Neonatal coxsackie B virus infection?a treatable disease?

Abstract

Ten neonates with coxsackie B viral infection presented over a 3-month period. Clinical features included meningoencephalitis, thrombocytopenia, disseminated intravascular coagulopathy, cardiomyopathy, and hepatitis. Eight infants had multiorgan disease, four with severe myocardial dysfunction, of whom two died. All of the infants with severe disease developed symptoms within 7 days of age. In infants presenting within 10 days of birth, in all cases there were symptoms compatible with maternal infection prior to delivery. Severity was associated with perinatal transmission. Enteroviral polymerase chain reaction of CSF, urine, stool or throat swab was positive in nine of the ten babies. Seven of the infants were treated with a 7-day course of the new anti-picornaviral drug pleconaril (5 mg/kg 3 times daily). Conclusion: These cases highlight the importance of not missing coxsackie B viral infection in the differential diagnosis of the septic neonate, especially as there is now a potential treatment.

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

“…Intravenous (IV) IgG is advocated for treatment of neonatal enterovirus infection, but its benefits are still debated [3][4][5]. The antiviral agent pleconaril is a potential treatment for enterovirus infection in neonates or infants, but the experience is still limited [6,7].…”

A fatal course of neonatal meningo-encephalitis

“…16 Treatment of neonatal EV cases with pleconaril has been described. 14,15,[17][18][19] While a double-blind, placebo-controlled efficacy trial of pleconaril for the treatment of neonatal EV sepsis syndrome is registered and ongoing (www.clinicaltrials.gov, NCT00031512), the current standard treatment of neonatal EV infections is limited to supportive care. This report underlines the urgent need for additional data on the clinical efficacy and safety of specific antiviral treatment of neonatal EV infections.…”

Lebererkrankungen des Säuglings

“…Vertikale Infektionen mit Paramyxoviren und Enteroviren können zu einer ausgeprägten Hepatitis führen. Es gibt erste Berichte über Erfahrungen mit Pleconaril bei kongenitalen Coxsackie-Virus-Infektionen [3].…”