Clinical characterization of benign enterovirus infection in neonates

Abstract

Enteroviruses is a group of positive single-stranded RNA viruses ubiquitous in the environment, which is a causative agent of epidemic diseases in children and infants. But data on neonates are still limited. The present study aimed to describe the clinical characteristics of enterovirus infection in neonates and arise the awareness of this disease to general public. Between March 2018 and September 2019, data from all of the neonates diagnosed with enterovirus infection were collected and analyzed from neonatal intensive care unit of Zhangzhou Hospital in Fujian, China. A total of 23 neonates were enrolled. All of them presented with fever (100%), and some with rashes (39.1%). The incidence of aseptic meningitis was high (91.3%), but only a small proportion (28.6%) presented with cerebrospinal fluid (CSF) leukocytosis. The positive value for nucleic acid detection in CSF was significantly higher than throat swab (91.3% vs 43.5%, P = .007). Five of the infected neonates presented with aseptic meningitis (23.8%) underwent brain magnetic resonance imaging examination and no craniocerebral injuries were found. Subsequent follow-ups were performed in 15 of them (71.4%) and no neurological sequelae was found. Aseptic meningitis is a common type of enterovirus infection in neonates with a benign course. Nucleic acid detection of CSF has an important diagnostic value. Febrile neonates would be suggested to screen for enterovirus infection in addition to complete septic workup. An unnecessary initiation or earlier cessation of antibiotics could be considered in enterovirus infection, but that indications still need further studies to guarantee the safety.

Evaluation of enterovirus nucleic acids detection method based on ultra‐fast real‐time fluorescence RT‐PCR technology—A pilot study

“…In recent years, with the wide use of the domestic EV71 vaccine, the prevalence of hand‐foot‐and‐mouth disease has shown a certain degree of decline. The main epidemic types have gradually changed from EV71 and CA16 to CA virus groups such as CA6 and CA10, 6 causing severe clinical symptoms 3,5,7,8 …”

“…The upper respiratory tract, throat, and intestine tract are the entry portals of enteroviruses, which first proliferate in the local mucosa, pharynx, tonsils, and other lymphoid tissues and Peyer's patches, and then release into the blood to form the first viremia. After spreading to target tissues, and reproliferation, it causes a second viremia and clinical symptoms 2,3 . The main diseases caused by enteroviruses include hand‐foot‐and‐mouth disease, aseptic meningitis, polio, herpetic angina, epidemic chest pain, myocarditis and pericarditis, and conjunctivitis eye disease 4 .…”

“…Although most patients have mild symptoms, a considerable number of patients have a fatal cardiopulmonary disease and neurological complications, which will cause a rapid progression, and even lead to death. 3,5 Hand-foot-and-mouth disease has become a public health issue that seriously affects the health of residents. In recent years, with the wide use of the domestic EV71 vaccine, the prevalence of hand-foot-and-mouth disease has shown a certain degree of decline.…”

“…The main epidemic types have gradually changed from EV71 and CA16 to CA virus groups such as CA6 and CA10, 6 causing severe clinical symptoms. 3,5,7,8 Enteroviruses are generally detected by real-time fluorescent reverse transcription polymerase chain reaction (RT-PCR) method with TaqMan probe. The detection methods for a variety of enteroviruses and common subtypes of viruses have been established.…”

“…After spreading to target tissues, and reproliferation, it causes a second viremia and clinical symptoms. 2,3 The main diseases caused by enteroviruses include hand-foot-and-mouth disease, aseptic meningitis, polio, herpetic angina, epidemic chest pain, myocarditis and pericarditis, and conjunctivitis eye disease. 4 Among them, hand-foot-and-mouth disease is a common infectious disease characterized by fever, sore throat, general malaise, rash, or herpes on hands, feet, and mouth.…”