Intestinal probiotics in relieving clinical symptoms of severe hand, foot, and mouth disease and potential mechanism analysis

OBJECTIVE: In this prospective cohort study, the efficacy and action mechanism of an intestinal probiotic formulation, Golden Bifid, in severe hand, foot, and mouth disease (HFMD) were determined in 63 consecutively admitted patients successfully treated in the Pediatrics Emergency Department of our hospital.

PATIENTS AND METHODS: All patients had a persistent fever; 43 patients had rashes on hands, feet, crissum, and hips; and 45 patients had neurological signs and symptoms. Patients were treated with standard supportive therapy along with ventilator-assisted respiration combined with bedside hemofiltration for removal of circulatory toxins and to achieve acid-base equilibrium and electrolyte stability. Golden Bifid was orally administered for 2 weeks, and vaccination was performed after patients were in stable condition. Additional supportive nursing care was also provided. Patients were categorized into the effective treatment (n = 40) and ineffective treatment (n = 23) groups.

RESULTS: Serum levels of proinflammatory factors [interleukin (IL)-1β, IL-6, tumor necrosis factor-α, and interferon-γ] were significantly decreased and those of anti-inflammatory factors (IL-13, IL-4, and IL-10) were significantly increased after treatment in the effective treatment group. In contrast, in the ineffective treatment group, serum proinflammatory factor levels were significantly increased and serum anti-inflammatory factor levels were significantly decreased. Between-group difference was significant. After treatment, serum D-lactic acid, diamine oxidase, and endotoxin levels were significantly decreased in the effective group and significantly increased in the ineffective group by intra- and inter-group comparisons.

CONCLUSIONS: Intestinal probiotics were effective in relieving clinical symptoms of severe HFMD, maintaining intestinal immunity and anti-inflammatory responses, and enhancing intestinal barrier function, with better safety and efficacy, which should be further evaluated for more extensive clinical applications.

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