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Hirade T, Abe Y, Ito S, Suzuki T, Katano H, Takahashi N, Koike D, Nariai A, Kato F. Congenital Echovirus 11 Infection in a Neonate. Pediatr Infect Dis J 2023; 42:1002-1006. [PMID: 37523578 DOI: 10.1097/inf.0000000000004052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Neonates infected with enterovirus in utero would be fulminant at birth or develop symptoms within a few days. Echovirus 11 causes life-threatening hepatic necrosis with coagulopathy and adrenal hemorrhagic necrosis. The prognosis depends on the enterovirus serotype and the absence of serotype-specific maternal antibodies at the time of delivery. We describe a fatal neonatal case of congenital echovirus 11 infection.
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Affiliation(s)
- Tomohiro Hirade
- From the Department of Pediatrics, Shimane Prefectural Central Hospital, Shimane, Japan
| | - Yasuhiro Abe
- From the Department of Pediatrics, Shimane Prefectural Central Hospital, Shimane, Japan
| | - Satoko Ito
- Department of Neonatology, Shimane Prefectural Central Hospital, Shimane, Japan
| | - Tadaki Suzuki
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Harutaka Katano
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Naoto Takahashi
- Department of Pediatrics, University of Tokyo Hospital, Tokyo, Japan
| | - Daisuke Koike
- From the Department of Pediatrics, Shimane Prefectural Central Hospital, Shimane, Japan
| | - Akiyoshi Nariai
- From the Department of Pediatrics, Shimane Prefectural Central Hospital, Shimane, Japan
| | - Fumihide Kato
- Department of Neonatology, Shimane Prefectural Central Hospital, Shimane, Japan
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Storm KK, De Herdt D, Couderé K, Verweij JJ, Torn L, Hundscheid T, van Wering HM. Severe neonatal enterovirus infection in twins with different outcomes: A case report. Front Pediatr 2023; 11:1181698. [PMID: 37744436 PMCID: PMC10511746 DOI: 10.3389/fped.2023.1181698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/08/2023] [Indexed: 09/26/2023] Open
Abstract
Enteroviruses are among the most common causes of acute viral illness worldwide, and in neonates, the clinical course of these infections is heterogeneous. Severe complications, such as myocarditis, are associated with high mortality rates. In this case report, we present the clinical course of premature twins born at 35 weeks of gestational age, suffering from a severe neonatal enterovirus infection with cardiac involvement, which proved fatal in one of the twins. This course led to prompt identification in the other twin and facilitated timely transfer to a neonatal intensive care unit with neonatal hemodynamic expertise, and facilitated the timely transfer to a neonatal intensive care nit with hemodynamic expertise and immediate availability of AZCMO would it have been indicated. Early supportive therapy in the other twin contributed to a positive outcome. Therefore, we emphasize the importance of early recognition in averting adverse consequences. As a recommendation, we propose routine screening of enterovirus in viral panels for febrile newborns.
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Affiliation(s)
- Kelly K. Storm
- Department of Pediatrics, Amphia Hospital, Breda, Netherlands
- Division of Neonatology, Department of Neonatal and Pediatric Intensive Care, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Daan De Herdt
- Department of Pediatrics, Amphia Hospital, Breda, Netherlands
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Karen Couderé
- Microvida, Laboratory of Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | - Jaco J. Verweij
- Microvida, Laboratory of Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | | | - Leo Torn
- Department of Pediatrics, Amphia Hospital, Breda, Netherlands
| | - Tim Hundscheid
- Department of Neonatology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, Netherlands
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Hu YL, Lin SY, Lee CN, Shih JC, Cheng AL, Chen SH, Chang LY, Fang CT. Serostatus of echovirus 11, coxsackievirus B3 and enterovirus D68 in cord blood: The implication of severe newborn enterovirus infection. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023; 56:766-771. [PMID: 37330377 DOI: 10.1016/j.jmii.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 03/06/2023] [Accepted: 05/27/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Maternal transplacental antibody is an important origins of passive immunity against neonatal enterovirus infection. Echovirus 11 (E11) and coxsackievirus B3 (CVB3) are important types causing neonatal infections. There were few investigations of enterovirus D68 (EVD68) infection in neonates. We aimed to investigate the serostatus of cord blood for these three enteroviruses and evaluate the factors associated with seropositivity. METHODS We enrolled 222 parturient (gestational age 34-42 weeks) women aged 20-46 years old between January and October 2021. All participants underwent questionnaire investigation and we collected the cord blood to measure the neutralization antibodies against E11, CVB3 and EVD68. RESULTS The cord blood seropositive rates were 18% (41/222), 60% (134/232) and 95% (211/222) for E11, CVB3 and EVD68, respectively (p < 0.001). Geometric mean titers were 3.3 (95% CI 2.9-3.8) for E11, 15.9 (95% CI 12.5-20.3) for CVB3 and 109.9 (95% CI 92.4-131.6) for EVD68. Younger parturient age (33.8 ± 3.6 versus 35.2 ± 4.4, p = 0.04) was related to E11 seropositivity. Neonatal sex, gestational age and birth body weight were not significantly different between the seropositive group and the seronegative group. CONCLUSION Cord blood seropositive rate and geometric mean titer of E11 were very low, so a large proportion of newborns are susceptible to E11. The circulation of E11 was low after 2019 in Taiwan. A large cohort of immune naïve newborns existed currently due to lack of protective maternal antibodies. It is imminent to monitor the epidemiology of neonates with enterovirus infections and strengthen the relevant preventive policies.
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Affiliation(s)
- Ya-Li Hu
- Department of Paediatrics, Cathay General Hospital, Taiwan; Department of Paediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taiwan
| | - Shin-Yu Lin
- Department of Obstetrics and Gynaecology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taiwan
| | - Chien-Nan Lee
- Department of Obstetrics and Gynaecology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taiwan
| | - Jin-Chung Shih
- Department of Obstetrics and Gynaecology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taiwan
| | - Ai-Ling Cheng
- Department of Paediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taiwan
| | - Shun-Hua Chen
- Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Taiwan
| | - Luan-Yin Chang
- Department of Paediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taiwan.
| | - Chi-Tai Fang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan
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Wang P, Xu Y, Liu M, Li H, Wang H, Liu Y, Wang B, Xia S, Su H, Wei M, Tao L, Chen X, Lu B, Gu X, Lyu H, Zhou W, Zhang H, Gong S. Risk factors and early markers for echovirus type 11 associated haemorrhage-hepatitis syndrome in neonates, a retrospective cohort study. Front Pediatr 2023; 11:1063558. [PMID: 37090924 PMCID: PMC10117901 DOI: 10.3389/fped.2023.1063558] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/14/2023] [Indexed: 04/25/2023] Open
Abstract
Background Echovirus type 11(E-11) can cause fatal haemorrhage-hepatitis syndrome in neonates. This study aims to investigate clinical risk factors and early markers of E-11 associated neonatal haemorrhage-hepatitis syndrome. Methods This is a multicentre retrospective cohort study of 105 neonates with E-11 infection in China. Patients with haemorrhage-hepatitis syndrome (the severe group) were compared with those with mild disease. Clinical risk factors and early markers of haemorrhage-hepatitis syndrome were analysed. In addition, cytokine analysis were performed in selective patients to explore the immune responses. Results In addition to prematurity, low birth weight, premature rupture of fetal membrane, total parenteral nutrition (PN) (OR, 28.7; 95% CI, 2.8-295.1) and partial PN (OR, 12.9; 95% CI, 2.2-77.5) prior to the onset of disease were identified as risk factors of developing haemorrhage-hepatitis syndrome. Progressive decrease in haemoglobin levels (per 10 g/L; OR, 1.5; 95% CI, 1.1-2.0) and platelet (PLT) < 140 × 10⁹/L at early stage of illness (OR, 17.7; 95% CI, 1.4-221.5) were associated with the development of haemorrhage-hepatitis syndrome. Immunological workup revealed significantly increased interferon-inducible protein-10(IP-10) (P < 0.0005) but decreased IFN-α (P < 0.05) in peripheral blood in severe patients compared with the mild cases. Conclusions PN may potentiate the development of E-11 associated haemorrhage-hepatitis syndrome. Early onset of thrombocytopenia and decreased haemoglobin could be helpful in early identification of neonates with the disease. The low level of IFN-α and elevated expression of IP-10 may promote the progression of haemorrhage-hepatitis syndrome.
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Affiliation(s)
- Ping Wang
- Division of Neonatology and Center for Newborn Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yi Xu
- Division of Infectious Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Ming Liu
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huixian Li
- Data Center, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Hui Wang
- Division of Neonatology, Tongji Medical College, Maternal and Child Health Hospital of Hubei Province, Huazhong University of Science and Technology, Wuhan, China
| | - Yumei Liu
- Division of Neonatology, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Bin Wang
- Division of Neonatology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Shiwen Xia
- Division of Neonatology, Tongji Medical College, Maternal and Child Health Hospital of Hubei Province, Huazhong University of Science and Technology, Wuhan, China
| | - Heng Su
- Division of Neonatology and Center for Newborn Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Mou Wei
- Division of Neonatology and Center for Newborn Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Li Tao
- Division of Neonatology and Center for Newborn Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiaowen Chen
- Division of Neonatology and Center for Newborn Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Bingtai Lu
- Medical Research Center of Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaoqiong Gu
- Department of Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hui Lyu
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wei Zhou
- Division of Neonatology and Center for Newborn Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huayan Zhang
- Division of Neonatology and Center for Newborn Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Division of Neonatology, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, United States
| | - Sitang Gong
- Division of Gestroenterology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Wang C, Yang R, Yang F, Han Y, Ren Y, Xiong X, Wang X, Bi Y, Li L, Qiu Y, Xu Y, Zhou X. Echovirus 11 infection induces pyroptotic cell death by facilitating NLRP3 inflammasome activation. PLoS Pathog 2022; 18:e1010787. [PMID: 36026486 PMCID: PMC9455886 DOI: 10.1371/journal.ppat.1010787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 09/08/2022] [Accepted: 08/01/2022] [Indexed: 11/28/2022] Open
Abstract
Echovirus 11 (ECHO 11) is a positive-strand RNA virus belonging to the genus Enterovirus of the family Picornaviridae. ECHO 11 infections can cause severe inflammatory illnesses in neonates, including severe acute hepatitis with coagulopathy. The activation of NLRP3 inflammasome is important for host defense against invading viruses, which also contributes to viral pathogenicity. However, whether and how ECHO 11 induces NLRP3 inflammasome activation remains unclear. In this study, we isolated a clinical strain of ECHO 11 from stools of an ECHO 11-infected newborn patient with necrotizing hepatitis. This virus shared 99.95% sequence identity with the previously published ECHO 11 sequence. The clinically isolated ECHO 11 can efficiently infect liver cells and strongly induces inflammation. Moreover, we showed that ECHO 11 induced IL-1β secretion and pyroptosis in cells and mouse bone marrow-derived macrophages (BMDMs). Furthermore, ECHO 11 infection triggered NLRP3 inflammasome activation, as evidenced by cleavages of GSDMD, pro-IL-1β and pro-caspase-1, and the release of LDH. ECHO 11 2B protein was required for NLRP3 inflammasome activation via interacting with NLRP3 to facilitate the inflammasome complex assembly. In vivo, expression of ECHO 11 2B also activated NLRP3 inflammasome in the murine liver. Besides, 2Bs of multiple EVs can also interact with NLRP3 and induce NLRP3 inflammasome activation. Together, our findings demonstrate a mechanism by which ECHO 11 induces inflammatory responses by activating NLRP3 inflammasome, providing novel insights into the pathogenesis of ECHO 11 infection. NLRP3 inflammasome is important for host defense against invading viruses, and contributes to viral pathogenicity. Human echovirus 11 (ECHO 11) belongs to the Enterovirus genus from the family Picornavirida, and it can cause severe acute hepatitis in newborns with high morbidity and mortality. However, the knowledge about the pathogenesis of ECHO 11 infection is limited. Whether and how ECHO 11 induces NLRP3 inflammasome activation remains unclear. This work provides the first demonstration that ECHO 11 can induce inflammatory responses via activating NLRP3 inflammasome and pyroptosis. More importantly, ECHO 11-encoded 2B protein was found to activate NLRP3 inflammasome in cells and in vivo, and the interaction between 2B and NLRP3 was required for inflammasome complex assembly. Furthermore, we uncovered that 2Bs of other enteroviruses, including enterovirus 71, coxsackievirus A16 (CVA16) and CVB3 could induce NLRP3 inflammasome and interact with NLRP3. Our findings uncover a mechanism by which ECHO 11 induces inflammatory responses and demonstrate a novel function of ECHO 11 2B.
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Affiliation(s)
- Chong Wang
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou, Guangdong, China
- State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, Hubei, China
| | - Ruyi Yang
- State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, Hubei, China
| | - Fengxia Yang
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou, Guangdong, China
| | - Yang Han
- Joint Laboratory of Infectious Diseases and Health, Wuhan Institute of Virology & Wuhan Jinyintan Hospital, Wuhan Jinyintan Hospital, Wuhan, Hubei, China
| | - Yujie Ren
- State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, Hubei, China
| | - Xiaobei Xiong
- State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, Hubei, China
| | - Xingyun Wang
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou, Guangdong, China
| | - Yidan Bi
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou, Guangdong, China
| | - Lijun Li
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou, Guangdong, China
| | - Yang Qiu
- State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, Hubei, China
- * E-mail: (YQ); (YX); (XZ)
| | - Yi Xu
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou, Guangdong, China
- * E-mail: (YQ); (YX); (XZ)
| | - Xi Zhou
- State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, Hubei, China
- * E-mail: (YQ); (YX); (XZ)
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Singh S, Mane SS, Kasniya G, Cartaya S, Rahman MM, Maheshwari A, Motta M, Dudeja P. Enteroviral Infections in Infants. NEWBORN (CLARKSVILLE, MD.) 2022; 1:297-305. [PMID: 36304567 PMCID: PMC9599990 DOI: 10.5005/jp-journals-11002-0036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Enteroviruses (EVs) are major pathogens in young infants. These viruses were traditionally classified into the following four subgenera: polio, coxsackie A and B, and echoviruses. Now that poliomyelitis seems to be controlled in most parts of the world, coxsackie and echoviruses are gaining more attention because (i) the structural and pathophysiological similarities and (ii) the consequent possibilities in translational medicine. Enteroviruses are transmitted mainly by oral and fecal-oral routes; the clinical manifestations include a viral prodrome including fever, feeding intolerance, and lethargy, which may be followed by exanthema; aseptic meningitis and encephalitis; pleurodynia; myopericarditis; and multi-system organ failure. Laboratory diagnosis is largely based on reverse transcriptase-polymerase chain reaction, cell culture, and serology. Prevention and treatment can be achieved using vaccination, and administration of immunoglobulins and antiviral drugs. In this article, we have reviewed the properties of these viruses, their clinical manifestations, and currently available methods of detection, treatment, and prognosis.
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Affiliation(s)
- Srijan Singh
- Department of Pediatrics, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Sushant Satish Mane
- Department of Pediatrics, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Gangajal Kasniya
- Department of Pediatrics, Cohen Children’s Medical Center, New Hyde Park, New York, United States of America
| | - Sofia Cartaya
- Department of Pediatrics, University of South Florida, Tampa, Florida, United States of America
| | - Mohd Mujibur Rahman
- Department of Neonatology, Institute of Child and Mother Health, Dhaka, Bangladesh
| | - Akhil Maheshwari
- Global Newborn Society, Clarksville, Maryland, United States of America
| | - Mario Motta
- Neonatologia e Terapia Intensiva Neonatale ASST Spedali Civili di Brescia, Italy
| | - Pradeep Dudeja
- Department of Gastroenterology, University of Illinois at Chicago, Illinois, United States of America
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Belov Y, Many A, Givon I, Marom R, Yogev Y, Halutz O, Fouks Y. Maternal presentation and neonatal outcome in peripartum enterovirus infection. Acta Paediatr 2021; 110:1483-1489. [PMID: 33251624 DOI: 10.1111/apa.15703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 11/29/2022]
Abstract
AIM Enterovirus is a common pathogen. Although mostly asymptomatic, this infection has the potential to be life-threatening in neonates. This article aims to describe the early neonatal outcomes in peripartum infection. METHODS We performed a retrospective cohort study in a tertiary hospital between 1/2014 and 5/2019. The enterovirus infection was established by real-time polymerase chain reaction analysis. RESULTS Out of 161 neonates tested for the enterovirus infection 13 (8%) were positive. Maternal fever was the most common sign (n = 8, 66.7%). The mean gestational age at delivery was 36 + 5 (range 30 + 5 to 40 + 6 weeks). The mean time interval from birth to neonatal manifestations of infection was 5.2 (0-9) days. The most common presenting sign in the neonates was fever (n = 8, 61.5%). All neonates required the neonatal intensive care unit. The neonatal mortality rate was 3/13 (23%). CONCLUSION The neonatal morbidity and mortality from the enterovirus infection may have been associated with the severity of maternal presentation at the time of admission. Enterovirus real-time polymerase chain reaction analysis should be considered as part of the maternal evaluation in cases of maternal fever of unknown origin. Deferral of the induction of delivery for term pregnancies with confirmed enterovirus infections should be considered.
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Affiliation(s)
- Yekaterina Belov
- Department of Obstetrics and Gynecology Tel Aviv Sourasky Medical Centre Lis Maternity Hospital Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Ariel Many
- Department of Obstetrics and Gynecology Tel Aviv Sourasky Medical Centre Lis Maternity Hospital Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Ido Givon
- Department of Obstetrics and Gynecology Tel Aviv Sourasky Medical Centre Lis Maternity Hospital Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Ronella Marom
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Neonatology Department Tel Aviv Sourasky Medical Centre Dana Dwek Children’s Hospital Tel Aviv Israel
| | - Yariv Yogev
- Department of Obstetrics and Gynecology Tel Aviv Sourasky Medical Centre Lis Maternity Hospital Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Ora Halutz
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Virology Laboratory Division of Medical Microbiology Tel Aviv Sourasky Medical Centre Tel Aviv Israel
| | - Yuval Fouks
- Department of Obstetrics and Gynecology Tel Aviv Sourasky Medical Centre Lis Maternity Hospital Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
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Enteroviral infection in neonates. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2019; 52:851-857. [PMID: 31607572 DOI: 10.1016/j.jmii.2019.08.018] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 08/14/2019] [Accepted: 08/20/2019] [Indexed: 01/26/2023]
Abstract
Enteroviruses generally cause mild and self-limited diseases, but they have been found to affect neonates much differently, and often more severely than older children. Clinical manifestations are difficult to differentiate from those of bacterial sepsis, such as fever, poor feeding, lethargy, respiratory distress and cardiovascular collapse. Severe life threatening complications, including hepatic necrosis with coagulopathy, meningoencephalitis and myocarditis, usually present during the first week of life. Factors affecting severity and outcome include virus serotype, mode of transmission, and presence or absence of passively acquired, serotype-specific maternal antibodies. Echoviruses and coxsackievirus B viruses are most common serotypes associated with the neonatal sepsis. An awareness of the clinical syndromes, recognition of the risk factors and monitoring parameters associated with severe cases and use of rapid reverse-transcriptase polymerase chain reaction test for viral load may help physicians in diagnosing severe cases in a timely manner. Prompt aggressive treatment including early intravenous immunoglobulin treatment may help in reducing morbidity and mortality. Enterovirus infections in neonates are common and should be routinely considered in the differential diagnosis of febrile neonates, particularly during enterovirus season. This article provides an overview of what is known about non-polio enteroviruses in neonates including epidemiology, transmission, clinical presentation, diagnosis, and treatment.
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Kadambari S, Braccio S, Ribeiro S, Allen DJ, Pebody R, Brown D, Cunney R, Sharland M, Ladhani S. Enterovirus and parechovirus meningitis in infants younger than 90 days old in the UK and Republic of Ireland: a British Paediatric Surveillance Unit study. Arch Dis Child 2019; 104:552-557. [PMID: 30530486 DOI: 10.1136/archdischild-2018-315643] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 11/06/2018] [Accepted: 11/07/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study aimed to prospectively collect detailed clinical information for all enterovirus (EV) and human parechovirus (HPeV) meningitis cases in infants aged <90 days in the UK and Ireland. PARTICIPANTS, DESIGN AND SETTING Prospective, active national surveillance during July 2014 to July 2015 through the British Paediatric Surveillance Unit. Reporting paediatricians completed questionnaires requesting information on clinical presentation, investigations, management and outcomes at hospital discharge and after 12 months. MAIN OUTCOME MEASURES To describe the clinical burden of EV and HPeV meningitis in infants aged <90 days. RESULTS During the 13-month surveillance period, 703 cases (668 EV, incidence0.79/1,000 live- births; 35 HPeV, 0.04/1,000 live-births) were identified. The most common clinical presentations were fever (EV: 570/668(85%); HPeV: 28/35(80%)), irritability (EV: 441/668(66%); HPeV: 23/35(66%)) and reduced feeding (EV: 363/668(54%); HPeV 23/35(66%)). Features of circulatory shock were present in 27% (182/668) of EV and 43% (15/35) of HPeV cases. Overall, 11% (76/668) of EV and 23% (8/35) of HPeV cases required intensive care support. Nearly all cases (678/703, 96%) were confirmed by cerebrospinal fluid (CSF) PCR, with 52% (309/600) having normal CSF white cell count for age. Two infants with EV meningitis died (2/668, 0.3%) and four survivors (4/666, 0.6%) had long-term complications at 12 months' follow-up. Infants with HPeV meningitis survived without sequelae. Overall 189 infants had a formal hearing test and none had sensorineural hearing loss. CONCLUSION The incidence of laboratory-confirmed EV/HPeV meningitis in young infants is more than twice that for bacterial meningitis. Less than 1% will develop severe neurological complications or die of their infection. Further studies are required to formally assess long-term neurodevelopmental sequelae.
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Affiliation(s)
- Seilesh Kadambari
- Paediatric Infectious Diseases Research Group, St George's University of London, London, UK.,Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Serena Braccio
- Paediatric Infectious Diseases Research Group, St George's University of London, London, UK
| | - Sonia Ribeiro
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, Colindale, London, UK
| | - David J Allen
- Virology Reference Department, Public Health England, London, UK
| | - Richard Pebody
- Influenza and other Respiratory Viruses Section, Public Health England, London, UK
| | - David Brown
- Virology Reference Department, Public Health England, London, UK
| | - Robert Cunney
- Department of Microbiology, Temple Street Children's University Hospital, Dublin, Ireland
| | - Mike Sharland
- Paediatric Infectious Diseases Research Group, St George's University of London, London, UK
| | - Shamez Ladhani
- Paediatric Infectious Diseases Research Group, St George's University of London, London, UK.,Immunisation, Hepatitis and Blood Safety Department, Public Health England, Colindale, London, UK
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10
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Azuma J, Yamamoto T, Sakurai M, Amou R, Yamada C, Hashimoto K, Kajita S, Yamamoto K, Kijima E, Mizoguchi Y, Nakata K, Shimotsuji T, Ozono K. Urinary β2-microglobulin as an early marker of infantile enterovirus and human parechovirus infections. Medicine (Baltimore) 2018; 97:e12930. [PMID: 30412100 PMCID: PMC6221734 DOI: 10.1097/md.0000000000012930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Enterovirus and human parechovirus (HPeV) are RNA viruses belonging to the family Picornaviridae that frequently infect infants. These infections show a wide variety of clinical manifestations, from mild to severe. However, there are no known early clinical markers for diagnosis and prediction of disease severity. The aim of this study was to examine the clinical utility of urinary beta 2-microglobulin (β2MG) for the early detection and prognosis of infantile enterovirus and HPeV infections.This retrospective study included 108 full-term infants younger than 60 days of age, including 15 with enterovirus or HPeV-3 (enterovirus/HPeV-3), 22 with respiratory syncytial virus (RSV), and 24 with bacterial infections. Laboratory data and clinical characteristics were compared among these 3 groups. Of the 15 patients with enterovirus/HPeV-3, 6 were treated with intravenous immunoglobulin (IVIG subgroup) because of severe clinical conditions.Urinary β2MG to creatinine ratio (β2MG/Cr) was significantly higher in the enterovirus/HPeV-3 group compared to bacterial and RSV infection groups (both P < .001). In the enterovirus/HPeV-3 group, mean peak urinary β2MG/Cr was observed on day 1 or 2. Urinary β2MG/Cr values were significantly higher in the IVIG subgroup than the non-IVIG subgroup (P < .001).Increased urinary β2MG/Cr in early-stage infection may be a useful clinical marker for the detection and prediction of infantile enterovirus and HPeV infection severity.
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Affiliation(s)
- Junji Azuma
- Department of Pediatrics, Minoh City Hospital
| | | | | | - Ryuko Amou
- Department of Pediatrics, Minoh City Hospital
| | | | | | | | | | - Eri Kijima
- Department of Pediatrics, Minoh City Hospital
| | | | - Keiko Nakata
- Department of Infectious Diseases, Osaka Institute of Public Health, Osaka, Japan
| | | | - Keiichi Ozono
- Department of Pediatrics, Osaka University Graduate School of Medicine
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11
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Abstract
Infections during pregnancy may affect a developing fetus. If left untreated, these infections can lead to the death of the mother, fetus, or neonate and other adverse sequelae. There are many factors that impact infection during pregnancy, such as the immune system changes during pregnancy, hormonal flux, stress, and the microbiome. We review some of the outcomes of infection during pregnancy, such as preterm birth, chorioamnionitis, meningitis, hydrocephaly, developmental delays, microcephaly, and sepsis. Transmission routes are discussed regarding how a pregnant woman may pass her infection to her fetus. This is followed by examples of infection during pregnancy: bacterial, viral, parasitic, and fungal infections. There are many known organisms that are capable of producing similar congenital defects during pregnancy; however, whether these infections share common mechanisms of action is yet to be determined. To protect the health of pregnant women and their offspring, additional research is needed to understand how these intrauterine infections adversely affect pregnancies and/or neonates in order to develop prevention strategies and treatments.
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12
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Abstract
Infections with enteroviruses and human parechoviruses are highly prevalent, particularly in neonates, where they may cause substantial morbidity and mortality. Individuals with B-cell-related immunodeficiencies are at risk for severe enteroviral infections, usually a chronic and fatal meningoencephalitis. In transplant recipients and patients with malignancy, enterovirus infections typically involve the respiratory tract, but cases of severe, disseminated infection have been described. The mainstay of diagnosis for enterovirus and human parechovirus infections involves the use of molecular diagnostic techniques. However, routine nucleic acid-detection methods for enteroviruses will not detect human parechoviruses. Laboratory diagnosis of these viral infections is important in determining a patient's prognosis and guiding clinical management.
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13
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Abstract
There are currently 12 species and over 100 serotypes that have been identified in the enterovirus genus, including the coxsackieviruses, echoviruses, and polioviruses. Since their discovery 65 years ago, much has been discovered and continues to be researched regarding the pathogenicity and scope of disease of nonpolio enteroviruses. Like many infections, enteroviruses have been found to affect neonates much differently, and often more severely, than older children and adults. Neonatal infections often cause mild illnesses with nonspecific symptoms, but they may also have severe presentations involving the cardiovascular, gastrointestinal, hematologic, or central nervous systems. This article provides an overview of what is known about nonpolio enteroviruses in neonates including epidemiology, transmission, clinical presentation, diagnosis, and treatment.
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14
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Abstract
Early-onset sepsis remains a common and serious problem for neonates, especially preterm infants. Group B streptococcus (GBS) is the most common etiologic agent, while Escherichia coli is the most common cause of mortality. Current efforts toward maternal intrapartum antimicrobial prophylaxis have significantly reduced the rates of GBS disease but have been associated with increased rates of Gram-negative infections, especially among very-low-birth-weight infants. The diagnosis of neonatal sepsis is based on a combination of clinical presentation; the use of nonspecific markers, including C-reactive protein and procalcitonin (where available); blood cultures; and the use of molecular methods, including PCR. Cytokines, including interleukin 6 (IL-6), interleukin 8 (IL-8), gamma interferon (IFN-γ), and tumor necrosis factor alpha (TNF-α), and cell surface antigens, including soluble intercellular adhesion molecule (sICAM) and CD64, are also being increasingly examined for use as nonspecific screening measures for neonatal sepsis. Viruses, in particular enteroviruses, parechoviruses, and herpes simplex virus (HSV), should be considered in the differential diagnosis. Empirical treatment should be based on local patterns of antimicrobial resistance but typically consists of the use of ampicillin and gentamicin, or ampicillin and cefotaxime if meningitis is suspected, until the etiologic agent has been identified. Current research is focused primarily on development of vaccines against GBS.
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15
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Fuchs I, Golan A, Borer A, Shemer-Avni Y, Dagan R, Greenberg D. Proactive approach to containment of enterovirus infection in the nursery. Clin Pediatr (Phila) 2013; 52:639-44. [PMID: 23572447 DOI: 10.1177/0009922813484087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Administration of prophylactic intravenous immunoglobulins to contacts of infants actively shedding enterovirus during a hospital nursery outbreak may attenuate severity of disease in those contacts and aid in containment of the outbreak. Four cases of neonatal enteroviral disease were treated in our hospital nursery in July and August 2011; 3 were presumed or proven vertical transmission cases and 1 was a presumed horizontal transmission. We aimed to prevent development of severe illness in contacts of affected neonates following a ministry of health advisory during the summer of 2011 warning of increased neonatal enteroviral morbidity and mortality in Israel. Strict infection control measures were implemented, including meticulous decontamination of the nursery environment and administration of intravenous immunoglobulin prophylaxis to contacts. No further horizontal transmission occurred after infection control interventions. Immunoglobulin prophylaxis to control enteroviral infection in the nursery should be considered as an auxiliary infection control intervention during a nursery outbreak.
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Affiliation(s)
- Inbal Fuchs
- The Pediatric Infectious Disease Unit, Soroka University Medical Center and Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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16
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Muñoz-Vélez M, Cabrerizo M, Zozaya C, Romero-Gómez MP. [Favourable outcome in a case of a severe neonatal disease due to echovirus 11]. Enferm Infecc Microbiol Clin 2013; 31:561-2. [PMID: 23517742 DOI: 10.1016/j.eimc.2013.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 01/17/2013] [Accepted: 01/22/2013] [Indexed: 10/27/2022]
Affiliation(s)
- Marta Muñoz-Vélez
- Servicio de Microbiología, Hospital Universitario La Paz, IdiPAZ, Madrid, España
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17
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Detection of enteroviral RNA from preserved umbilical cord. J Clin Virol 2013; 56:274-5. [DOI: 10.1016/j.jcv.2012.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 11/07/2012] [Accepted: 11/13/2012] [Indexed: 11/23/2022]
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18
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van den Berg-van de Glind GJ, de Vries JJC, Wolthers KC, Wiggers-de Bruine FT, Peeters-Scholte CMPCD, van den Hende M, van Wezel-Meijler G. A fatal course of neonatal meningo-encephalitis. J Clin Virol 2012; 55:91-4. [PMID: 22673128 DOI: 10.1016/j.jcv.2012.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 05/08/2012] [Accepted: 05/09/2012] [Indexed: 11/29/2022]
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19
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Abstract
Enteroviruses, which include echoviruses, coxsackie A and B viruses, polioviruses and the 'numbered' enteroviruses, are among the most common viruses causing disease in humans. A large proportion of enteroviral infections occur in neonates and infants. There is a wide spectrum of clinical manifestations that can be caused by enterovirus infection with varying degrees of severity. In the neonatal age group, enteroviral infections are associated with significant morbidity and mortality, particularly when infection occurs antenatally. This review provides a detailed overview of the epidemiology and clinical features of enterovirus infections in the neonatal period. In addition, laboratory features and diagnostic investigations are discussed. A review of the currently available data for prophylactic and therapeutic interventions, including antiviral therapy, is also presented.
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Affiliation(s)
- Marc Tebruegge
- Department of Paediatrics, The University of Melbourne, Royal Children's Hospital Melbourne, Flemington Road, Parkville, VIC 3052, Australia
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20
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Pérez-Vélez CM, Anderson MS, Robinson CC, McFarland EJ, Nix WA, Pallansch MA, Oberste MS, Glodé MP. Outbreak of Neurologic Enterovirus Type 71 Disease: A Diagnostic Challenge. Clin Infect Dis 2007; 45:950-7. [PMID: 17879907 DOI: 10.1086/521895] [Citation(s) in RCA: 154] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Accepted: 07/02/2007] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Similar to poliovirus, enterovirus type 71 (EV71) causes severe disease, including aseptic meningitis, encephalitis, acute flaccid paralysis, and acute cardiopulmonary dysfunction. Large epidemics of EV71 infection have been reported worldwide. METHODS After recognition of a cluster of cases of EV71 disease, we reviewed records of patients with EV71 disease who required hospitalization at The Children's Hospital in Denver, Colorado, from 2003 through 2005. The presence of enterovirus was detected by reverse-transcriptase polymerase chain reaction (PCR) and/or viral culture of specimens from multiple sources, and the virus was typed as EV71 using genetic sequencing. RESULTS Eight cases of EV71 disease were identified in both 2003 and 2005. Fifty-six percent of patients with EV71 disease were < or = 6 months of age (range, 4 weeks to 9 years). All 16 patients had EV71 central nervous system infection. Enterovirus PCR (EV-PCR) of cerebrospinal fluid specimens yielded positive results for only 5 (31.2%) of the 16 patients; all of these patients were < 4 months of age and had less severe disease. However, EV-PCR of upper respiratory tract specimens yielded positive results for 8 (100%) of 8 patients, and EV-PCR of lower gastrointestinal tract specimens yielded positive results for 7 (87.5%) of 8 patients. CONCLUSIONS An outbreak of neurologic EV71 disease occurred in Denver, Colorado, during 2003 and 2005. Likely, EV71 disease remains unrecognized in other parts of the United States, because EV-PCR of cerebrospinal fluid frequently yields negative results. EV-PCR of specimens from the respiratory and gastrointestinal tracts had higher diagnostic yields than did EV-PCR of cerebrospinal fluid. EV71 infection should be considered in young children presenting with aseptic meningitis, encephalitis, acute flaccid paralysis, or acute cardiopulmonary collapse. EV71 infection may be an underrecognized emerging disease in the United States.
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Affiliation(s)
- Carlos M Pérez-Vélez
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado School of Medicine, and The Children's Hospital, Denver, Colorado 80218, USA.
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21
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Abstract
This case report describes a 36-week gestational age infant diagnosed with coxsackie B1 meningitis at 20 days of age. A head ultrasound 5 days after diagnosis was consistent with cystic periventricular leukomalacia. The scientific literature does not clearly elucidate differences between bacterial and viral infections in infants. When difficulties arise, it is pertinent to consider a viral etiology for the underlying illness and obtain a detailed maternal and infant history focusing on clinical symptoms, seasonality, geographic location, exposure, and incubation period. Polymerase chain reaction is a rapid and sensitive diagnostic test for the identification of enteroviruses in cerebrospinal fluid, blood, urine, and throat specimens and should be performed as part of the general workup in the evaluation of a febrile infant with sepsis. In retrospect, it may have established an earlier diagnosis of meningitis, consequently preventing the unnecessary use of antibiotics, potentially decreasing the length of hospitalization, and eliminating the need for more detailed investigations to rule out other etiological factors. In addition, treatment with pleconaril may have affected the severity of the encephalitis. This article reviews the pathogenesis, clinical manifestations, and differential diagnoses of enteroviral infections, specifically focusing on the prevention, treatment, and prognosis of the disease and the implications for clinical practice.
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22
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Yen MH, Tsao KC, Huang YC, Huang CG, Huang YL, Lin R, Chang ML, Huang CC, Yan DC, Lin TY. Viral Load in Blood Is Correlated with Disease Severity of Neonatal Coxsackievirus B3 Infection: Early Diagnosis and Predicting Disease Severity Is Possible in Severe Neonatal Enterovirus Infection. Clin Infect Dis 2007; 44:e78-81. [PMID: 17443457 DOI: 10.1086/515399] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Accepted: 01/30/2007] [Indexed: 11/04/2022] Open
Abstract
We conducted a study during an outbreak of coxsackievirus B3 infection in 2005 and found that viral RNA could be detected in patients' blood specimens soon after the onset of fever, and the level of viral RNA was positively correlated with disease severity. Timely diagnosis is possible in severe neonatal enterovirus infection.
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Affiliation(s)
- Meng-Hsiu Yen
- Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan
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23
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Abstract
Coxsackievirus B3 can cause severe neonatal disease with high mortality. We present the first report of detection of coxsackievirus B3 in the mothers' milk of 2 severely infected neonates by culture and reverse transcriptase-polymerase chain reaction. Reverse transcriptase-polymerase chain reaction is a rapid and sensitive tool to detect coxsackievirus B3 in breast milk within few hours. By 12 to 14 days after onset of symptoms, coxsackievirus B3 could not be detected in the breast milk of the symptomatic mothers.
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Affiliation(s)
- Mei-Ling Chang
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Tiawan
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24
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Abstract
The nonpoliovirus enteroviruses commonly infect newborns, with consequences ranging from asymptomatic infection and benign illness, to severe, life-threatening disease. Frequently occurring symptoms include fever, irritability, lethargy, anorexia, and rash. Although most illnesses are mild, severe disease develops in a subset of newborns infected in the first 2 weeks of life. Severe disease may consist of sepsis, meningoencephalitis, myocarditis, pneumonia, hepatitis, and/or coagulopathy. Substantial mortality rates have been reported, and long-term sequelae may occur among survivors. Risk factors and clinical features associated with severe disease include absence of neutralizing antibody to the infecting serotype, maternal illness prior to or at delivery, prematurity, illness onset within the first few days of life, multiorgan disease, severe hepatitis, positive serum viral culture, and specific infecting serotype (e.g. group B coxsackieviruses and echovirus 11). Whereas the mainstay of diagnosis has traditionally been viral isolation in tissue culture, the polymerase chain reaction has been demonstrated to be more sensitive than culture, highly specific, and rapid. Immunoglobulin has been used as a therapeutic agent for neonates with enterovirus disease; however, clinical efficacy has not been proven. Specific antiviral therapy for enteroviruses is in development. Pleconaril is an investigational agent that inhibits viral attachment to host cell receptors and uncoating of viral nucleic acid. It has broad and potent anti-enterovirus activity, excellent oral bioavailability, and is well tolerated. Some clinical trials have demonstrated benefit in children and adults with enterovirus meningitis, and in adults with upper respiratory tract infections caused by picornaviruses (rhinoviruses or enteroviruses). Data summarizing compassionate use for severe enterovirus diseases (including neonatal sepsis) also suggest possible benefit. Limited pharmacokinetic data are available in infants and neonates. A multicenter, placebo-controlled, randomized trial of pleconaril in neonates with severe hepatitis, coagulopathy, and/or myocarditis is currently being conducted.
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Affiliation(s)
- Mark J Abzug
- Department of Pediatrics, Pediatric Infectious Diseases, University of Colorado School of Medicine and The Children's Hospital, Denver, Colorado 80218, USA
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25
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Lin TY, Kao HT, Hsieh SH, Huang YC, Chiu CH, Chou YH, Yang PH, Lin RI, Tsao KC, Hsu KH, Chang LY. Neonatal enterovirus infections: emphasis on risk factors of severe and fatal infections. Pediatr Infect Dis J 2003; 22:889-94. [PMID: 14551490 DOI: 10.1097/01.inf.0000091294.63706.f3] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Neonatal enterovirus infections have diverse manifestations, from asymptomatic to fatal. An understanding of the risk factors associated with severe cases might help to reduce enterovirus-related morbidity and mortality. METHODS From July 1989 through June 1998, neonates with virus culture-confirmed nonpolio enterovirus infection at Chang Gung Children's Hospital were enrolled in the study and divided into three groups: nonspecific febrile illness; aseptic meningitis; and hepatic necrosis with coagulopathy (HNC). Demographic factors, clinical manifestations, laboratory data and outcome were analyzed to reveal factors associated with clinical severity and fatality. RESULTS There were 146 cases including 43 neonates with nonspecific febrile illness, 61 with aseptic meningitis and 42 with HNC. By multiple logistic regression analysis, the most significant factors associated with HNC were prematurity, maternal history of illness, earlier age of onset (< or =7 days), higher white blood cell count (WBC > or =15 000/mm3) and lower hemoglobin (< or =10.7 g/dl). In 10 (24%) of 42 cases, HNC was fatal. In comparison with nonfatal cases of HNC, fatal cases had higher WBC, lower hemoglobin, higher bilirubin and higher incidence of concurrent myocarditis. Multivariate analysis showed the most significant factors associated with fatality from HNC to be total bilirubin >14.3 mg/dl (adjusted odds ratio, 29.1; 95% confidence interval, 2.5 to 355.5; P = 0.007) and concurrent myocarditis (adjusted odds ratio, 13.7; 95% confidence interval, 1.1 to 177.2; P = 0.04). Intravenous immunoglobulin did not correlate with clinical outcomes in cases with HNC. CONCLUSIONS Prematurity, maternal history of illness, earlier age of onset, higher WBC and lower hemoglobin are significant factors associated with HNC; higher total bilirubin and concurrent myocarditis were most significantly associated with fatality from HNC.
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Affiliation(s)
- Tzou-Yien Lin
- Division of Pediatric Infecti=ious Diseases, Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan
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26
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Nishikii Y, Nakatomi A, Doi T, Oka S, Moriuchi H. Favorable outcome in a case of perinatal enterovirus 71 infection. Pediatr Infect Dis J 2002; 21:886-7. [PMID: 12380593 DOI: 10.1097/00006454-200209000-00024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 5-day-old newborn baby presented with skin eruption, oral vesicles, and fever. His mother developed skin eruption at the same time, and his four-year-old sister was diagnosed with hand-foot-mouth disease 1 week before his delivery. Enterovirus 71 was isolated from cerebrospinal fluid that showed mild pleocytosis. This rare case of virology documented perinatal enterovirus 71 infection recovered without sequelae.
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Affiliation(s)
- Yumi Nishikii
- Department of Pediatrics Sasebo Kyosai Hospital Sasebo, Japan
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27
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Abstract
The picornaviruses are a diverse group of viral pathogens that together comprise the most common causes of infections of humans in the developed world. Within the picornavirus family are three well-known groups of human pathogens-the enteroviruses (including polioviruses, coxsackieviruses, and echoviruses), the rhinoviruses, and the hepatoviruses (including hepatitis A). Recently, the parechoviruses (formerly, echoviruses 22 and 23) have been classified as a fourth genus of human picornaviruses. This article will focus on the enteroviruses and rhinoviruses agents, for which substantial effort has been expended and recent successes reported towards the development of safe and effective antiviral therapy.
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Affiliation(s)
- Harley A Rotbart
- Department of Pediatrics, University of Colorado School of Medicine, 4200 E. 9th Avenue, Box C227, Denver, CO 80262, USA.
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28
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Abstract
Neonatal enteroviral hepatitis carries high morbidity and mortality. We treated three full term neonates with severe enteroviral hepatitis with pleconaril on an open label compassionate use protocol. Each mother had history of a viral-like syndrome within 1 week before delivery. The neonates presented at 4 to 5 days of age with fulminant hepatic failure with severe coagulopathy, and each yielded an echovirus. All were treated with pleconaril (VP63843) at 5 mg/kg every 8 h by nasogastric tube. Two of the three neonates with life-threatening enteroviral hepatitis recovered fully. Further experience with pleconaril for neonatal enteroviral hepatitis is warranted.
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Affiliation(s)
- E Aradottir
- Department of Pediatrics, Northwestern University Medical School, Children's Memorial Hospital, Chicago, IL, USA
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29
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Infections nosocomiales à entérovirus en néonatalogie et dans les nurseries: un risque à ne pas négliger. Med Mal Infect 2000. [DOI: 10.1016/s0399-077x(01)80001-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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30
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Abstract
The picornaviruses are a diverse group of viral pathogens that together comprise the most common causes of infection of humans in the developed world. Within the picornavirus family are three well-known groups of human pathogens--the rhinoviruses, the enteroviruses (including polioviruses, coxsackieviruses and echoviruses) and the hepatoviruses (including hepatitis A virus). This article will focus on the rhinoviruses and enteroviruses, agents for which substantial effort has been expended, and recent successes reported, toward the development of safe and effective antiviral therapy.
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Affiliation(s)
- H A Rotbart
- University of Colorado School of Medicine, Department of Pediatrics, Denver, USA.
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31
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Chambon M, Bailly JL, Béguet A, Henquell C, Archimbaud C, Gaulme J, Labbé A, Malpuech G, Peigue-Lafeuille H. An outbreak due to echovirus type 30 in a neonatal unit in France in 1997: usefulness of PCR diagnosis. J Hosp Infect 1999; 43:63-8. [PMID: 10462641 DOI: 10.1053/jhin.1999.0634] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Between February and August 1997, 53 patients with enterovirus meningitis were hospitalized in Clermont-Ferrand, France. All but one were children. Echovirus type 30 was involved in 70% of cases with identified serotype. The outbreak ceased on August 8. Two months later, a neonate was admitted to the neonatal unit with an echovirus type 30 meningitis thought to be acquired at delivery. Twenty days later a nosocomial outbreak of echovirus type 30 involving five neonates occurred. Two of them presented with meningitis and two with febrile seizure; One was asymptomatic. The retrospective examination of the maternal sera in a neutralization test, using the index case strain as a source of antigen, showed that none of the neonates was passively immunized before hospitalization. The use of genome detection in cerebrospinal fluid allowed rapid diagnosis and infection was contained by re-inforcing hygiene measures. Prospective examination of stools in the neonatal and paediatric units showed no further occurrences of the disease. No sporadic case was observed in the general population. Hence, nosocomial infections can occur a long time after an outbreak in the general population; rapid diagnosis with molecular tools is useful both for a definite diagnosis in patients already hospitalized, and to act as a rapid alert, even in intervals between seasonal outbreaks.
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Affiliation(s)
- M Chambon
- Departments of Paediatrics and Clinical Virology, Centre Hospitalier Universitaire, Clermont-Ferrand, France
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32
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33
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Affiliation(s)
- H A Rotbart
- University of Colorado School of Medicine, Department of Pediatrics, Denver 80262, USA
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34
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Abstract
Clinical manifestations of neonatal echovirus type 18 infections include a nonspecific febrile illness, diarrhea, and meningitis with or without exanthem. We report a successful outcome in a case of neonatal sepsis with shock caused by echovirus type 18, a complication not previously associated with this serotype.
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Affiliation(s)
- S S Shah
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
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35
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Galama JMD, Vogels MTE, Jansen GH, Gielen M, Heessen FWA. Antibodies against enteroviruses in intravenous Ig preparations: Great variation in titres and poor correlation with the incidence of circulating serotypes. J Med Virol 1997. [DOI: 10.1002/(sici)1096-9071(199711)53:3<273::aid-jmv16>3.0.co;2-i] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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36
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Affiliation(s)
- J F Modlin
- Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA
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37
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Verboon-Maciolek MA, Swanink CM, Krediet TG, van Loon AM, Bruning HJ, Kaan JA, Gerards LJ, Galama JM, Fleer A. Severe neonatal echovirus 20 infection characterized by hepatic failure. Pediatr Infect Dis J 1997; 16:524-7. [PMID: 9154551 DOI: 10.1097/00006454-199705000-00016] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- M A Verboon-Maciolek
- Department of Neonatology, University Children's Hospital, Utrecht, The Netherlands
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38
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Dagan R. Nonpolio enteroviruses and the febrile young infant: epidemiologic, clinical and diagnostic aspects. Pediatr Infect Dis J 1996; 15:67-71. [PMID: 8684880 DOI: 10.1097/00006454-199601000-00015] [Citation(s) in RCA: 107] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- R Dagan
- Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
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39
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Valduss D, Murray DL, Karna P, Lapour K, Dyke J. Use of intravenous immunoglobulin in twin neonates with disseminated coxsackie B1 infection. Clin Pediatr (Phila) 1993; 32:561-3. [PMID: 8258213 DOI: 10.1177/000992289303200912] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- D Valduss
- Department of Pediatrics and Human Development, Michigan State University, East Lansing 48824-1317
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Ehrnst A, Eriksson M. Epidemiological features of type 22 echovirus infection. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1993; 25:275-81. [PMID: 8362222 DOI: 10.3109/00365549309008499] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
During a 25-year observation period, isolates of type 22 echovirus were obtained from 109 patients. 92% of the patients were < 2 years old. Echovirus type 22 was isolated with peaks both during late summer and autumn, as enterovirus infections, and during the winter months and early spring, as respiratory viruses. Diarrhea was the most common symptom, followed by obstructive bronchitis and, less often, CNS symptoms. Nosocomial infections were common. In a noticeable number of the children, maternal neutralizing antibodies were most probably present at the time of infection. The epidemiologic features of type 22 echovirus infections with regard to age and seasonal distribution, contagiousness and a relative lack of protection by neutralizing antibodies differed from most enterovirus infections.
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Affiliation(s)
- A Ehrnst
- Department of Virology, Central Microbiological Laboratory of Stockholm County Council, Sweden
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Garcia AG, Basso NG, Fonseca ME, Zuardi JA, Outanni HN. Enterovirus associated placental morphology: a light, virological, electron microscopic and immunohistologic study. Placenta 1991; 12:533-47. [PMID: 1775446 DOI: 10.1016/0143-4004(91)90029-f] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The purpose of this study was to identify the possible effect of enteroviruses on placental tissue. Seventy-eight pregnant women were studied throughout their pregnancy: enteroviral infection was detected by faecal viral isolation and seric neutralization of previously identified virus in cell culture. In 19 cases of confirmed maternal infection, placentae were examined grossly, by optical microscopy, immunohistochemical and electron microscopic methods. Ten term placentae from women included in the study, with no clinical, serological or virological evidence of enteroviral infection, were used as control, and examined by gross and optical microscopy. In 17 specimens (echovirus-coxsackievirus) an haematogenous placentitis was suspected on the basis of gross observation. Microscopic lesions were similar to those found in other viral infections, with specific features. The nature of the inflammatory reaction pointed to the presence of an acute type of haematogenous placentitis, not present in placentae of the control group. The authors (AA) comment on the results and present the hypotheses about the available data: (1) maternal enteroviremia and faecal virus shedding without placental invasion, placentary damage being an unspecific consequence of infection; (2) direct virus-induced injury is not the only possible cause for the lesions: (3) placental enteroviral infection occurred with placental pathology but the virus did not cross the organ as the newborn had no signs of infection.
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Affiliation(s)
- A G Garcia
- Departamento de Anatomia Patologica do Instituto Fernandes Figueira, FIOCRUZ, Rio de Janeiro, Brasil
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Isaacs D, Dobson SR, Wilkinson AR, Hope PL, Eglin R, Moxon ER. Conservative management of an echovirus 11 outbreak in a neonatal unit. Lancet 1989; 1:543-5. [PMID: 2564069 DOI: 10.1016/s0140-6736(89)90078-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Two babies in a neonatal unit presented on the same day with meningitis due to echovirus 11, which was thought to have been introduced by staff. At this time echovirus 11 was also isolated from the stools of eight other babies; five of them did not have signs of infection. No intervention was made except to emphasise the importance of handwashing. There was evidence of secondary spread to two babies who were both clinically well. The attack rate was twelve (29%) of forty-one babies exposed. Seven of the twelve infected babies were born before 30 weeks' gestation and would have had little or no maternal antibody, yet only two of the seven babies had signs of infection. Despite lack of special measures, all babies recovered. Most cases of horizontally acquired neonatal echovirus infection are mild: extreme measures in the management of outbreaks are unnecessary.
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Affiliation(s)
- D Isaacs
- Department of Paediatrics, John Radcliffe Hospital, Oxford
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Amstey MS, Miller RK, Menegus MA, di Sant 'Agnese PA. Enterovirus in pregnant women and the perfused placenta. Am J Obstet Gynecol 1988; 158:775-82. [PMID: 2834954 DOI: 10.1016/0002-9378(88)90071-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A survey of all nonpolio enterovirus infections in adults for a 10-year period revealed that most such infections will occur in the child-bearing age group during the third quarter of the year. Coxsackieviruses occurred more often than echovirus infection. Fourteen pregnant women, including four with meningitis, who had an enterovirus infection from 16 to 37 weeks of gestation delivered uninfected, healthy infants. Attempts to demonstrate transplacental passage of Coxsackie B-3 or ECHO-11 viruses by use of the dual, recirculating, in vitro perfusion of an isolated placental lobule were unsuccessful even with a maternal virus input of 200,000 median tissue culture infectious doses. This suggests that transplacental passage of virus does not occur readily, and that most neonates of infected mothers will be unharmed.
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Affiliation(s)
- M S Amstey
- Department of Obstetrics-Gynecology, University of Rochester School of Medicine and Dentistry, New York
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Abstract
In comparison to older children and adults, neonates are immunologically incompetent. They are susceptible to infections caused by a variety of microorganisms, including bacteria, fungi and viruses. These infectious agents may be acquired by neonates either prenatally, during the intrapartum period or postnatally. The purpose of this review is to emphasize the potential impact of viral infections contracted by neonates at the time of delivery or within the neonatal period. The viruses reviewed include the herpes group of viruses (cytomegalovirus, herpes simplex viruses and varicella-zoster virus), type B hepatitis virus, human immunodeficiency virus, respiratory viruses, enteroviruses, rotavirus and human papilloma virus. For each virus the potential sources and incidence of the infection, the common manifestations of the illness, and possible means of prevention and therapy are discussed. Although infections caused by bacteria tend to be more clinically dramatic and more immediately life-threatening, it is emphasized that infections caused by viruses are common and associated with substantial long-term morbidity. Perinatal viral infections need to be recognized as early in life as possible so that their natural history can be more completely defined and any possible intervention made.
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Reyes MP, Zalenski D, Smith F, Wilson FM, Lerner AM. Coxsackievirus-positive cervices in women with febrile illnesses during the third trimester in pregnancy. Am J Obstet Gynecol 1986; 155:159-61. [PMID: 3014880 DOI: 10.1016/0002-9378(86)90102-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Coxsackievirus B5 infection was demonstrated in five of seven third-trimester pregnant women with undifferentiated febrile illnesses or aseptic meningitis. Coxsackievirus B5 was recovered from the cervix and throat in four women and from the rectum in three. No obvious illnesses were evident in the babies. These findings suggest that previously unrecognized cervical enterovirus carriage or infection is common in infected pregnant women in the last trimester and that subsequent neonatal infection at delivery may result.
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Reiss-Levy E, Baker A, Don N, Caldwell G. Two concurrent epidemics of enteroviral meningitis in an obstetric neonatal unit. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1986; 16:365-72. [PMID: 3465313 DOI: 10.1111/j.1445-5994.1986.tb01188.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A small epidemic of viral infection occurred in a neonatal unit. It involved 11 infants, all of whom recovered. Echovirus 11 was the cause of illness in six infants, coxsackie B3 in four, and one infant had a biphasic illness, due first to echo 11, then to coxsackie B3. The epidemic coincided with a major outbreak of echovirus 11 and a smaller outbreak of coxsackie B3 in the community. Several staff became ill. Five infants were considered to have been infected by perinatal materno-infant spread, others by cross-infection. The epidemic ended when the nursery was closed.
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50
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Garraffo R, Lapalus P. Simplified liquid chromatographic analysis for cyclosporin A in blood and plasma with use of rapid extraction. JOURNAL OF CHROMATOGRAPHY 1985; 337:416-22. [PMID: 3988870 DOI: 10.1016/0378-4347(85)80057-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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