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

• Published in: American journal of perinatology reports 2016-07, Vol.6 (3), p.e344-e351
• Main Authors: Morriss, Frank H., Lindower, Julie B., Bartlett, Heather L., Atkins, Dianne L., Kim, Jean O., Klein, Jonathan M., Ford, Bradley A.
• Format: Article
• Language: English
• Subjects: Case Report; enterovirus; immunoglobulin intravenous; meningoencephalitis; myocarditis; neonate; periventricular leukomalacia
• ISSN: 2157-6998; 2157-7005
• DOI: 10.1055/s-0036-1593406

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.