Therapeutic efficacy of milrinone in the management of enterovirus 71-induced pulmonary edema

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Abstract

Hand, foot, and mouth disease and herpangina are the major clinical manifestations of enterovirus 71 (EV71) infections. Brain-stem encephalitis and pulmonary edema are severe complications that can lead to death. This study was designed to evaluate the potential therapeutic effect of milrinone, a phosphodiesterase (PDE) inhibitor, in the treatment of patients with EV71-induced pulmonary edema. We conducted a historically controlled trial of 24 children with severe EV71-induced pulmonary edema from April 1998-June 2003 in southern Taiwan. Patients were divided into groups treated before and after the introduction of milrinone therapy. Etiological diagnosis was established by viral cultures and confirmed by specific immunofluorescence and neutralization tests. All 24 patients were below 5 years of age. The mortality was lower in the milrinone-treated vs. nontreated group (36.4% vs. 92.3%, P = 0.005). Sympathetic tachycardia was decreased in patients treated with milrinone compared to controls (144 ± 17/min vs. 206 ± 26/min, P = 0.004). A marked decrease in IL-13 (77 ± 9 pg/ml vs. 162 ± 88 pg/ml, P = 0.001) was observed in milrinone-treated patients compared to controls. There was a significant reduction in white blood cell (10,838 ± 4,537/mm 3 vs. 19,475 ± 7,798/mm3, P = 0.009) and platelet (257 ± 45 × 103/mm3 vs. 400 ± 87 × 103/mm3, P = 0.001) counts in milrinone-treated patients compared to controls. These results were associated with improvement in sympathetic regulation and decrease in IL-13 production. Milrinone therapy may provide a useful therapeutic approach for this highly lethal disorder.

Original languageEnglish
Pages (from-to)219-223
Number of pages5
JournalPediatric Pulmonology
Volume39
Issue number3
DOIs
Publication statusPublished - 2005 Mar 1

Fingerprint

Milrinone
Enterovirus
Pulmonary Edema
Interleukin-13
Therapeutics
Herpangina
Hand, Foot and Mouth Disease
Enterovirus Infections
Neutralization Tests
Phosphodiesterase Inhibitors
Therapeutic Uses
Encephalitis
Taiwan
Tachycardia
Brain Stem
Fluorescent Antibody Technique
Leukocytes
Blood Platelets
Mortality

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Pulmonary and Respiratory Medicine

Cite this

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title = "Therapeutic efficacy of milrinone in the management of enterovirus 71-induced pulmonary edema",
abstract = "Hand, foot, and mouth disease and herpangina are the major clinical manifestations of enterovirus 71 (EV71) infections. Brain-stem encephalitis and pulmonary edema are severe complications that can lead to death. This study was designed to evaluate the potential therapeutic effect of milrinone, a phosphodiesterase (PDE) inhibitor, in the treatment of patients with EV71-induced pulmonary edema. We conducted a historically controlled trial of 24 children with severe EV71-induced pulmonary edema from April 1998-June 2003 in southern Taiwan. Patients were divided into groups treated before and after the introduction of milrinone therapy. Etiological diagnosis was established by viral cultures and confirmed by specific immunofluorescence and neutralization tests. All 24 patients were below 5 years of age. The mortality was lower in the milrinone-treated vs. nontreated group (36.4{\%} vs. 92.3{\%}, P = 0.005). Sympathetic tachycardia was decreased in patients treated with milrinone compared to controls (144 ± 17/min vs. 206 ± 26/min, P = 0.004). A marked decrease in IL-13 (77 ± 9 pg/ml vs. 162 ± 88 pg/ml, P = 0.001) was observed in milrinone-treated patients compared to controls. There was a significant reduction in white blood cell (10,838 ± 4,537/mm 3 vs. 19,475 ± 7,798/mm3, P = 0.009) and platelet (257 ± 45 × 103/mm3 vs. 400 ± 87 × 103/mm3, P = 0.001) counts in milrinone-treated patients compared to controls. These results were associated with improvement in sympathetic regulation and decrease in IL-13 production. Milrinone therapy may provide a useful therapeutic approach for this highly lethal disorder.",
author = "Shih-Min Wang and Lei, {Huan Yao} and Mei-Chih Huang and Jing-Ming Wu and Chen, {Chun Ta} and Jieh-Neng Wang and Jen-Ren Wang and Ching-Chuan Liu",
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AU - Wang, Shih-Min

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AU - Huang, Mei-Chih

AU - Wu, Jing-Ming

AU - Chen, Chun Ta

AU - Wang, Jieh-Neng

AU - Wang, Jen-Ren

AU - Liu, Ching-Chuan

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N2 - Hand, foot, and mouth disease and herpangina are the major clinical manifestations of enterovirus 71 (EV71) infections. Brain-stem encephalitis and pulmonary edema are severe complications that can lead to death. This study was designed to evaluate the potential therapeutic effect of milrinone, a phosphodiesterase (PDE) inhibitor, in the treatment of patients with EV71-induced pulmonary edema. We conducted a historically controlled trial of 24 children with severe EV71-induced pulmonary edema from April 1998-June 2003 in southern Taiwan. Patients were divided into groups treated before and after the introduction of milrinone therapy. Etiological diagnosis was established by viral cultures and confirmed by specific immunofluorescence and neutralization tests. All 24 patients were below 5 years of age. The mortality was lower in the milrinone-treated vs. nontreated group (36.4% vs. 92.3%, P = 0.005). Sympathetic tachycardia was decreased in patients treated with milrinone compared to controls (144 ± 17/min vs. 206 ± 26/min, P = 0.004). A marked decrease in IL-13 (77 ± 9 pg/ml vs. 162 ± 88 pg/ml, P = 0.001) was observed in milrinone-treated patients compared to controls. There was a significant reduction in white blood cell (10,838 ± 4,537/mm 3 vs. 19,475 ± 7,798/mm3, P = 0.009) and platelet (257 ± 45 × 103/mm3 vs. 400 ± 87 × 103/mm3, P = 0.001) counts in milrinone-treated patients compared to controls. These results were associated with improvement in sympathetic regulation and decrease in IL-13 production. Milrinone therapy may provide a useful therapeutic approach for this highly lethal disorder.

AB - Hand, foot, and mouth disease and herpangina are the major clinical manifestations of enterovirus 71 (EV71) infections. Brain-stem encephalitis and pulmonary edema are severe complications that can lead to death. This study was designed to evaluate the potential therapeutic effect of milrinone, a phosphodiesterase (PDE) inhibitor, in the treatment of patients with EV71-induced pulmonary edema. We conducted a historically controlled trial of 24 children with severe EV71-induced pulmonary edema from April 1998-June 2003 in southern Taiwan. Patients were divided into groups treated before and after the introduction of milrinone therapy. Etiological diagnosis was established by viral cultures and confirmed by specific immunofluorescence and neutralization tests. All 24 patients were below 5 years of age. The mortality was lower in the milrinone-treated vs. nontreated group (36.4% vs. 92.3%, P = 0.005). Sympathetic tachycardia was decreased in patients treated with milrinone compared to controls (144 ± 17/min vs. 206 ± 26/min, P = 0.004). A marked decrease in IL-13 (77 ± 9 pg/ml vs. 162 ± 88 pg/ml, P = 0.001) was observed in milrinone-treated patients compared to controls. There was a significant reduction in white blood cell (10,838 ± 4,537/mm 3 vs. 19,475 ± 7,798/mm3, P = 0.009) and platelet (257 ± 45 × 103/mm3 vs. 400 ± 87 × 103/mm3, P = 0.001) counts in milrinone-treated patients compared to controls. These results were associated with improvement in sympathetic regulation and decrease in IL-13 production. Milrinone therapy may provide a useful therapeutic approach for this highly lethal disorder.

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