中华皮肤科杂志 ›› 2011, Vol. 44 ›› Issue (2): 80-83.

• 论著 • 上一篇    下一篇

24例皮损不典型的重症手足口病临床及病原学研究

高宇1,汪洪姣2,金宛宛3,黄嫦嫦2,陈益平2   

  1. 1. 温州医学院附属第二医院皮肤科
    2. 温州医学院附属第二医院 育英儿童医院
    3.
  • 收稿日期:2010-08-05 修回日期:2010-10-09 出版日期:2011-02-15 发布日期:2011-02-10
  • 通讯作者: 高宇 E-mail:gaoyu@medmail.com.cn

Clinical and pathogenical analysis of severe hand-foot-mouth disease with atypical skin lesions: 24 case report

  • Received:2010-08-05 Revised:2010-10-09 Online:2011-02-15 Published:2011-02-10

摘要:

目的 探讨皮损不典型的重症手足口病的临床特点、治疗和转归。方法 回顾分析2010年1 - 5月无典型皮损的重症手足口病24例的临床资料。结果 24例中,男17例,女7例。其中3例肠道病毒71型(EV71)阳性首诊时未见皮损,仅表现为口腔疱疹2例,仅表现为臀部皮疹3例,仅表现为手掌皮疹5例,仅表现膝盖皮疹2例,同时累及手足臀9例。皮疹较为稀疏或出疹部位不典型,均有发热,平均持续6 ~ 7 d,神经系统受累24例,肺出血4例。病原学检测:24例咽拭子标本EV71阳性13例,CoxA16阳性2例,其它肠道病毒阳性3例。24例大便标本EV71阳性9例,CoxA16阳性1例,其他肠道病毒阳性2例。5例咽拭子及大便标本EV71均阳性。4例危重型患儿死于多脏器功能衰竭,20例重型患儿预后良好,临床治愈出院。结论 引起本组重症手足口病的主要致病原是EV71,易感患儿年龄多在2岁以下,临床多伴高热,皮疹呈多样性。早期识别不典型皮损,及早处理是治疗重症手足口病的关键,能够提高患儿生存率。

关键词: 手足口病

Abstract:

Objective To investigate the clinical feature, treatment and prognosis of severe hand-foot-mouth disease without typical skin lesions. Methods Clinical data from 24 patients with severe hand-foot-mouth disease without typical skin lesions collected from January 2010 to May 2010 were retrospectively analyzed. Results There were 17 males and 7 females among the 24 patients. Of them, 3 patients with positive EV71 showed no skin lesions at the first visit, 2 presented with only herpes of mouth, 3 with only skin rashes in gluteal regions, 5 with only skin rashes on the palms, 2 with only skin rashes of the knees, 9 with skin rashes in hands, feet and gluteal regions simultaneously. The skin rashes were sparse with an atypical distribution. Fever occurred in all the 24 patients and lasted 6 - 7 days. Nervous system was involved in all the patients, and pulmonary hemorrhage occurred in 4 patients. RT-PCR and real-time PCR showed that the pharyngeal swab was positive for EV71 in 13 patients, for CoxA16 in 2, for other enterovirus in 3, and feces samples were positive for EV71 in 9 patients, for CoxA16 in 1, for other enterovirus in 2. Five patients were positive for EV71 in both pharyngeal swab and feces samples. Four patients died of multiple organ failure, the other 20 patients were cured and discharged from hospital. Conclusions The major pathogen causing severe hand-foot-mouth disease is EV71 in the 24 patients; children under 2 years are liable to this disease; high fever is common with various rashes. Early recognition of atypical skin lesions and timely management are most important for the control of severe hand-foot-mouth disease and improvement in overall survival of patients with this entity.

Key words: hand-foot-mouth disease