HAND, FOOT AND MOUTH DISEASE

Strain of HFMD killed toddler: doctors

POUNGCHOMPOO PRASERT

THE NATION

BANGKOK: -- As hand, foot and mouth disease (HFMD) continues to alarm parents around Thailand, virology experts yesterday concluded the 2-year-eight-month-old girl who died last week at Bangkok's Nopparat Rajathanee Hospital succumbed to Enterovirus 71, which can cause HFMD.

Two other children who died of illnesses recently - a 16-year-old boy in Sa Kaew and a 3-year-old girl in Lop Buri - were found not to have had HFMD.

Dr Prasert Thongcharoen told a media conference yesterday the 2-year-old girl, who had chronic asthma, developed a fever and respiratory difficulties on July 12, but had no blisters in her mouth.

She later developed high blood pressure, respiratory failure, a high amount of white blood cells, and faster-than-normal heart rate - symptoms in line with the enzyme test result for myocarditis. As a result, doctors stated she had died from respiratory failure, he explained.

Samples from the girl's faeces and spine fluid didn't show HFMD, but a B5 type of Enterovirus 71 was identified in her throat, he said. Although her symptoms weren't typical for HFMD, some - such as myocarditis - did match the disease, and the expert team concluded the girl died from severe HFMD.

Prasert emphasised there was no evidence linking particular HFMD strains to severe diseases.

He said the B5 type of Enterovi-rus 71 wasn't normally dangerous but the girl had severe symptoms because of other factors (such as her pre-existing illness and the late admission for treatment). He said the team found doctors had treated the girl properly and consulted experts frequently.

Prasert also said that the other two deaths did not involve HFMD; the 16-year-old boy in Sa Kaew died from encephalitis (also caused by Enterovirus 71) while the 3-year-old girl in Lop Buri had a heart condition and was admitted with high fever, vomiting, and shortness of breath, but the lab test couldn't find Enterovirus 71 virus.

Department of Medical Sciences chief Dr Boonchai Somboonsuk reported at least 30-40 HFMD samples were being submitted for lab tests each day. Next week, the department will train 14 centres in polymerase chain reaction (PCR), a DNA amplification, so they will have more manpower to detect |diseases better and faster |(within 2-3 hours), he said.

-- The Nation 2012-07-25

This statement has me confused:

"....the 16-year-old boy in Sa Kaew died from encephalitis (also caused by Enterovirus 71)."

Did the boy have EV-71 or is this just saying that EV-71 can cause encephalitis? Was the encephalitis caused by EV-71?

This is the second photo in an article showing, what seems to be, a teacher checking children for HFMD. In both photos the teachers are touching the children, in the other she was holding the child face close to their open mouth. I am not a doctor, but is this not promoting the spread of this disease? Is it possible to just visually check the child without touching them?

yups, one child has it, the teacher touches it (off course without washing hands) and there goes the spread to the rest of the children

i guess the deadly virus did not have a valid passport when it crossed the border with cambodia, so what we have here is not as dangerous and thailand is save, once again

Too stupid to make a wise crack.

On occasion with acute respiratory failure it is not so much the organism, be it bacteria or virus, rather that it is the person's auto-immune system going into high gear, and in some cases exceptionally high gear. The auto-immune bodies in a sense over-react, and oftentimes it's the collateral damage that causes the acute respiratory failure known as ARDS (Acute Respiratory Distress Syndrome). It's like the military getting hyped up because there's a mouse in a house, and they start lobbing grenades--well, yes, the mouse dies, but the house is destroyed also by the hyper-reactive response.

If many children were dieing this way then one might look at the strain of virus as the cause as sometimes certain organisms have the ability to hyper-activate the autoimmune system, but if only one child dies, it may be that child's autoimmune system became hyperactive and it may be an isolated case.

During the influenza epidemic of 1918 which killed more soldiers than combat did it was the strain of virus which caused the body's immune system to become hyperactive, and ARDS was the predominant cause of death. It's not the virus that killed people it was their body's hyper-reactive response. Phagocytes and other auto-immune components destroy its target by various means, if the autoimmune response is huge, the toxic chemicals (peroxides) being released to destroy the organism essentially destroys the lungs.

What is curious is that usually children are less likely to mount a hyper-reactive autoimmune response than adults. During the infuenza epidemic of 1918 children and elderly were spared where usually influenza is more lethal to children and adults--because it was the hyper-reactive autoimmune response.

WHO seems to want to relate those childs deaths to EV71 or HFMD, but reading the letter Dr Beat Richner, founder of Kantha Bopha Hospitals in Cambodia, posted on his facebook page it seems that the cause of their death is a fast lungs deterioration (6h till trespassing...) but not related to EV 71 or HFMD!

Like his page, he's a great humanist swiss doctor, and read his 5 pages letter for more infos!