Case: Hand, Foot and mouth disease and chicken pox
Posted on October 13, 2009Filed Under Hand-Foot-Mouth Disease Symptoms | Leave a Comment
Case REVIEW: Cheng Cheng 15 months, and the last 3 days, his body temperature fluctuations in the 38-38.5 ℃, a slight flow of white tears, oral mucosa with multiple herpes, antifeedant clear that multiple parts of hands and soles of the feet red maculopapular rash. Coincides with hand, foot and mouth disease epidemic season, the parents quickly took him to hospital. This is not the hand, foot and mouth disease in the end it?
【Case】
Fever herpes difficult to eat
Cheng Cheng 15 months, developed normally, nutrient medium. Communities prior to the onset incidence of children with hand, foot and mouth disease. Incidence of 3 days to children with body temperature fluctuations in the 38-38.5 ℃, a slight flow of white tears, no obvious chills, chills, no chest tightness, shortness of breath, no nausea, vomiting, no abdominal pain, diarrhea, accompanied by a number of oral mucosa one herpes, children antifeedant obvious multiple parts of hands and soles of the feet with red maculopapular rash, no pain, no itching, no other significant discomfort after the illness. Their children eat, parents are anxious.
Varicella, or hand, foot and mouth?
Admission examination: consciousness-ching, the spirit of a little soft, well-nourished, there are several herpes oral mucosa, hands and soles of the feet can be seen a red maculopapular rash, not pain, no itch, neck soft, no neck resistance, heart and lung auscultation, no obvious abnormalities, abdominal soft – , liver and spleen less than ribs, limb muscle strength to normal, did not elicit pathological sign.
Laboratory
Routine blood test: WBC12.0 * 10 ^ 9 / L, NE59.1%, L35.0%, HGB116g / L, PLT350 * 10 ^ 9 / L.
CSF General Tips: colorless, clear, WBC: 33 / uL, N58%, L42%, TP440mg / L.
Initial diagnosis after admission: fever, rash of unknown origin: Varicella? Hand, Foot and Mouth Disease? In view of fever associated with elevated white blood cell blood count, neutrophil percentage of normal, temporary given ceftriaxone 1.0g, qd anti-infection. Feces and urine routine, electrolyte, blood glucose normal, liver and kidney function, myocardial enzymes were normal.
Emergency treatment of disease have changed to keep up with
The next morning, the body temperature in children is still 38 ℃, runny nose and a slight improvement over the previous, examination: consciousness Naokiyo, mental hospital more than the soft, mouth and hands, soles of multiple herpes basic with the former, neck without resistance, heart and lung examination no significant positive findings, abdominal soft, liver and spleen less than ribs, limb muscle strength to normal, did not elicit pathological sign. Shortly before 13 pm on the spirit of obvious deterioration in children, was sleeping state, almost no response to external stimulation, no convulsions, seizures, no nausea, vomiting, no incontinence or retention. Diagnosis of hand, foot and mouth disease. Children admitted to hospital because of the spirit has been relatively soft, and the gradual emergence of drowsiness performance, but the neck reflex resistance and pathological examination were not many leads, so consider the hand, foot and mouth disease with severe, complications of encephalitis, the proposed line of hand, foot and mouth disease etiology inspection. The anti-infective, anti-virus, 20% mannitol dehydration, human gamma immunoglobulin infusion, intravenous injection of methylprednisolone 20mg, and other maintenance of water, electrolyte, acid-base balance and other measures, children recover.
The Medical Analysis】
1, hand, foot and mouth disease Why is it so terrible?
Hand, Foot and mouth disease is an infectious disease caused by enteroviruses, multi-occurred in children under 5 years of age, can cause hand, foot, mouth and other parts of the herpes, a small number of children can cause myocarditis, pulmonary edema, aseptic meningitis encephalitis complications. If the individual children with severe illness and rapid development, leading to death.
2, chicken pox, hand, foot and mouth disease how to distinguish?
Hand, Foot and mouth disease and chicken pox are caused by viral infection.
Hand, Foot and mouth disease: acute onset, fever; oral mucosa rash appears earlier, initially for the corn-like maculopapular rash or blisters surrounded by flush, tongue and cheeks are mainly located in the Department of lateral lips and teeth are also common. Subsequently palms, toes on the back, buttocks, skin, and refers to the folds between the toes appear herpes, about 1-3 mm in size, blisters after breaking into a shallow erosions, ulcers, burning feeling is very obvious; palms, toes on the back of friction parts are easy, there’s usually a red rash or blisters, ranging from a few to a few months. Some children may be accompanied by cough, runny nose, loss of appetite, nausea, vomiting, headache and other symptoms. The disease is self-limiting disease, the majority of good prognosis, without leaving any sequelae. A very small number of children can cause meningitis, encephalitis, myocarditis, acute flaccid paralysis, pulmonary edema and other serious complications.
Period of the onset of chickenpox generally throughout the body, the most intensive part is around the chest, abdomen back, in addition, head and face, scalp, soles of your feet, fingers and palms also can occur. In the heat at the same time, or the next day, there can be the size of the red rice varioliform, in a few hours later, Varioliform become bright as drops of herpes. Chickenpox can be seen under thin-film liquid, pimple-like top was pointed. Incubation period of varicella at the beginning of a long few days, we have all kinds of sick children who can see the rash, papules, herpes, crusts exist. This is a unique feature of chicken pox, which is unique to the “young and old 3 generation” rash behavior.
Whether it is hand, foot and mouth disease, or chicken pox, all belong to a strong infectious diseases, so parents of children who show no matter which of the above symptoms should immediately kids to children’s specialist hospital.
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