背景:手足口病(HFMD)是一种常见的儿童传染病。手足口病的非典型皮肤发现,通常与柯萨奇病毒A6(CVA6)有关,于2008年首次报告,此后全球报告不断增加。手足口病的非典型病变通常涉及手掌和脚底以外的部位,并且往往不寻常,多态形态。
方法:对具有不典型皮肤表现的小儿手足口病的临床特征和结局进行系统评价。
结果:纳入了85项研究,代表1359例,平均年龄2.4岁,男性占61%。报道最多的形态是囊泡(53%),丘疹(49%),和大疱(36%)。其他形态包括疱疹样湿疹(19%),紫癜性/瘀点(7%),和贾诺蒂·克罗斯蒂(4%)。常见的非典型部位包括手臂和/或腿(47%),脸(45%),和树干(27%)。在63%的病例中发现了CVA6。症状在平均10天内消失。总的来说,16%的病例接受了治疗,最常见的是阿昔洛韦,静脉注射抗生素,或外用类固醇.最常见的并发症是指甲改变(21%)和脱皮(4%),平均发生在症状后3周和2周,分别。
结论:由于与其他条件相似的异常形态,手足口病有不典型的皮肤表现可能会误诊,导致不适当和不必要的调查,住院治疗,和治疗。有必要提高对手足口病非典型表现的认识,以改善患者护理和感染控制预防措施的咨询。
BACKGROUND: Hand-foot-mouth disease (HFMD) is a common childhood infectious disease. Atypical skin findings of HFMD, often associated with coxsackievirus A6 (CVA6), were first reported in 2008, with increasing reports worldwide since. Atypical lesions of HFMD often involve sites beyond the palms and soles and tend to have unusual, polymorphic morphology.
METHODS: A systematic
review was conducted on clinical features and outcomes of pediatric HFMD with atypical cutaneous manifestations.
RESULTS: Eighty-five studies were included, representing 1359 cases with mean age 2.4 years and a male predominance of 61%. The most reported morphologies were vesicles (53%), papules (49%), and bullae (36%). Other morphologies included eczema herpeticum-like (19%), purpuric/petechial (7%), and Gianotti Crosti-like (4%). Common atypical sites included the arms and/or legs (47%), face (45%), and trunk (27%). CVA6 was identified in 63% of cases. Symptoms resolved in a mean of 10 days. Overall, 16% of cases received treatment, most commonly with acyclovir, intravenous antibiotics, or topical steroids. The most common complications were nail changes (21%) and desquamation (4%) which occurred a mean of 3 and 2 weeks after symptoms, respectively.
CONCLUSIONS: Due to unusual morphologies resembling other conditions, HFMD with atypical cutaneous findings may be misdiagnosed, leading to inappropriate and unnecessary investigations, hospitalization, and treatment. Greater awareness of atypical presentations of HFMD is warranted to improve patient care and counseling on infection control precautions.