Neonatal Enterovirus Infection: Case Series of Clinical Sepsis and Positive Cerebrospinal Fluid Polymerase Chain Reaction Test with Myocarditis and Cerebral White Matter Injury Complications

Frank H Morriss; Julie B Lindower; Heather L Bartlett; Dianne L Atkins; Jean O Kim; Jonathan M Klein; Bradley A Ford

doi:10.1055/s-0036-1593406

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Neonatal Enterovirus Infection: Case Series of Clinical Sepsis and Positive Cerebrospinal Fluid Polymerase Chain Reaction Test with Myocarditis and Cerebral White Matter Injury Complications

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Neonatal Enterovirus Infection: Case Series of Clinical Sepsis and Positive Cerebrospinal Fluid Polymerase Chain Reaction Test with Myocarditis and Cerebral White Matter Injury Complications

Frank H Morriss, Julie B Lindower, Heather L Bartlett, Dianne L Atkins, Jean O Kim, Jonathan M Klein and Bradley A Ford

American journal of perinatology reports, Vol.6(3), pp.e344-e351

07/2016

DOI: 10.1055/s-0036-1593406

PMCID: PMC5042705

PMID: 27695644

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Abstract

Objective We describe five neonates with enteroviral (EV) infection to demonstrate central nervous system (CNS) and cardiac complications and report successful treatment of myocarditis with immunoglobulin intravenous (IVIG) in two. Study Design Case series identified during three enteroviral seasons in one neonatal intensive care unit (NICU) by cerebral spinal fluid (CSF) reverse transcriptase polymerase chain reaction (PCR) testing for EV in neonates suspected to have sepsis, but with sterile bacterial cultures. Results Cases were identified in each of three sequential years in a NICU with 800 to 900 admissions/year. Two cases were likely acquired perinatally; all were symptomatic with lethargy and poor feeding by age 5 to 10 days. All had signs of sepsis and/or meningitis; one progressed to periventricular leukomalacia and encephalomalacia. Two recovered from myocarditis after treatment that included IVIG 3 to 5 g/kg. Conclusion Neonates who appear septic without bacterial etiology may have EV CNS infections that can be diagnosed rapidly by CSF PCR testing. Cases may be underdiagnosed in the early neonatal period if specific testing is not performed. Neonates with EV infection should be investigated for evidence of periventricular leukomalacia, screened for myocarditis, and considered for IVIG treatment.

meningoencephalitis

periventricular leukomalacia

enterovirus

immunoglobulin intravenous

myocarditis

neonate

Case Report

Details

Title: Subtitle: Neonatal Enterovirus Infection: Case Series of Clinical Sepsis and Positive Cerebrospinal Fluid Polymerase Chain Reaction Test with Myocarditis and Cerebral White Matter Injury Complications
Creators: Frank H Morriss - Stead Family Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa
Julie B Lindower - Stead Family Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa
Heather L Bartlett - Department of Pediatrics, University of Wisconsin, Madison, Wisconsin
Dianne L Atkins - Stead Family Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa
Jean O Kim - Department of Pediatrics, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
Jonathan M Klein - Stead Family Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa
Bradley A Ford - Departments of Pediatrics and of Pathology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa
Resource Type: Journal article
Publication Details: American journal of perinatology reports, Vol.6(3), pp.e344-e351
DOI: 10.1055/s-0036-1593406
PMID: 27695644
PMCID: PMC5042705
NLM abbreviation: AJP Rep
ISSN: 2157-6998
eISSN: 2157-7005
Publisher: Thieme Medical Publishers; 333 Seventh Avenue, New York, NY 10001, USA
Language: English
Date published: 07/2016
Academic Unit: Stead Family Department of Pediatrics; Pathology; Neonatology
Record Identifier: 9984047688602771

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