What is the clinical evidence from this study?

Study design: Observational. Population: Hand-Foot-Mouth Disease (HFMD) (n=34). Primary outcome: Persistence of EV71 specific nucleotides in throat swabs and feces.

June 18, 2010Open Access

Long persistence of EV71 specific nucleotides in respiratory and feces samples of the patients with Hand-Foot-Mouth Disease after recovery

JHJun HanUnion Hospital XMXuejun MaXinjiang Agricultural University JWJunfeng WanShanghai University of Electric Power

Key Result

EV71 shedding from the respiratory tract continued for up to 24 days after onset, while excretion through feces persisted for up to 42 days in patients recovering from Hand-Foot-Mouth Disease.

Study Design

Type

Observational (n=34)

Structured PICO

How long does EV71 shedding persist in respiratory and feces samples of patients with HFMD after recovery?

Population

34 definitely diagnosed patients with Hand-Foot-Mouth Disease (HFMD), including 30 mild cases and 4 severe cases

Outcome

Persistence and duration of EV71 specific nucleotides in throat swabs and fecessurrogate

EV71 shedding from the respiratory tract can continue for nearly four weeks, and fecal excretion for over five weeks after onset of HFMD.

Limitations

Identification of positive EV71 nucleotides by PCR does not indicate the presence of 100% live virus.
Detection of virus in a sample does not equal to being able to set up an efficient infection or transmission.

Abstract

BACKGROUND: EV71 is associated with the fatal cases of brain stem encephalitis during large HFMD outbreaks from 1998 to 2008. EV71 may continuously shed from upper respiratory tracts and feces of HFMD patients for relatively long time after recovery. However, the persistence of viruses in the patients' secretions and excretions is not clear. METHODS: Serial throat swabs and feces of 34 definitely diagnosed patients, including 30 mild cases and 4 severe cases, were traced and collected with the interval of 2 to 4 days for up to 32 and 48 days, respectively, and tested by a nested RT-PCR. RESULTS: The EV-71 specific sequences were identified by a Nested RT-PCR in all specimens of 0-4 days, and 5-8 days. The positive rates of EV71 in throat swabs dropped markedly to 42.86% during 9-12 days, and maintained at 20-30% during 13-24 days, while that in feces reduced to 71.43% during 9-12 days, and maintained roughly 20% till 37-40 days. EV71 nucleotide of 36.36% cases disappeared simultaneously both in throats and feces, 39.39% cases showed longer persistence of EV71 nucleotides in feces, and 21.21% were longer in throats. The longest duration of shedding observed was 24 days for throat swabs and 42 days for fecal specimens. CONCLUSIONS: EV71 shedding from respiratory tract may continue for nearly four weeks after onset, but its excretion through feces can persist more than five weeks.

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