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Enterovirus 71 (EV71), a major pathogen that is responsible for causing hand-foot-and-mouth disease (HFMD) worldwide, is a member of the Human Enterovirus species A, family Picornaviridae.

Although these studies did not reveal any specific cardiopulmonary collapse or pulmonary edema in response to CNS failure, the fact that EV71 targeted the CNS through circulation and other ways provides a basis for further research.

To investigate the detailed pathogenesis of EV71 infection, we studied the pathological changes of different organs, primarily the CNS and respiratory, circulatory and digestive organs, of rhesus monkeys that were infected intracerebrally, intravenously, orally or intratracheally.

The infection caused by intracerebral inoculation induced pulmonary edema and hemorrhage, along with impairment of neurons.

However, intravenous inoculation resulted in direct infection of the CNS, accompanied by obvious inflammation of lung tissue, as shown by impairment of the alveoli structure and massive cellular infiltration around the terminal bronchioles and small vessels.

Interestingly, the same pathological changes in lungs were observed in monkeys infected with EV71 via the respiratory and digestive tracts, but infection via these routes resulted in low levels of pathological damage to the CNS.

The mechanism that underlies this viral infection must be further investigated to develop clinical measures and specific vaccines against EV71.

Although the available human clinical and pathological data have not explained this mechanism, the following observations might provide some clues: first, EV71 infection can be transmitted via different routes within a population; and third, an infection of the CNS by EV71 suggests that circulation in the blood might be one of the ways the virus disseminates within the body.

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