Cardiopulmonary Failure in Children Infected with Enterovirus A71

Overview

Journal J Biomed Sci

Publisher Biomed Central

Specialty Biology

Date 2020 Apr 18

PMID 32299443

Citations 5

Authors

Shao-Hsuan Hsia

Jainn-Jim Lin

Oi-Wa Chan

Tzou-Yien Lin

Affiliations

Soon will be listed here.

Abstract

Enterovirus A71 (EV-A71) is one of the causative pathogens of hand, foot, and mouth disease (HFMD), which may cause severe neurological and cardiopulmonary complications in children. In this review, we discuss the pathogenesis, clinical manifestations, management strategy, and clinical outcomes of cardiopulmonary failure (CPF) in patients with EV-A71 infection.The pathogenesis of CPF involves both catecholamine-related cardiotoxicity following brainstem encephalitis and vasodilatory shock due to cytokine storm. Sympathetic hyperactivity, including tachycardia and hypertension, are the early clinical manifestations of cardiopulmonary involvement, which may progress to pulmonary edema/hemorrhage and/or CPF. The management strategy comprises multidisciplinary supportive treatment, including fluid management, positive pressure ventilation support, and use of milrinone, vasopressors, and inotropes. Some patients may require extracorporeal membrane oxygenation. Major neurological sequelae are almost inevitable once a child develops life-threatening illness. Long-term care of these children is an important medico-social issue.

Citing Articles

High mortality rates and long-term complications in children with infectious brainstem encephalitis: A study of sixteen cases.

Zhou Y, Zhu Y, Cao L, Shi Y, Shen J PLoS One. 2025; 20(2):e0318818.

PMID: 39903731 PMC: 11793775. DOI: 10.1371/journal.pone.0318818.

Overview of the Trending Enteric Viruses and Their Pathogenesis in Intestinal Epithelial Cell Infection.

Chio C, Chien J, Chan H, Huang H Biomedicines. 2025; 12(12.

PMID: 39767680 PMC: 11672972. DOI: 10.3390/biomedicines12122773.

A Novel Peptide from VP1 of EV-D68 Exhibits Broad-Spectrum Antiviral Activity Against Human Enteroviruses.

Lin X, Sun Q, Cao Y, Li Z, Xu C, Liu J Biomolecules. 2024; 14(10).

PMID: 39456264 PMC: 11506774. DOI: 10.3390/biom14101331.

Epidemiological Survey of Enterovirus Infections in Taiwan From 2011 to 2020: Retrospective Study.

Liu F, Chen B, Huang Y, Huang S, Chung R, Yu P JMIR Public Health Surveill. 2024; 10:e59449.

PMID: 39235279 PMC: 11391656. DOI: 10.2196/59449.

A review of enterovirus-associated hand-foot and mouth disease: preventive strategies and the need for a global enterovirus surveillance network.

Huang C, Su S, Chen K Pathog Glob Health. 2024; 118(7-8):538-548.

PMID: 39229797 PMC: 11892072. DOI: 10.1080/20477724.2024.2400424.

References

SCHMIDT N, LENNETTE E, Ho H . An apparently new enterovirus isolated from patients with disease of the central nervous system. J Infect Dis. 1974; 129(3):304-9. DOI: 10.1093/infdis/129.3.304. View

Packer M, Carver J, Rodeheffer R, Ivanhoe R, DiBianco R, Zeldis S . Effect of oral milrinone on mortality in severe chronic heart failure. The PROMISE Study Research Group. N Engl J Med. 1991; 325(21):1468-75. DOI: 10.1056/NEJM199111213252103. View

Liao Y, Wang S, Wang J, Yu C, Liu C . Norepinephrine and Epinephrine Enhanced the Infectivity of Enterovirus 71. PLoS One. 2015; 10(8):e0135154. PMC: 4529162. DOI: 10.1371/journal.pone.0135154. View

Wang S, Lei H, Huang M, Wu J, Chen C, Wang J . Therapeutic efficacy of milrinone in the management of enterovirus 71-induced pulmonary edema. Pediatr Pulmonol. 2005; 39(3):219-23. DOI: 10.1002/ppul.20157. View

Hsia S, Wu C, Chang J, Lin T, Chung H, Lin K . Predictors of unfavorable outcomes in enterovirus 71-related cardiopulmonary failure in children. Pediatr Infect Dis J. 2005; 24(4):331-4. DOI: 10.1097/01.inf.0000157219.19674.98. View

TAGAYA I, Tachibana K . Epidemic of hand, foot and mouth disease in Japan, 1972-1973: difference in epidemiologic and virologic features from the previous one. Jpn J Med Sci Biol. 1975; 28(4):231-4. DOI: 10.7883/yoken1952.28.231. View

Ooi M, Wong S, Lewthwaite P, Cardosa M, Solomon T . Clinical features, diagnosis, and management of enterovirus 71. Lancet Neurol. 2010; 9(11):1097-105. DOI: 10.1016/S1474-4422(10)70209-X. View

Chang L, Lin T, Hsu K, Huang Y, Lin K, Hsueh C . Clinical features and risk factors of pulmonary oedema after enterovirus-71-related hand, foot, and mouth disease. Lancet. 1999; 354(9191):1682-6. DOI: 10.1016/S0140-6736(99)04434-7. View

Noori S, Seri I . Neonatal blood pressure support: the use of inotropes, lusitropes, and other vasopressor agents. Clin Perinatol. 2012; 39(1):221-38. DOI: 10.1016/j.clp.2011.12.010. View

10.

Nagy G, Takatsy S, KUKAN E, Mihaly I, DOMOK I . Virological diagnosis of enterovirus type 71 infections: experiences gained during an epidemic of acute CNS diseases in Hungary in 1978. Arch Virol. 1982; 71(3):217-27. DOI: 10.1007/BF01314873. View

11.

DEIBEL R, Gross L, Collins D . Isolation of a new enterovirus (38506). Proc Soc Exp Biol Med. 1975; 148(1):203-7. DOI: 10.3181/00379727-148-38506. View

12.

McKinney Jr R, Katz S, Wilfert C . Chronic enteroviral meningoencephalitis in agammaglobulinemic patients. Rev Infect Dis. 1987; 9(2):334-56. DOI: 10.1093/clinids/9.2.334. View

13.

Wang S, Lei H, Huang M, Su L, Lin H, Yu C . Modulation of cytokine production by intravenous immunoglobulin in patients with enterovirus 71-associated brainstem encephalitis. J Clin Virol. 2006; 37(1):47-52. DOI: 10.1016/j.jcv.2006.05.009. View

14.

Li R, Liu L, Mo Z, Wang X, Xia J, Liang Z . An inactivated enterovirus 71 vaccine in healthy children. N Engl J Med. 2014; 370(9):829-37. DOI: 10.1056/NEJMoa1303224. View

15.

Lu W, Hsieh K, Lu P, Wu Y, Ho W, Cheng P . Different impacts of α- and β-blockers in neurogenic hypertension produced by brainstem lesions in rat. Anesthesiology. 2014; 120(5):1192-204. DOI: 10.1097/ALN.0000000000000218. View

16.

Chi C, Khanh T, Thoa L, Tseng F, Wang S, Thinh L . Milrinone therapy for enterovirus 71-induced pulmonary edema and/or neurogenic shock in children: a randomized controlled trial. Crit Care Med. 2013; 41(7):1754-60. DOI: 10.1097/CCM.0b013e31828a2a85. View

17.

Biso S, Wongrakpanich S, Agrawal A, Yadlapati S, Kishlyansky M, Figueredo V . A Review of Neurogenic Stunned Myocardium. Cardiovasc Psychiatry Neurol. 2017; 2017:5842182. PMC: 5569748. DOI: 10.1155/2017/5842182. View

18.

Wang J, Yao C, Yeh C, Huang C, Wang S, Liu C . Critical management in patients with severe enterovirus 71 infection. Pediatr Int. 2006; 48(3):250-6. DOI: 10.1111/j.1442-200X.2006.02198.x. View

19.

. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004; 114(2 Suppl 4th Report):555-76. View

20.

Shindarov L, CHUMAKOV M, Voroshilova M, BOJINOV S, Vasilenko S, Iordanov I . Epidemiological, clinical, and pathomorphological characteristics of epidemic poliomyelitis-like disease caused by enterovirus 71. J Hyg Epidemiol Microbiol Immunol. 1979; 23(3):284-95. View