14PET P 104/min RR 42/minBW 8.2 kgHEENT: no intraoral lesion, injected pharynxHeart: normal S1 S2Lung: clearAbd: mild distention, liver & spleen – neg.Extremity: a few small vesicles & MP rash both soles
15Progression3 hr after admission,he vomited many timesLethargyDevelop dyspneaBP 80/50 sat. 89%Rales both lungsHe was intubated+pink frothy sputum
16He was on ventilatorDeveloped convulsionTachycardia HR /minDeveloped hypotentionInotropic drugs, IVIG were givenThe patient died after 14 hrs.
17Specimen collection Stool: PCR positive for EV 71 Throat swab: negative for EV 71 & others HEVSerum antibodyEV 71 = 1:1,536Cox A10 = 1:12A16 < 1:4No second serum
26Stage II: Meningoencephalitis Admit to PICU p.r.n.Monitor BP, HR, sugar, ABG, e¯ ,coma scaleIntubate patient and provide mechanical ventilator for GCS< 9 or significant IICP or any deterioration signsIVIG:1gm/kgFluid restriction: 1/2-2/3 maintenanceFurosemide for patients with high CVP??Invasive monitoring: CVP, ABPConsult cardiologist as needed and arrange echocardiography
35EV 71 Viral testing & surveillance recommended in: Severe HFMD need hospitalizationComplication :Respiratory, Cardiovascular and Neurologic complicationClusters of HFMDAcute pulmonary edema of unidentified cause
36Specimen collection 8 grams of stool in the sterile tube Put in the sealed plastic bagKeep cold (ice packs)PCRThroat swab ( symptoms < 7 days)Paired serum - 14 days apartAntibody- microneutralization test
37Control measure A Classroom closure : 2 cases of HFMD in a class IsolationContact (fecal-oral route)Young children are susceptibleNursery, kindergarten, elementary schoolA Classroom closure : 2 cases of HFMD in a classA school closure: > 1 class or > 5 casesFor 7 days: (5 working days)