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Table 1 Clinical manifestations of EV-A71 infections: four stages and management

From: Cardiopulmonary failure in children infected with Enterovirus A71

StageSigns of cardiopulmonary involvementOther clinical manifestationsLaboratory/exam findingsManagement of CPF
1. HFMD/
Herpangina
➢ None➢ Vesicular rash on hands, elbows, feet, knees and buttocks
➢ Oral ulcers and herpangina
➢ Fever
➢ GI symptoms
➢ Generally within normal limit➢ None
2. CNS Involvement➢ Prehypertension (systolic pressure between 90 and 95% by age ≈ 105–115 mmHg for high risk age groups) [17]
➢ Tachycardia (resting heart rate higher than normal but < 150/min) and abnormal heart rate variability( [18] [19];)
➢ Myoclonic jerk
➢ Meningism
➢ Ataxia, tremors
➢ Lethargy
➢ Limb weakness and Polio-like syndrome
➢ Altered mental status
➢ Generalized tonic-clonic convulsion
➢ CSF pleocytosis
➢ MRI: high signal intensities on T2 weighted images in brainstem and spinal cord [20]
➢ Limited fluid replacement therapy
➢ Early intubation and PPV
➢ IVIg
3. ANS Dysregulation➢ Inappropriate tachycardia (resting heart rate > 150/min)
➢ Severe hypertension (systolic pressure > 95% by age ≈ 115–120 mmHg for high risk age groups) [17]
➢ Tachypnea
➢ Hemoptysis, pink frothy sputum
➢ Low Pao2: Fio2 ratio
➢ Chest radiography: PE/H
➢ Hyperglycemia (> 150 mg/dL)
➢ Profuse sweating
➢ Cranial nerve abnormality and GCS deterioration
➢ Hypoxemia
➢ Hyperglycemia
➢ Intubation and PPV
➢ HFOV
➢ Milrinone
4. CPF➢ Hypotension
➢ Low cardiac output
➢ Signs of poor perfusion
➢ Absence of spontaneous respiration though pulmonary edema improves
➢ Coma, paralysis
➢ Neurological sequelae
➢ Elevated troponin I and cardiac enzyme
➢ Lactic acidosis
➢ Poor left ventricle ejection fraction
➢ Dopamine and epinephrine
➢ ECMO
➢ Volume expansion