Classification of 730 Children with HFMD. The flow chart shows the distribution and classification of disease severity of 730 children with HFMD in the 2006 outbreak according to the duration of fever and the risk factors that were present when they first presented to the hospital. CSF examination is indicated if the children have features indicative of more serious illness of HFMD (see case definition in main text). Hx lethargy: History of lethargy, Temp ≥ 38.5°C: body temperature ≥ 38.5°C, CSF exam: cerebrospinal fluid examination, HFMD: Hand, foot, and mouth disease, HFMD-CNS: Hand, foot, and mouth disease with central nervous system complication, HFMD-Non-CNS: Severe HFMD without central nervous system involvement, BENC: brainstem encephalitis, ASM: aseptic meningitis. a. Of the 48 children with HFMD-CNS, 40 had BENC, 6 had ASM and 2 had BENC associated with cardiorespiratory failure (1 of whom died). b. Of the 102 children with HFMD-CNS, 74 had BENC, 26 had ASM, 1 had encephalitis and 1 had fatal BENC associated with cardiorespiratory failure. c. Of the 24 children with HFMD-CNS, 13 had BENC, 8 had ASM, 1 each had BENC associated with cardiorespiratory failure, encephalitis, and encephalitis associated with acute flaccid paralysis. d. Of the 17 children with HFMD-CNS, 11 had BENC, 5 had BENC associated with cardiorespiratory failure (4 of whom died) and 1 had ASM. e. Of the 40 children with HFMD-CNS, 22 had BENC, 17 had ASM and 1 had fatal BENC associated with cardiorespiratory failure. f. Of the 19 children with HFMD-CNS, 10 had BENC, 7 had ASM and 1 each had encephalitis with acute flaccid paralysis, and BENC associated with cardiorespiratory failure.
Ooi et al. BMC Infectious Diseases 2009 9:3 doi:10.1186/1471-2334-9-3