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

Enterovirus 71 (EV71) causes epidemics of hand, foot, and mouth disease ass ociated with neurological complications in young children. We report an out break of EV71-associated neurological disease that occurred from February t hrough September 1999 in Perth, Western Australia. Fourteen children with c ulture-proven, EV71-induced neurological disease were identified. Nine pati ents (64%) developed severe neurological disease; 4 of these patients devel oped long-term neurological sequelae. Neurological syndromes included asept ic meningitis, Guillain-Barre' syndrome, acute transverse myelitis, acute c erebellar ataxia, opso-myoclonus syndrome, benign intracranial hypertension , and a febrile convulsion. Clinical and magnetic resonance imaging data in dicated that immunopathology was a major factor in the pathogenesis of neur ological disease in this outbreak. This finding is in contrast to reports o f previous EV71 epidemics, in which virus-induced damage to gray matter was the most frequent cause of neurological disease.