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During April-July 1998, an increase in fatal cases of neurologic disease in young children occurred in Taiwan, with at least 55 fatalities reported. Concurrently, an outbreak of hand, foot, and mouth disease (HFMD) was also occurring. In fatal cases, the acute illness was characterized by fever, or rash, or mouth ulcers, followed by a rapid cardiopulmonary failure; death frequently occurred within 24 hours of hospitalization. Approximately three-fourths of the fatalities were in children less than 3 years of age. We report here the findings from autopsy specimens from two of the fatal cases of encephalomyelitis.
In Case 1, a 9-year-old female, H&E sections of central neurologic system (CNS) tissue showed perivascular infiltrate, areas of inflammation, necrosis, and neuronal degeneration. Immunohistochemical (IHC) staining was positive when using a monoclonal antibody for enterovirus 71 (EV71), a picornavirus associated with HFMD.
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