Enterovirus-A71 Rhombencephalitis Outbreak in Catalonia : Characteristics, Management and Outcome

Andrés Antón, Magda Campins Martí, Tomàs Pumarola Suñé, Carlos Rodrigo Gonzalo de Líria, Núria Wörner, Rocío Rodrigo-García, Ester Castellarnau, Ignacio Delgado Martínez, Èlida Vazquez, Sebastià González, Lluís Mayol, Maria Méndez, Eduard Solé, Jaume Rosal, Cristina Andrés, Alejandro Casquero, Esther Lera, Mónica Sancosmed

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Observational, multicenter study analyzing characteristics, treatment and outcome of patients with EV-A71 rhombencephalitis diagnosed in 6 publicly funded hospitals within the Catalonian Health Institute. A review of clinical characteristics, diagnosis, treatment and outcome of these patients was conducted. Sixty-four patients met the clinical and virologic criteria for rhombencephalitis caused by EV-A71. All patients had symptoms suggesting viral disease, mainly fever, lethargy, ataxia and tremor, with 30% of hand-foot-mouth disease. Intravenous immunoglobulin therapy was given to 44/64 (69%) patients and methylprednisolone to 27/64 (42%). Six patients (9%) required pediatric intensive care unit admission. Three patients had acute flaccid paralysis of 1 limb, and another had autonomic nervous system (ANS) dysfunction with cardiorespiratory arrest. Outcome in all patients (except the patient with hypoxic-ischemic encephalopathy) was good, with complete resolution of the symptoms. During the 2016 outbreak, rhombencephalitis without ANS symptoms was the predominant form of presentation and most patients showed no hand-foot-mouth disease. These findings contrast with those of other patient series reporting associated ANS dysfunction (10%-15%) and hand-foot-mouth disease (60%-80%). Complete recovery occurred in almost all cases. In light of the favorable outcome in untreated mild cases, therapies for this condition should be reserved for patients with moderate-severe infection. The main relevance of this study is to provide useful information for setting priorities, management approaches and adequate use of resources in future EV-A71 associated rhombencephalitis outbreaks.
Original languageEnglish
Pages (from-to)628-633
Number of pages6
JournalPediatric Infectious Disease
Publication statusPublished - 2021


  • Enterovirus rhonbencephalitis


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