Neurological manifestations of enterovirus 71 infection in children during an outbreak of hand, foot, and mouth disease in Western Australia

Clin Infect Dis. 2001 Jan 15;32(2):236-42. doi: 10.1086/318454. Epub 2000 Dec 28.


Enterovirus 71 (EV71) causes epidemics of hand, foot, and mouth disease associated with neurological complications in young children. We report an outbreak of EV71-associated neurological disease that occurred from February through September 1999 in Perth, Western Australia. Fourteen children with culture-proven, EV71-induced neurological disease were identified. Nine patients (64%) developed severe neurological disease; 4 of these patients developed long-term neurological sequelae. Neurological syndromes included aseptic meningitis, Guillain-Barré syndrome, acute transverse myelitis, acute cerebellar ataxia, opso-myoclonus syndrome, benign intracranial hypertension, and a febrile convulsion. Clinical and magnetic resonance imaging data indicated that immunopathology was a major factor in the pathogenesis of neurological disease in this outbreak. This finding is in contrast to reports of previous EV71 epidemics, in which virus-induced damage to gray matter was the most frequent cause of neurological disease.

MeSH terms

  • Acute Disease
  • Antibodies, Viral / blood
  • Australia / epidemiology
  • Cerebellar Ataxia / etiology
  • Child
  • Child, Preschool
  • Disease Outbreaks*
  • Enterovirus / immunology
  • Enterovirus / isolation & purification*
  • Enterovirus Infections / blood
  • Enterovirus Infections / epidemiology
  • Enterovirus Infections / virology*
  • Female
  • Guillain-Barre Syndrome / etiology
  • Hand, Foot and Mouth Disease / blood
  • Hand, Foot and Mouth Disease / epidemiology
  • Hand, Foot and Mouth Disease / virology*
  • Humans
  • Infant
  • Magnetic Resonance Imaging
  • Male
  • Meningitis, Aseptic / etiology
  • Myelitis, Transverse / etiology
  • Nervous System Diseases / blood
  • Nervous System Diseases / virology*
  • Paraneoplastic Syndromes, Nervous System / etiology


  • Antibodies, Viral