Clinical risk of severe cases of HFMD with CV-A6 serotype
Objective To analyze the clinical characteristics and the risk of severe disease of patients with coxsackievirus A6(CV-A6)serotype infection,explore the relevant risk factors,and provide a scientific basis for the prevention and treatment of severe hand-foot-and-mouth disease(HFMD)infected by CV-A6.Method Data of severe HFMD in Guangxi Zhuang Autonomous Region from 2017 to 2018 were collected,and analyzed by descriptive analysis,variance analysis,x2 test,and restricted cubic spline curve based on logistic regression.Results A total of 578 cases of severe HFMD were included,mainly scattered children(94.12％),and the serotypes were mainly CV-A6 and enterovirus A71(EV-A71),accounting for 53.11％and 33.74％,respectively.There were significant differences between different serotypes of severe HFMD in terms of residential address,school age subgroups,caregivers and time from onset to diagnosis of severe illness(x2/F=79.452,20.935,258.178,4.454;all P＜0.05).There were significant differences in rash in hands,feet,mouth,buttocks and limbs among different serotypes(x2=12.287,17.625,15.777,46.690,10.754;all P＜0.05);the main manifestation of CV-A6 was typical rash of HFMD.Patients with different serotypes infections were different in neurological impairments such as bad spirit/somnolence,headache,delirium,myoclonus,convulsion and acute flaccid paralysis(x2=120.835,83.329,7.901,38.622,13.312,11.173;all P＜0.05),and CV-A6 had a lower proportion of severe neurological impairments compared with EV-A7 but had a higher risk of transfer to critical care.HFMD showed an increasing risk of ICU admission after an interval of＞2 days from onset to diagnosis of severe illness(P＜0.05).Conclusions The pathogen type of HFMD was constantly changing,and CV-A6 had gradually become the dominant serotype,with a higher risk of becoming severe.It was necessary to strengthen the monitoring and detecting of HFMD pathogens.
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