Fatal enterovirus 71 encephalomyelitis☆,☆☆,★
Section snippets
ANTECEDENT ILLNESS
Four children, 3 male and 1 female between 15 months to 4 years old, were admitted to University Hospital Kuala Lumpur between July and October, 1997. Three children were seen at the emergency department in a state of pulmonary and cardiovascular instability. The history was fever of 3 to 5 days’ duration. Cases 1 and 3 had cough with sore throat. Case 3 had red spots on the hands and feet, and case 4 had oral ulcers. Case 4 had flaccid paralysis with hyporeflexia of the lower limbs. In the
RESULTS
All 4 cases showed similar pathologic findings. The main pathologic complications were in the brainstem and spinal cord, where severe and widespread inflammation was noted in the grey matter. Inflammatory changes consisted of perivascular cuffing by mononuclear cells predominantly and neutrophils occasionally. Clusters of neurons showed degeneration and necrosis with neuronophagia. Microglial nodules were prominent (Fig 2).
DISCUSSION
The epidemic of HFMD in Peninsular Malaysia affected thousands of young children (Ministry of Health, Malaysia). Serious neurologic disease, the hallmark of EV-71 infections, was seen in 8 other fatal cases in other hospitals in Peninsular Malaysia. These cases, however, were investigated suboptimally. In our cases, although specific neurologic signs were present in only 1 case, all 4 cases showed severe involvement of the spinal cord and brainstem. A strong etiologic link between EV-71 and the
Acknowledgements
We thank the Virology Laboratory, Department of Pathology, Singapore General Hospital for its technical assistance.
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From the Department of Pediatrics, the Department of Pathology, the Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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Reprint requests: Lucy Chai-See Lum, MBBS, MRCP, Department of Pediatrics, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
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0022-3476/98/$5.00 + 0 9/22/94196