Table 1.
Occurrence time of signs or symptoms in 288 severe cases after EV-A71 infection (hours)
| Symptoms/signs | Median (range)a | Mean ± SD |
|---|---|---|
| Prodromal symptoms (4 items) | ||
| Fever (n = 284) | 0 (0–96) | 6.4 ± 16.7 |
| Rash (n = 274) | 0 (0–78) | 3.3 ± 12.1 |
| Herpangina (n = 145) | 0 (0–78) | 3.0 ± 11.9 |
| Flu-like symptom (n = 7) | 0 | 0 |
| Vague location symptoms (6 items) | ||
| Vomiting (n = 74) | 30 (0–96) | 35.0 ± 25.2 |
| Persistent hyperpyrexia (n = 28) | 36 (0–96) | 40.2 ± 27.4 |
| Hydrostomia (n = 18) | 24 (6–54) | 27.3 ± 16.8 |
| Headache (n = 4) | 24 (6–72) | 31.5 ± 28.7 |
| Dizziness (n = 0) | — | — |
| Palpitation (n = 0) | — | — |
| Disturbance of consciousness indicators (5 items) | ||
| Fatigue/sleepiness (n = 115) | 48 (0–136) | 44.0 ± 26.5 |
| Somnolence (n = 25) | 48 (6–120) | 57.4 ± 27.3 |
| Mild coma (n = 7) | 36 (24–96) | 49.7 ± 27.0 |
| Moderate coma (n = 9) | 68 (27–106) | 58.9 ± 25.9 |
| Deep coma (n = 6) | 73.5 (30–75) | 59.3 ± 22.7 |
| Autonomic dysfunction indicators (30 items) | ||
| Poor peripheral perfusion (4 items) | ||
| CRT extension (n = 27) | 48 (18–114) | 52.9 ± 25.4 |
| Clammy skin (n = 25) | 48 (18–114) | 52.4 ± 26.1 |
| Pale skin (n = 13) | 42 (18–96) | 50.9 ± 25.8 |
| Mottled skin (n = 12) | 53.75 (18–106) | 53.5 ± 26.6 |
| Circulatory (7 items) | ||
| Arrhythmia (n = 15) | 48 (12–144) | 57.8 ± 38.8 |
| Tachycardia (n = 12) | 47.5 (24–120) | 49.6 ± 26.3 |
| Excessive tachycardia (n = 7) | 62 (26–88) | 58.1 ± 23.2 |
| Hypertension (n = 7) | 48 (24–83) | 53.0 ± 23.6 |
| Bradycardia (n = 6) | 74 (48–96) | 76.7 ± 18.0 |
| Ultrahyperpyrexia (n = 5) | 47 (26–76) | 47.4 ± 21.3 |
| Ultrahypertension (n = 3) | 75 (72–82) | 76.3 ± 5.1 |
| Perspiration (3 items) | ||
| Hyperhidrosis (n = 2) | 70.5 (27–114) | 70.5 ± 61.5 |
| Adiapneustia (n = 2) | 72 (24–120) | 72.0 ± 67.9 |
| Partial body sweating (n = 0) | — | — |
| Respiratory (9 items) | ||
| Irregular respiratory rhythm (n = 19) | 48 (24–120) | 60.1 ± 27.1 |
| Tachypnea (n = 16) | 48 (6–120) | 49.1 ± 27.7 |
| Hyperventilation (n = 8) | 48 (12–120) | 57.5 ± 35.1 |
| Ataxia respiratory (n = 6) | 63.5 (26–78) | 57.8 ± 20.9 |
| Apneustic breathing (n = 3) | 29 (24–99) | 50.7 ± 41.9 |
| Cheyne-stokes breathing (n = 1) | — | 72 |
| Cluster breathing (n = 1) | — | 54 |
| Slowed breathing (n = 1) | — | 32 |
| Paradoxical breathing (n = 0) | — | — |
| Other autonomic dysfunction indicators (5 items) | ||
| Frequent vomiting (n = 3) | 24 (12–64) | 33.3 ± 27.2 |
| Erythema multiforme (n = 2) | 70.5 (27–114) | 70.5 ± 61.5 |
| Urinary retention (n = 2) | — | 120 |
| Central diabetes insipidus (n = 1) | — | 82 |
| Anuria (n = 1) | — | 120 |
| Failures (2 items) | ||
| Pulmonary edema and/or hemorrhage (n = 23) | 72 (24–120) | 62.9 ± 28.6 |
| Refractory shock (n = 9) | 72 (30–93) | 59.9 ± 23.7 |
| Dyskinesia indicators (46 items) | ||
| Emotional movement disorders (6 items) | ||
| Startled (n = 211) | 30 (0–84) | 30.0 ± 23.0 |
| Anxiety (n = 39) | 36 (0–136) | 40.1 ± 31.1 |
| Dysphoria (n = 17) | 42 (0–96) | 44.2 ± 23.1 |
| Fright (n = 14) | 48 (0–72) | 45.7 ± 22.1 |
| Gibberish (n = 2) | 33 (24–42) | 33.0 ± 12.7 |
| Mania symptoms (n = 1) | — | 72 |
| Limb/muscle movement disorders (14 items) | ||
| Myoclonic jerks/tremor (n = 162) | 36 (0–96) | 33.3 ± 23.0 |
| Dysphagia (n = 8) | 60 (12–68) | 51.3 ± 18.4 |
| Acute lower extremity flaccid paralysis (n = 12) | 54 (0–125) | 55.6 ± 37.8 |
| Seizures (n = 10) | 24 (0–96) | 31.7 ± 26.9 |
| Nuchal rigidity (n = 8) | 59.5 (24–130) | 66.5 ± 37.0 |
| Acute extremities flaccid paralysis (n = 5) | 72 (48–120) | 72.0 ± 29.4 |
| Neck weakness (n = 5) | 48 (24–72) | 48.0 ± 24.0 |
| Hypomyotonia (n = 5) | 47 (0–125) | 53.6 ± 48.0 |
| Acute upper extremity flaccid paralysis (n = 5) | 72 (47–125) | 72.8 ± 31.7 |
| Hypermyotonia (n = 2) | 36 (24–48) | 36.0 ± 17.0 |
| Galloping tongue (n = 1) | — | 84 |
| Thalamus hand/foot (n = 1) | — | 42 |
| Body ataxia (n = 0) | — | — |
| Ptosis (n = 0) | — | — |
| Abnormal eyeball movements (8 items) | ||
| Nystagmus (n = 16) | 48 (18–99) | 51.8 ± 28.5 |
| Eyeball ataxia (n = 10) | 54 (24–99) | 57.6 ± 31.7 |
| Autokinetic eyeball (n = 8) | 45 (18–72) | 43.8 ± 18.3 |
| Fixed eyeball (n = 3) | 72 (60–84) | 72.0 ± 17.0 |
| Gaze (n = 2) | 30 (18–42) | 30.0 ± 16.8 |
| Ocular abduction (n = 1) | — | 36 |
| Turning up eyeball (n = 1) | — | 48 |
| Eyeball cohesion (n = 0) | — | — |
| Involuntary movements (5 Items) | ||
| Chew (n = 1) | — | 60 |
| Bruxism (n = 1) | — | 72 |
| Blink/frown (n = 1) | — | 30 |
| Suck (n = 1) | — | 48 |
| Catch empty air/grope (n = 1) | — | 56 |
| Abnormal pupil movements (6 items) | ||
| Abnormal pupillary light reflex (PLR) (n = 5) | 72 (32–79) | 65.8 ± 19.1 |
| Mydriasis (n = 4) | 76.5 (36–79) | 67.0 ± 20.7 |
| Myosis (n = 1) | — | 60 |
| Anisocoria (n = 1) | — | 48 |
| Dyscoria (n = 1) | — | 26 |
| Variable pupil (n = 1) | — | 60 |
| Other neural reflexes (7 items) | ||
| Absence of pharyngeal reflex (n = 8) | 66 (12–120) | 63.9 ± 34.7 |
| Knee hyporeflexia (n = 7) | 54 (36–72) | 55.1 ± 12.5 |
| Ankle clonus (n = 4) | 54 (24–64) | 49 ± 18 |
| Knee hyperreflexia (n = 2) | 66 (48–84) | 66.0 ± 25.5 |
| Asymmetrical knee reflex (n = 2) | 42 (12–72) | 42 ± 42.4 |
| Babinski’s sign (n = 2) | 48 | 48 |
| Absence of corneal reflex (n = 1) | — | 120 |
| Death (n = 7) | 77 (32–105) | 63.4 ± 29.6 |
aA duration of 0 h indicates the initial symptoms