The long-term neurologic sequelae, neurodevelopment, and cognitive function of 142 children with a history of enterovirus (EV) 17 infection with CNS involvement were determined in a study at the National Taiwan University Hospital, Taipei; and Chang Gung Children's Hospital, Taoyuan, Taiwan. The median age of disease onset was 1.8 years (range 0.1 to 13.5), and age at time of assessment was 5.0 years (range 1.3 to 20.8). Sixty-one had aseptic meningitis, 53 had severe CNS involvement, and 28 had cardiopulmonary failure after the CNS involvement. Limb weakness and atrophy developed in 9 (56%) of 16 patients with a poliomyelitis-like syndrome, and in 1 (20%) of 5 with encephalomyelitis. Of the 28 with cardiopulmonary failure following CNS involvement, 18 (64%) had limb weakness and atrophy, 17 (61%) required tube feeding, and 16 (57%) required ventilator support. Children with the complication of cardiopulmonary failure had a significantly higher incidence of delayed neurodevelopment and lower IQ scores than children with CNS involvement alone. Scores on the Denver Development Screening Test for children 6 years of age or younger were delayed in 21 of 28 (75%) with cardiopulmonary failure cf to 1 of 20 (5%) with severe CNS involvement alone ((P<0.001); the mean full-scale IQ on the WISC Test for children 4 years of age or older was lower in patients with cardiopulmonary failure (P=0.003). [1]

COMMENT. Enterovirus, an RNA nonpoliovirus, causes significant and frequent illnesses in infants and children. Clinical manifestations of EV17 are protean and include hand-foot-and mouth disease, brainstem encephalitis and polio-like paralysis. Isolation of the virus in cell culture is the standard diagnostic method, and stool and throat specimens produce the highest yield (AAP Redbook, 27th ed, 2006). The above report shows that neurologic sequelae are frequent, especially in patients with cardiopulmonary failure. Behavior and learning problems present later on attending school, and 13% are diagnosed and treated for ADHD.