2018年Cox-A6感染性手足口病住院患儿82例临床特征和病原学分析

Clinical features and phylogenetic analysis of hospitalized children with Coxsackievirus A6-associated HFMD in 2018

目的了解2018年柯萨奇A6(Cox-A6)感染性手足口病(HFMD)住院患儿的临床和病原学特征。方法分析2018年82例Cox-A6感染性HFMD住院患儿的临床和实验室资料,并构建Cox-A6分子进化树。结果82例患儿年龄(18.6±9.8)个月,男性占64.6%(53/82)。主要临床症状包括皮疹(100%)、高热(75.6%)、咳嗽(54.9%)、扁桃体肿大(45.1%)、纳差(23.2%)、呕吐(29.3%)等。重症HFMD患儿11例(13.4%),7例(8.5%)确诊为病毒性脑炎,3例(3.7%)存在肺水肿。实验室指标主要以白细胞(WBC)、血小板(PLT)、天门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)和肌酸激酶同工酶(CK-MB)升高为主。分子进化树显示12株Cox-A6均属于E2亚群,与2017年云南、广东和广西地区分离的毒株具有高度同源性。结论2018年Cox-A6感染性HFMD住院患儿的主要临床特征为年龄小、高热、皮疹,伴随扁桃体肿大、咳嗽、呕吐、惊厥等;部分Cox-A6感染患儿出现肺水肿等重症HFMD表现;E2亚群是Cox-A6的流行优势株。

Objective To investigate the clinical and phylogenetic characteristics among hospitalized children with Coxsackievirus A6(Cox-A6)-associated hand-foot-mouth disease(HFMD)in 2018.Methods Clinical features and laboratory characteristics of 82 hospitalized children with Cox-A6-associated HFMD were collected,and the Cox-A6 phylogenetic tree was depicted.Results Of the 82 HFMD patients with Cox-A16 infections,the mean(SD)age was 18.6(9.8)months and 53 patients(64.6%)were male.For clinical manifestations,skin eruption(100%),high fever(75.6%),cough(54.9%),tonsillar enlargement(45.1%),poor appetite(23.2%),and vomiting(29.3%)were often.And 13.4%(11/82)were diagnosed as severe HFMD.8.5%(7/82)were diagnosed with viral encephalitis while 3.7%(3/82)showed mild pulmonary edema.The laboratory diagnosis showed that the levels of WBC,PLT,AST,LDH and CK-MB were higher than the normal range.Phylogenetic analysis showed the current Cox-A6 strains belong to the cluster E2 and were closest to the isolates from Yunnan,Guangdong and Guangxi of China in 2017.Conclusion The hospitalized children with Cox-A6-associated HFMD in 2018 had younger age,high fever and rash,accompanied with tonsillar enlargement,cough,vomiting,shock,startled,and ect.Severe manifestations such as viral encephalitis and pulmonary edema can occur in severe HFMD.Cluster E2 is the prevalent strain.