Neurological Manifestations of Enterovirus 71 Infection in Children during an Outbreak of Hand, Foot, and Mouth Disease in Western Australia

TLDR

Enterovirus 71 (EV71) causes epidemics of hand, foot, and mouth disease associated with neurological complications in young children. We report an outbreak of EV71‑associated neurological disease that occurred from February through September 1999 in Perth, Western Australia. Fourteen children with culture‑proven, EV71‑induced neurological disease were identified. Among 14 children, 9 (64%) suffered severe neurological disease, 4 of whom had long‑term sequelae, with syndromes ranging from aseptic meningitis to Guillain‑Barré syndrome, and imaging and clinical data suggested immunopathology as the main driver—contrasting with earlier outbreaks where direct viral gray‑matter damage predominated.

Abstract

Enterovirus 71 (EV71) causes epidemics of hand, foot, and mouth disease associated with neurological complications in young children. We report an outbreak of EV71-associated neurological disease that occurred from February through September 1999 in Perth, Western Australia. Fourteen children with culture-proven, EV71-induced neurological disease were identified. Nine patients (64%) developed severe neurological disease; 4 of these patients developed long-term neurological sequelae. Neurological syndromes included aseptic meningitis, Guillain-Barré syndrome, acute transverse myelitis, acute cerebellar ataxia, opso-myoclonus syndrome, benign intracranial hypertension, and a febrile convulsion. Clinical and magnetic resonance imaging data indicated that immunopathology was a major factor in the pathogenesis of neurological disease in this outbreak. This finding is in contrast to reports of previous EV71 epidemics, in which virus-induced damage to gray matter was the most frequent cause of neurological disease.