Pathologic studies of fatal cases in outbreak of hand, foot, and mouth disease, Taiwan.

During April through July 1998, an outbreak of hand, foot, and mouth disease occurred in Taiwan; enterovirus 71 (EV71) was identified as the main etiologic agent. The outbreak was associated with an unusually high death rate in young children. At least 55 fatal cases were initially reported (1,2) in healthy children, who had refractory shock after an acute prodromal illness; many of them manifested neurologic disorders during illness and died within 24 hours of hospitalization (3). In many fatal cases, EV71 was indicated as the etiologic agent by serologic, virologic, and polymerase chain reaction tests conducted on specimens from nonsterile sites, such as throat swabs or stool specimens. While these results may indicate a precedent EV71 infection in the fatal cases, they do not directly implicate EV71 as the causative agent of neurologic disorders and eventual death. In contrast, histopathologic examination in conjunction with special pathology techniques, such as immunohistochemistry (IHC), in situ hybridization, and electron microscopy, can provide unequivocal evidence linking a particular agent to death. We report results of pathologic examination of two fatal cases during this outbreak.