Objective: To study the clinical characteristics of outpatients with hand, foot and mouth disease (HFMD) caused by different serotypes of enteroviruses. Methods: This was a prospective study. From February 2017 to March 2018, 563 outpatients with HFMD were enrolled by systematic sampling in the Department of Infectious Diseases, Henan Children's Hospital. Throat swabs were collected to determine the serotypes via PCR. Demographic, clinical, and laboratory data were collected by standard questionnaire. All cases were followed up twice at 2 and 9 weeks after the initial outpatient visit through telephone interview. A total of 563 cases were enrolled and 555 (98.6%) cases were positive for human enteroviruses, including 338 (60.9%) males. Analyses were stratified by enterovirus serotypes, Chi square test or Fisher's exact test, Rank sum test was used for comparison among different groups. Results: The age of 555 cases was 24.2 (16.4, 41.3) months. Among them 44.0% (224 cases) were identified as coxsackievirus (CV)-A6, while 189 cases, 35 cases, 14 cases and 73 cases were identified as CV-A16, enterovirus (EV)-A71, CV-A10 and other serotypes, respectively. Fever (≥37.5 ℃) was present in 51.4% (285/555) of laboratory confirmed cases. The proportions of fever in cases of CV-A6 (68.9%(168/244)) and CV-A10 (12/14) were significantly higher than those in cases of CV-A16 (31.7%(60/189),χ(2)=57.344,14.313,both P=0.000), other serotypes (43.8%(32/73),χ(2)=15.101 and 8.242, P=0.000 and 0.004) and EV-A71 (37.1%(13/35), χ(2)=13.506 and 9.441, P=0.000 and 0.002) respectively. There was no significant difference between CV-A6 and CV-A10 in presentation of fever (χ(2)=1.785, P=0.182). There were 359 cases (64.7%) with eruptions in mouth, hands, feet and buttocks. Cases infected with EV-A71 had the highest proportions (74.3%(26/35)) of rash emerging simultaneously in mouth, hands, feet, and buttocks. The proportion in cases of CV-A16, CV-A6, CVA10 and other serotype were 73.5% (139/189), 61.9% (151/244), 7/14 and 49.3% (36/73), respectively. The proportion of rash on other parts of body, such as face, limbs or torso in cases infected with CV-A6 (16.8% (41/244)) was the higherest and the proportion in cases of CV-A16, EV-A71, CV-A10 or other serotypes were 8.5% (16/189) , 5.7% (2/35) , 1/14, 6.8% (5/73) , respectively. None of these cases developed serious complications. Desquamation occurred in 45.5% (179/393) cases 7.5 (5.0, 9.0) days after disease onset and 13.5% (53/393) cases showed onychomadesis 31.0 (18.0, 33.5) days after disease onset. The proportion of desquamation and onychomadesis associated with CV-A6 (64.2% (95/148) and 31.8% (47/148)) was significantly higher than CV-A16 (31.8% (49/154) and 1.3% (2/154), χ(2)=33.601 and 52.482, both P=0.000) and other serotypes (38.0%(19/50) and 6.0%(3/50),χ(2)=10.236 and 12.988, P=0.001 and 0.000). Desquamation appeared more in cases of CV-A6 than in cases of CV-A10 (2/11,χ(2)=9.386, P=0.002), with the proportion of onychomadesis higher in CV-A6 than in EV-A71 (3.3% (1/30),χ(2)=11.088, P=0.001). Conclusion: Clinical manifestation such as fever, rash emerging parts, desquamation and onychomadesis are different among outpatient HFMD cases infected with CV-A16, CV-A6, EV-A71, CV-A10 and other enteroviruses.
目的： 探讨不同血清型肠道病毒引起的儿童手足口病门诊病例的临床特征差异。 方法： 前瞻性研究。2017年2月至2018年3月，在河南省儿童医院感染科门诊通过系统抽样纳入563例手足口病患儿，采集咽拭子标本进行PCR诊断，通过标准问卷收集基本人口学资料、临床特征和末梢血常规结果，并于就诊后2周和9周分别进行电话随访，追踪病例恢复情况。563例门诊手足口病例中实验室确诊病例555例（98.6%)，其中男338例（60.9%),按肠道病毒血清型进行分组，χ(2)检验或Fisher确切概率检验、秩和检验用于组间比较。 结果： 555例实验室确诊患儿年龄为24.2(16.4,41.3）月龄；共检测出244例柯萨奇病毒（CV）-A6，189例CV-A16，35例肠道病毒A71型（EV）-A71、14例CV-A10和73例其他肠道病毒血清型。285例（51.4%）实验室确诊病例出现发热（≥37.5 ℃），其中CV-A6和CV-A10感染患儿发热比例[68.9%(168/244）和12/14]均分别高于CV-A16[31.7%（60/189），χ(2)=57.344、14.313,P均=0.000]、其他血清型[43.8%（32/73），χ(2)=15.101、8.242,P=0.000、0.004]和EV-A71[37.1%（13/35），χ(2)=13.506、9.441,P=0.000、0.002]；CV-A6与CV-A10感染病例在发热比例方面差异无统计学意义（χ(2)=1.785,P=0.182)。359例（64.7%）患儿的口、手、足和臀部均出疹，EV-A71病例比例最高（74.3%, 26/35)，CV-A16(73.5%,139/189）次之，其次为CV-A6(61.9%, 151/244），CV-A10(7/14）和其他血清型（49.3%, 36/73)；CV-A6病例出现其他部位皮疹的比例为16.8%(41/244)，CV-A16、EV-A71、CV-A10和其他血清型病例分别为8.5%（16/189）、5.7%（2/35)、1/14、6.8%（5/73）。全部555例确诊病例均未出现临床并发症。45.5%(179/393）患儿在发病后7.5(5.0，9.0)d出现脱皮，而且13.5%(53/393）在发病后31.0(18.0，33.5)d出现脱甲症，CV-A6脱皮发生率64.2%(95/148)，脱甲发生率31.8%(47/148）均高于CV-A16[31.8%(49/154）和1.3%(2/154)，χ(2)=33.601、52.482，P均=0.000]和其他肠道病毒病例[38.0%(19/50）和6.0%(3/50)，χ(2)=10.236、12.988，P=0.001、0.000]，CV-A6脱皮发生率高于CV-A10病例（2/11，χ(2)=9.386，P=0.002)，脱甲发生率高于EV-A71病例[3.3%（1/30），χ(2)=11.088，P=0.001]。 结论： CV-A16、CV-A6、EV-A71、CV-A10和其他肠道病毒血清型感染引起的儿童手足口病门诊病例在发热、皮疹部位，病后脱皮、脱甲发生率上存在较为明显的差异。.
Keywords: Desquamation; Enterovirus infections; Hand, foot and mouth disease; Onychomadesis; Outpatients.