Severe Hand-Foot-and-Mouth Disease Caused by Mixed Infection of Enterovirus 71 and Coxsackie A16:Report of 6 Cases

Objective To analyze the epidemiology and clinical characteristic of 6 cases of severe hand foot and mouth disease with complicated nervous system infections caused by EV71 and CoxA16 mixed infection. Methods Clinical features,laboratory findings and prognosis of 6 cases of EV71-CoxA16 mixed infection(mixed infection group) derived hand foot and mouth disease with complicated nervous system infection were retrospectively analyzed and compared with those of the EV71-only infection group and the CoxA16-only infection group. Results Of the 6 cases of EV71-CoxA16 mixed infection,5 were primary infection and hospital infection can′t be ruled out in the left one case.The clinical features of mixed infection included fever,skin rashes on hand foot mouth and buttocks,hyperarousal,shake,stiff neck,vomit,and so on.The settling time of patient condition were(59.0±38.1)hours in the EV71 group,(58.3±47.9) hours in the CoxA16 group,and(86.4±44.4)hours in the EV71-CoxA16 mixed infection group;the settling time of body temperature were(39.7±26.3) hours in the EV71 group,(28.3±17.9) hours in the CoxA16 group,and(54.0±12.0) hours in the EV71-CoxA16 mixed infection group.The rates of critical illness transfer were 7.1% in the EV71 group,0 in the CoxA16 group,and 1/6 in the EV71-CoxA16 mixed infection group. Conclusion The clinical features of EV71-CoxA16 mixed infection are similar to hand foot and mouth diseases caused by merely EV71 or CoxA16 infection,while worse condition,longer courses,and higher critical illness transfer rates are found in mixed infections.