Cardiopulmonary failure in children infected with Enterovirus A71

Shao Hsuan Hsia, Jainn Jim Lin, Oi Wa Chan, Tzou Yien Lin

Research output: Contribution to journalReview articlepeer-review

10 Citations (Scopus)


Enterovirus A71 (EV-A71) is one of the causative pathogens of hand, foot, and mouth disease (HFMD), which may cause severe neurological and cardiopulmonary complications in children. In this review, we discuss the pathogenesis, clinical manifestations, management strategy, and clinical outcomes of cardiopulmonary failure (CPF) in patients with EV-A71 infection. The pathogenesis of CPF involves both catecholamine-related cardiotoxicity following brainstem encephalitis and vasodilatory shock due to cytokine storm. Sympathetic hyperactivity, including tachycardia and hypertension, are the early clinical manifestations of cardiopulmonary involvement, which may progress to pulmonary edema/hemorrhage and/or CPF. The management strategy comprises multidisciplinary supportive treatment, including fluid management, positive pressure ventilation support, and use of milrinone, vasopressors, and inotropes. Some patients may require extracorporeal membrane oxygenation. Major neurological sequelae are almost inevitable once a child develops life-threatening illness. Long-term care of these children is an important medico-social issue.

Original languageEnglish
Article number53
JournalJournal of Biomedical Science
Issue number1
Publication statusPublished - Apr 16 2020
Externally publishedYes


  • Brainstem encephalitis
  • Cardiopulmonary failure
  • Children
  • Enterovirus A71
  • Pulmonary edema

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Molecular Biology
  • Clinical Biochemistry
  • Cell Biology
  • Biochemistry, medical
  • Pharmacology (medical)


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