J Korean Med Assoc JKMA Journal of the Korean Medical Association 1975-8456 Korean Medical Association 10.5124/jkma.2009.52.9.886 Continuing Education Column Hand-Foot-Mouth Disease Related to Enterovirus 71 Kim Jong-Hyun MD 1 2 Kim Seong-Joon MD 1 2 Cheon Doo-Sung PhD 1 2 Department of Childhood and Adolescent Medicine, College of Medicine, The Catholic University of Korea, Korea. Division of Enteric and Hepatitis Viruses, National Institute of Health, Korea Centers for Disease Control and Prevention, Korea. jh00mn@catholic.ac.kr 09 2009 30 09 2009 52 9 886 894 Copyright © 2009 Korean Medical Association 2009

Hand-foot-mouth disease (HFMD), one of the more distinctive rash syndromes, is most frequently caused by coxsackievirus A16, but can also be caused by enterovirus 71 (EV71) and other coxsackieviruses. Recently, there have been large outbreaks of simple, neurologically complicated and even fatal HFMD caused by EV71 in Western Pacific Area. However, in the Republic of Korea, despite its location in EV71 endemic Western Pacific Area, published reports on HFMD with EV71 are rare and there are no published reports on fatal cases. After the first fatal case of HFMD caused by EV71 announced in May 2009, much more cases of neurologically complicated HFMD have been announced. Even now, physician's increased awareness about the seriousness of HFMD, viral surveillance and early warning system of HFMD, and early detection and proper management of potentially life threatening HFMD caused by EV71 are required in the Republic of Korea, as in the neighboring countries.

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The phylogenetic analysis based on VP1 gene of enterovirus 71(EV71) circulating in Korea, 2009*.

Two genetic clusters were detected from patients with serious infection induced by EV71 in Korea. EV71 strain detected from first case showing acute flaccid paralysis in 2009 belonged to genotype C1 corresponding to Korea strain detected in 2001.

Genotype C4a were detected in five cases with serious infections including an expired case with EV71 in 2009, which had 98% homology with Chinese strains circulating in 2008 based on VP1 sequences of EV71.

*Adapted from reference (8).

Number of cases and outcome of severe hand-foot-and mouth disease and herpangina in Taiwan from the week of February 15, 1998 through the week of December 20, 1998*.

Number of severe hand-foot-and mouth disease and herpangina in Taiwan, 1998-2005 (Adapted from reference 14).

Age distribution of patients with neurologically complicated hand-foot-and mouth disease and herpangina in Republic of Korea from April 22, 2009 through July 24, 2009.

(*Unpublished data from Division of Enteric and Hepatitis Viruses, National Institute of Health, Korea Centers for Disease Control and Prevention)

Subgenogroup classification based on the VP1 and VP4 regions*

*Adapted from reference (9).

Types of enteroviruses of neurologically complicated hand-foot-and mouth disease in Republic of Korea from April 22, 2009 to July 24, 2009*

*Unpublished data from Division of Enteric and Hepatitis Viruses, National Institute of Health, Korea Centers for Disease Control and Prevention.

Various clinical syndromes during the 1998 enterovirus 71 epidemic in Taiwan*

†EV71; enterovirus 71

*Adapted from reference (17).

Clinical course of enterovirus 71 infection*

*Adapted from reference (18).

Factors significantly associated with pulmonary edema§

*Blood glucose > 8.3 mmol/L on admission.

†White blood cell count > 17,500/µL on admission.

‡P values were obtained by Fisher's exact test.

§Adapted from reference (18).

Factors significantly associated with central nervous system involvement without pulmonary edema§.

*Blood glucose > 8.3 mmol/L on admission.

†White blood cell count > 17,500/µL on admission.

‡P values were obtained by Fisher's exact test.

§Adapted from reference (18).