通用型肠道病毒感染重症手足口病临床病理特点分析

Clinicopathological features of severe hand-foot-and-mouth disease caused by unclassified enterovirus

目的探讨通用型肠道病毒感染所致重症手足口病的临床病理特点。方法回顾分析2例通用型肠道病毒感染所致重症手足口病的临床资料及尸检病理结果,总结其临床、病理特点,并与肠道病毒71型(EV71)感染病例比较。结果两名患儿年龄均<3岁,均以发热、手足皮疹、口腔疱疹为首发表现,伴有神经系统受累表现,粪便拭子核酸检测结果提示通用型肠道病毒;病程相对较长,治疗后病情反复,最终出现肺水肿、肺出血而死亡。尸体解剖显示:大脑及脑干存在水肿、炎症、坏死表现;肺水肿、出血;心、肝、脾、肾、胰等器官无明显改变。结论与EV71感染病例比较,通用型肠道病毒感染所致重症手足口病的病程较长、病情反复,但两者病理特征相似。

Objective To investigate the clinicopathological features of severe hand-foot-and-mouth disease（ HFMD） caused by unclassified enterovirus. Methods The clinical data and pathological results at autopsy of 2 cases of severe hand-foot-and-mouth disease（ HFMD） caused by unclassified enterovirus were retrospectively analyzed. The clinical and pathological features were summarized and were compared with the features of the cases caused by enterovirus 17（ EV17）. Results Both children were younger than 3 years. The symptoms of initial onset included fever,hand and foot rashes and oral herpes,and nervous system involvement was also observed. The result of nucleic acid detection of stool swab indicated unclassified enterovirus. The durations of disease were quite long. Relapse occurred after treatment. And the children died of pulmonary edema and pulmonary hemorrhage. Autopsy showed that edema,inflammation and necrosis were found in the brain and brain stem,edema and hemorrhage in lung,and no obvious change in heart,liver,spleen,kidney and pancreas. Conclusion Compared to the case caused by EV17,severe HFMD caused by unclassified enterovirus has longer duration of disease and might relapse.But the pathological features of both are similar.