肠道病毒71型与柯萨奇A组16型混合感染致手足口病并发中枢神经系统感染临床分析

摘要

Objective To analyze the epidemiology and clinical characteristic of 6 cases of severe hand foot and mouth disease with complicated nervous system infections caused by EV71 and CoxA16 mixed infection. Methods Clinical features, laboratory findings and prognosis of 6 cases of EV71 - CoxA16 mixed infection ( mixed infection group ) derived hand foot and mouth disease with complicated nervous system infection were retrospectively analyzed and compared with those of the EV71 - only infection group and the CoxA16 - only infection group. Results Of the 6 cases of EV71 - CoxA16 mixed infection, 5 were primary infection and hospital infection can't be ruled out in the left one case. The clinical features of mixed infection included fever, skin rashes on hand foot mouth and buttocks, hyperarousal, shake, stiff neck, vomit, and so on. The settling time of patient condition were ( 59. 0 ± 38. 1 ) hours in the EV71 group, ( 58. 3 ± 47. 9 ) hours in the CoxA16 group, and ( 86. 4 ± 44. 4 ) hours in the EV71 - CoxA16 mixed infection group; the settling time of body temperature were ( 39. 7 ± 26. 3 ) hours in the EV71 group, ( 28. 3 ± 17. 9 ) hours in the CoxA16 group, and ( 54. 0 ± 12. 0 ) hours in the EV71 - CoxA16 mixed infection group. The rates of critical illness transfer were 7. 1% in the EV71 group, 0 in the CoxA16 group, and 1/6 in the EV71 - CoxA16 mixed infection group. Conclusion The clinical features of EV71 - CoxA16 mixed infection are similar to hand foot and mouth diseases caused by merely EV71 or CoxA16 infection, while worse condition, longer courses, and higher critical illness transfer rates are found in mixed infections.%目的 分析6例肠道病毒71型(EV71)与柯萨奇A组16型(CoxA16)混合感染所致手足口病并发中枢神经系统感染患者的流行病学及临床特征.方法 回顾性分析6例EV71与CoxA16混合感染(混合感染组)所致手足口病并发中枢神经系统感染的临床特征、实验室检查、预后等,并与单纯EV71(EV71组)、CoxA16(CoxA16组)感染所致手足口病并发中枢神经系统感染患者进行比较.结果 6例EV71与CoxA16混合感染中5例为院外原发混合感染,1例不除外院内交叉感染.EV71与CoxA16混合感染致手足口病并发中枢神经系统感染的临床表现包括发热,手、足、口腔、臀部皮疹,肢体易惊、抖动,颈项强直,呕吐等.EV71组、CoxA16组、混合感染组患者的病情稳定时间分别为(59.0±38.1)h、(58.3±47.9)h、(86.4±44.4)h,体温稳定时间分别为(39.7±26.3)h、(28.3±17.9)h、(54.0±12.0)h,转危重型率分别为7.1%、0、1/6.结论 混合感染所致手足口病并发中枢神经系统感染的临床表现与EV71与CoxA16感染所致的手足口病无明显差别,但病情更重、病程较长,危重型的发生率较高.