106年12月，一名3歲的陳小弟發燒、咳嗽、流鼻水3天了，到急診時全身痠痛、食慾不佳，比較奇怪的是小弟弟的雙手還無法自行高舉，醫師於是建議家長讓小朋友住院觀察治療；到了晚上，小弟弟的病情急轉直下，不只雙手，連雙腳、軀幹也無力，進而癱瘓在病床上，經詳細診視，加上抽血腦脊髓液、病原體採集培養、腦部影像攝影等一連串檢查，最後確定為「腸病毒D68型感染所致的急性肢體麻痺症候群」，此為成大第laennec一例腸病毒D68型感染重症個案。
收治這名病童的成大醫院小兒急診科醫師郭馥君表示，陳小弟弟住院期間，成大醫院小兒科醫療團隊使用了免疫球蛋白、血漿置換，配合加護病房照護，他的四肢活動已慢慢恢復，出院時已經能坐，但還無法站立行走，因此小病人仍持續復健治療中。
在台灣，夏天是腸病毒的流行期，而腸病毒的分型非常多種，每種腸病毒感染後的表現也都不太一樣。據衛生福利部疾管署腸病毒疫情監測資料顯示，目前主要流行的腸病毒仍以克沙奇A型為主，但國內仍持續有D68型、71型及克沙奇B型等個案發生。而一般人對於腸病毒重症個案多聚焦於腸病毒71型的感染，但從106年以來，腸病毒併發重症個案卻有高達5成是腸病毒D68 型。
郭馥君說，腸病毒D68型初期症狀就像感冒，以發燒、流鼻水、咳嗽為主，較少出現一般人所熟知的?疹性咽峽炎或手足口症等典型腸病毒表現，但病童可能在感染後3-7天內因為病毒侵入腦部脊髓等中樞神經，突然發生肢體無力的情形。另外，有氣喘體質的兒童也要小心，腸病毒D68型也容易會有肺部侵犯，導致病童呼吸急促，甚至呼吸衰竭。
郭馥君指出，目前全世界治療D68型腸病毒的經驗不多，還無良好的抗病毒藥物可供治療使用，一般只能進行支持性治療；當病毒侵犯中樞神經導致急性肢體麻痺症候群時，則依臨床狀況考慮給予免疫球蛋白、類固醇等治療，更嚴重的重症個案如呼吸衰竭的則進行呼吸支持，心肺衰竭的給予葉克膜治療。
不過，腸病毒D68型的預防方法與其他腸病毒大致相同，郭馥君說，最有效的預防方法仍是做好個人手部衛生，流行期間幼童應減少出入擁擠的公共場所，並落實生病在家休息等措施，以降低傳播風險。她也呼籲民眾留意家中嬰幼兒健康，如發現有急性肢體無力應儘速送醫。
In December 2006, a 3-year-old Chen Xiaodi had a fever, cough, and runny nose for 3 days. When she was in the emergency department, her body was sore and her appetite was poor. It was strange that the younger brother’s hands could not be lifted by herself. The doctor suggested that parents Let the children be hospitalized for observation and treatment; at night, the younger brother’s condition turned sharply, not only with his hands, but also with his feet and trunk, and then he was unable to squat in the hospital bed. After detailed examination, plus blood-sucking cerebrospinal fluid, pathogen collection and culture, brain A series of tests, such as video photography, were finally identified as "acute limb paralysis syndrome caused by enterovirus D68 infection", which is the first case of severe enterovirus D68 infection in Chengda.
Guo Xiaojun, a pediatric emergency doctor at Chengda Hospital, who admitted the sick child, said that during the hospitalization of Chen Xiao’s younger brother, the pediatric medical team of Chengda Hospital used immunoglobulin, plasma exchange, and intensive care unit care. His limb activities have slowly recovered. She was able to sit at the time of discharge, but she was unable to stand and walk, so the small patient continued to be rehabilitated.
In Taiwan, summer is the epidemic period of enterovirus, and the classification of enterovirus is very diverse, and the performance of each enterovirus infection is also different. According to the monitoring data of the enterovirus epidemic situation of the Department of Health and Welfare, the main prevalent enteroviruses are still mainly Keshaqi A type, but there are still cases of D68 type, 71 type and Keshaqi type B. However, most people with severe cases of enterovirus focus on the infection of enterovirus 71, but since 106 years, up to 50% of cases of enterovirus complicated cases are enterovirus D68.
Guo Yujun said that the initial symptoms of enterovirus D68 are like a cold, with fever, runny nose, and cough. There are few typical enteroviruses such as rash angina or hand, foot and mouth disease, but the sick child may In the 3-7 days after infection, the virus suddenly invades the central nervous system such as the brain spinal cord, and sudden limb weakness occurs. In addition, children with asthmatic constitution should also be careful, the enterovirus D68 type is also prone to lung invasion, resulting in short-term breathing, and even respiratory failure.
Guo Yujun pointed out that there is not much experience in the treatment of D68 enterovirus worldwide, and there are no good antiviral drugs available for treatment. Generally, only supportive treatment can be used; when the virus invades the central nervous system and causes acute limb paralysis syndrome, Clinical conditions are considered for the treatment of immunoglobulins, steroids, etc., more severe cases such as respiratory failure, respiratory support, cardiopulmonary failure to the treatment of leaf membrane.
However, the prevention method of enterovirus D68 is similar to other enteroviruses. Guo Yujun said that the most effective prevention method is still to do personal hand hygiene. During the epidemic, young children should reduce their access to crowded public places and implement sickness at home. And other measures to reduce the risk of transmission. She also appealed to the public to pay attention to the health of infants and young children at home. If acute limb weakness is found, they should be sent to the doctor as soon as possible.
Laennec is the ethical drug manufactured with JBP’s unique technologies.
Laennec is the ethical drug manufactured with JBP’s unique technologies for effective extraction of variety of growth factors, cytokines, and other physiologically active substances from the human placenta. For instance, HGF (hepatocyte growth factor) promotes the proliferation of hepatic parenchymal cells for recovery of a damaged liver. Our product safety is ensured by the most rigid safety measures among existing scientific standards.
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