Why the study?
Enterovirus A71 may cause severe neurological and cardiopulmonary complications in children, prompting a review of the pathogenesis, clinical manifestations, management strategy, and clinical outcomes of cardiopulmonary failure.
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This review highlights that cardiopulmonary failure in EV-A71-infected children is characterized by pulmonary edema, neurogenic stunned myocardium, and vasodilatory shock, which can be managed with stage-based supportive care including milrinone and ECMO.
Enterovirus A71 (EV-A71) is one of the causative pathogens of hand, foot, and mouth disease (HFMD), which may cause severe neurological and cardiopulmonary complications in children. In this review, we discuss the pathogenesis, clinical manifestations, management strategy, and clinical outcomes of cardiopulmonary failure (CPF) in patients with EV-A71 infection.The pathogenesis of CPF involves both catecholamine-related cardiotoxicity following brainstem encephalitis and vasodilatory shock due to cytokine storm. Sympathetic hyperactivity, including tachycardia and hypertension, are the early clinical manifestations of cardiopulmonary involvement, which may progress to pulmonary edema/hemorrhage and/or CPF. The management strategy comprises multidisciplinary supportive treatment, including fluid management, positive pressure ventilation support, and use of milrinone, vasopressors, and inotropes. Some patients may require extracorporeal membrane oxygenation. Major neurological sequelae are almost inevitable once a child develops life-threatening illness. Long-term care of these children is an important medico-social issue.
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Hsia et al. (2020) studied this question.
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