An outbreak of Coxsackie virus type B2 among neonates in an obstetrical ward

Clinical and epidemiological aspects of an enterovirus outbreak in a neonatal unit

An outbreak of enterovirus infection occurred among neonates in a maternity hospital between July 7 and 22, 1999. Twenty neonates became ill (18 confirmed and two probable), an attack rate of 33%. The incubation period ranged from three to six days (mean, 4.2). The male:female ratio was 11:9 and the mean age at the onset of illness was 5.5 days. All the babies had fever, eight, a maculopapular rash, and six had symptoms of gastroenteritis, 11 developed meningitis. Nineteen neonates required hospitalization for three to seven days, but all were discharged home without sequelae. Enteroviral RNA was detected in all of 18 urines, and 14 cerebrospinal fluid specimens tested. A case-control study was conducted to determine risk factors associated with the outbreak. Rooming in the nursery ward was a significant risk factor (odds ratio=33.35; 95% confidence interval, 3.79-800; P=0.00002). No association was found between illness and other possible risk factors. Appropriate control measures resulted in resolution of the outbreak. Our findings demonstrate the potential for enteroviruses to cause widespread illness among newborns, and emphasize the usefulness of polymerase chain reaction in the early diagnosis of infection, and underline the role of effective control measures in interrupting viral transmission.

Enteric infectious disease in neonates. Epidemiology, pathogenesis, and a practical approach to evaluation and therapy

There are many bacterial and viral pathogens that have been associated with enteric disease during the newborn period. These pathogens have widely different mechanisms of action on the intestinal epithelium and are associated with a spectrum of clinical findings. Infected infants can be asymptomatic, have gastroenteritis, or have a fulminant sepsis picture. To determine therapy and institute appropriate infection control measures requires the ability to recognize the clinical syndrome and correctly interpret laboratory results. All of these principles can be applied to the premature infant in the neonatal intensive care nursery as well as the full-term infant at home.

Coxsackie B virus epidemiology and neonatal infection in Belgium

Outbreaks of Coxsackie B virus infection occur mainly in the warm spring and summer when enteroviruses are most prevalent. A study of five Coxsackie B virus serotypes was made over the last decade by collecting and typing nearly all enteroviruses isolated in Belgium. The study showed that Coxsackie B virus infection appeared in waves. We describe two outbreaks of Coxsackie B virus infection in our maternity unit. The first took place in 1988, when Coxsackie B 2 virus was the most prevalent serotype in the general population. One baby fell ill 6 days after birth and developed signs of meningitis. In a second baby the infection showed a diphasic pattern. The first phase was relatively mild but, after a period of recovery the child developed signs of myocarditis. After a period of low prevalence or complete absence from 1982 to 1988, Coxsackie B I virus reappeared in the summer of 1989. That summer, a small outbreak was seen in our maternity unit where one baby was infected from his mother and the infection spread from that baby to another one. Both babies developed meningitis but their convalescence was uncomplicated. A higher risk of outbreaks in nurseries was observed in summer when viruses are most prevalent. Measures to prevent such infections are discussed.

Coxsackie B antigen in the central nervous system of a patient with fatal acute encephalitis: immunohistochemical studies of formalin-fixed paraffin-embedded tissue

A case of fatal acute encephalitis due to Coxsackie B1 virus is described. Confirmation of Coxsackie B virus as the etiological agent of encephalitis was based on identification of the virus antigen in formalin-fixed paraffin-embedded tissue sections. In the past, the diagnosis was obtained by serological studies of peripheral blood and viral isolation. This is the first report in which indirect immunofluorescent and immunoperoxidase methods using rabbit antiserum raised against Coxsackie B types 1-6 was utilized in determining the etiology of encephalitis. It must be emphasized that these methods can be used both on biopsy or autopsy specimens, even retrospectively.

Two cases of coxsackie B2 infection in neonates: clinical, virological, and epidemiological aspects

Two cases of neonatal coxsackie virus B2 infection are described. One infant presented with meningitis and enteritis, the other with rhinitis, meningoencephalitis, and enteritis. Both infants made good recoveries. The virus infection could also be demonstrated in all nonimmune family members, most of whom gave a history of recent mild febrile disease (pharyngitis, diarrhea). Enterovirus infections may be suspected in cases of neonatal meningitis or myocarditis associated with gastrointestinal signs, especially 1. when it is during the hot season July-October, 2. when there has been febrile illness in other family members recently. For an effective and rapid isolation of the agent, rectal swabs or stool specimens not only from the patient, but also from household contacts should be sent to the virus laboratory on several consecutive days. Meningitic infection may be proved by an early c.s.f. sample. For serodiagnosis a first blood specimen should be drawn as soon as possible, a second one some days later. The importance of rapid virological diagnosis and of stringent hygienic measures to prevent spread of the infection is stressed.

The spread of Coxsackie B1 infection

During June and July 1977 5 junior boys in a boarding school for 800 pupils became ill with a mild infection caused by Coxsackie B1. The school had been taking part in a vaccine trial, and paired blood samples had been taken from new entrants in October 1976 and October 1977. 18% of the boys susceptible to the infection developed antibodies. The results suggest that dormitories are more important than the day-to-day contacts in the spread of infection. The advisability of nursing children with known or suspected enterovirus infections in open wards in hospital is questioned.

Entérovirus et infections respiratoires

The importance of enteroviruses in upper and lower respiratory infections is reviewed. Occasionaly summer epidemics of upper respiratory infections seem due to an enterovirus : on the other hand, the lower respiratory injections rarely seem due to these viruses.The relationship between the enteroviruses and respiratory infections remains to be proved.