腸病毒感染及其併發症 - ccd.org.tw

1 (Enterovirus). Picornaviridae (pico= ; rna=RNA). 30 nm . RNA (+).. (50oC 1 hr). ( ) ( ) ( ppm). (Enterovirus): 67 . : . (coxsackievirus). A : 1-24 (A23 ) 23 . B : 1-6 6 . (echovirus). 1-34 (8,10,28 ) 31 . enteric cytopathogenic human orphan virus (newer enteroviruses). 68, 69, 70, 71.. : . : .. NTUH Experience: Year 1998. 1871 outpatients: hand-foot-mouth disease or herpangina Male/female= 900. 800. <12 M/O 700. 600. 1-4 Y/O 500. 400. 300. 5-14 Y/O 200. 100. >15 Y/O 0. Nov Jun Aug Jul Jan Sep Dec Feb Apr May Mar Oct Number of cases and outcome of severe HFMD and herpangina in Taiwan, 1998. Ho, M. et al., N Engl J Med 1999;341:929-35. Liu CC, et al., J Clin Virol 2000;17:23-30.. 40-90%.. 70 .. : . : . (minor viremia).. (major viremia).. : 2-3 (1-35 ). : -3 -- 35 .. : .. : . ( ). (meningeal sign). : .. : . ( ). (meningeal sign).. : .. 1-2 .. X : .. : . : . 1/5 -- 2/3. B (B1-B4) 11 . Enterovirus: Neonatal infection Most vulnerable age for severe infection 666 neonates culture at 24 hr, 1 wk, 2 wk, 3 wk, 1 mo nonpolio infection risk factors lower socioeconomic status lack of breast-feeding 50/100,000 coxsackie B.

2 Vs 12/100,000 herpes simplex infection .. : 4-5 .. (IVIG).. Immune modulation ( ).. : . , Salk (IPV). 71 (Enterovirus 71). 1969 .. 71 (Enterovirus 71).. (polio-like syndrome). 10-30 . 1/2 .. 1998 71 in Taiwan: I. : 1980 , 1986 , 1995(?) . AFP : 5-6 ? .. 1998 71 in Taiwan: II.. 50-75 . 1-10/100,000.. ( ).. Polio Cox A Cox B ECHO. + + + +. + + + +. + + + +. - - + +. - - + - - + + +. - + (EV71) + +. - + + +. + + + +. The clinical course of EV71 Infections Stage 1 Onset HFMD, herpangina, fever Stage 2 Encephalomyelitis Limb weakness, lethargy, headache, vomiting, upward gaze, seizure Stage 3 ANS dysfunction (Present Stage 3A). Neurogenic bladder, paralytic ileus, insomnia, profuse sweating, hyperglycemia, leukocytosis, tachycardia Stage 4 Pulmonary edema (Present Stage 3B). Tachypnea, hypoxia, shock Chang LY, et al. Lancet 1999. Staging of EV71 Infection Patient Stage I: hand, foot, and Neurologic syndrome mouth disease Aseptic meningitis Stage II: Rhombencephalitis meningoencephalitis Grade I (myoclonus with tremor, ataxia, or Stage IIIa: ANS both).

3 Dysregulation Grade II (myoclonus Stage IIIb: with cranial-nerve cardiovascular collapse, involvement). pulm edema Grade III (rapid cardiopulmonary failure). Stage IV: recovery Acute flaccid paralysis Lin, et al. Clin Infect Dis Huang, et al. N Engl J Med 1999;. 2002;34(suppl 2):S52-57 341:936-42.. 1.. 2.. 3.. 39. 3 (myoclonic jerk) .. (>150mg/dl) >17500/mm3 .. Fluid restriction and administration of osmotic diuretics for those with signs of increased intracranial pressure Furosemide for those suspected having fluid overload IVIG was administered Blood pressure, oximeter, coma scale and blood sugar were closely monitored Patients were managed in ICU if they had tachypnea/apnea, hypertension/hypotension, signs of increased intracranial pressure or hyperglycemia .. (encephalitis).. Patients in Stage 3 when they required ventilator support and inotropic agents Stage 3A (hypertension and pulmonary edema). ICU management: continuous fluid restriction, administration of milrinone to control severe hypertension and to increase cardiac output early intubation with positive pressure mechanical ventilation with increased positive end expiratory pressure for pulmonary edema High frequency oscillatory ventilator was considered if pulmonary edema or hemorrhage persisted or if patients developed severe hypoxemia Stage 3B (hypotension).

4 When a patient's blood pressure dropped below normal for his or her age In some cases blood pressure is very unstable, requiring fine adjustments of inotropic agents such as dopamine and epinephrine A .. B .. (153 ) . 2 1.. ( 48 ) ( . 170 ) .. 4 .. 71 . Shieh WJ et al. Emerg Infect Dis 2001.. I.. (myoclonic jerk).. 39 . 3 .. (>150mg/dl). Chang LY, et al. Lancet, 1999. II.. (>150mg/dl). (>17500/mm3).. Chang LY, et al. Lancet, 1999.. End EV71 . The answer is VACCINE. Thanks for your attention !.