Outline of ProMED-mail posts

ProMED-mail Archive Number 20100625.2121
Published Date 25-JUN-2010
Subject PRO/EDR> Hand, foot & mouth disease (05): China, rural areas
Date: Fri 25 Jun 2010
Source: China Daily, Xinhuanet English News [edited]
　http://news.xinhuanet.com/english2010/china/2010-06/25/c_13369085.htm

中国の手足口病 hand, foot and mouth disease (HFMD)死亡例の約 71%は農村部で報告されている。地方-都市間の大きな医療格差 huge rural-urban medical gap の明確な印である[中国衛生省 24 Jun 2010]。
中国本土で2010年6月22日現在、987 779人近くが発症し、このうち[HFMD患者]計 537人が死亡した。2009年同期の死者数は 186人。
診断が遅くなると、本疾患に対する有効な治療開始が遅れ、まれな症例ではあるが、脳炎などの致死的な合併症を来たす。
死亡例のうち、92%はエンテロウイルス 71型 (EV71)であった。
EV71ウイルスの迅速検査キットを地方の医師に紹介し、衛生省は休みなく国内の地方の医師を指導している。

[Mod. CP氏解説:
Enterovirus 71 (EV71) has emerged also as a major cause of neurological threat following the eradication of poliovirus. Most EV71 infections commonly result in hand, foot and mouth disease but some cases are associated with brainstem encephalitis and acute flaccid paralysis.

Mortality has been high high in EV71 brainstem encephalitis complicated with pulmonary edema, particularly in children below 5 years of age. Destruction of vasomotor in the brainstem by EV71 produces autonomic nervous system dysregulation prior to the pulmonary edema. The pulmonary edema is the result of increased pulmonary vascular permeability caused by the direct brainstem lesions and/or a systemic inflammatory response syndrome produced by the release of cytokines and chemokines.

There is currently no specific antiviral agent to treat or vaccine to prevent EV71 diseases. Treating severe EV71 brainstem encephalitis patients with intravenous IgG and milrinone is associated with significantly decreased mortality by attenuated sympathetic activity and cytokine production (recently reviewed by Wang SM, Liu CC. Expert
Rev Anti Infect Ther. 2009 Aug;7(6):735-42
　http://www.ncbi.nlm.nih.gov/pubmed/19681701
).
]