-content/uploads/2022/07/APCPH2022-P-9.pdf
https://apcph.cphm.my/wp-content/uploads/wpforms/1176-1e04940bb5d885bf8711ed19095a89ed/APCPH2022-P-9-Poster-print-081605c605be6475c488362f4cf648e1.pdf},
year = {2022},
date = {2022-08-02},
urldate = {2022-08-02},
issue = {7},
abstract = {Introduction: The Hand-Foot-Mouth Disease (HFMD) is caused by the members of the genus Enterovirus of the P icornaviridae family; predominantly coxsackievirus A16 (CVA16) and enterovirus 71 (EV71). It is often observed among young children under five years of age, typically benign and self-limiting. However, HFMD caused by EV71 is often more severe than CVA16 in which severe complications may occur including encephalitis, myocarditis, neurogenic pulmonary edema and death. The EV71-related infection is considered endemic in South-East Asian in which a cyclical pattern of outbreaks was often observed every 2 to 3 years. In 2018, nearly 38,000 HFMD cases were recorded in Malaysia in between January to July with three reported deaths. Until 28 May, 65,535 HFMD cases were reported throughout the year 2022. We reported a sporadic case of EV71 HFMD complicated with meningoencephalitis and myocarditis in Kelantan, Malaysia.
Case Presentation: In April 2022, a previously healthy four-year-old Malay girl, residing in Pasir Puteh, Kelantan, presented with fever associated with mouth ulcer, vesicular lesions over palm and soles along with tachycardia, followed by alteration of consciousness, vomiting and seizure. The throat swab specimen was negative but EV71 was detected from the rectal swab by PCR test. She was diagnosed with severe HFMD complicated with myocarditis and brainstem meningoencephalitis with anterior spinal cord syndrome, requiring prolonged mechanical ventilation in the Pediatric Intensive Care Unit (PICU). The source of infection for this case was unclear. However, she had history of visiting public places particularly hypermarket and shops during incubation. Shortly after, another five cases of EV71 were identified in the state with no clear epidemiological link found between the cases; suggesting the spreading of EV71 infection in the communities, making control a challenge. Only two of these cases were associated with outbreaks at different nurseries and four of them were from Pasir Puteh district. At the time of diagnosis, the estimated incidence of HFMD in Kelantan for 2022 was 122/100,000 in general population; highest among children aged four-year-old and below (545.4/100,000). The increment of cases could be attributed to increasing non-immune population during the COVID-19 pandemic, among other factors. In response, investigation and contact tracing were conducted early within 48 hours by the district health offices. Other public health interventions involving multiple agencies carried out including dissemination of HFMD alert to healthcare facilities, and widespread health education activities among communities, educational institution and business premises. The enteroviral surveillance was also intensified among sporadic cases in hospital and selected clinics. Due to limited resources, risk stratification were used to facilitate the preventive measures. Conclusion: Although the vast majority of HFMD cases were self-limiting, EV71 infection could be life threatening. In the absence of effective vaccine or antiviral for EV71, early case detection and health educations to prevent secondary spread appear to be the most effective public health measure to limit the transmission. Public health surveillance and preventive measures for HFMD needs to be continued and strengthen to prevent the occurrence of such complications associated with EV71 infection.},
howpublished = {published online at https://apcph.cphm.my},
note = {Type: POSTER PRESENTATION; Organisation: Communicable Disease Control Unit, Kelantan State Health Department, Ministry of Health Malaysia; Pasir Puteh District Health Office},
keywords = {EV71, HFMD, Kelantan, Severe},
pubstate = {published},
tppubtype = {proceedings}
}