Sequelae of Central-Nervous-System Enterovirus Infections

Sells, Clifford J.; Carpenter, Robert L.; Ray, C. George

doi:10.1056/nejm197507032930101

Cited by 140 publications

(48 citation statements)

References 11 publications

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“…On the other hand, neonates and immunocompromised individuals are well-recognized groups that are particularly prone to the development of severe EV disease. [14][15][16] In our study, a wide spectrum of symptomatic enteroviral disease was seen. This included mild disease such as upper respiratory infection, pharyngitis, rash and fever, to more severe disease, such as aseptic meningitis, sepsis-like illness, disseminated infection and pneumonia, which all required hospital admission.…”

Section: Discussionmentioning

confidence: 53%

“…This included mild disease such as upper respiratory infection, pharyngitis, rash and fever, to more severe disease, such as aseptic meningitis, sepsis-like illness, disseminated infection and pneumonia, which all required hospital admission. The neonate with sepsis-like illness presents a good example of the severity of this illness in this age group, which has been well known and documented in previous studies 14,15 (this patient survived after a stormy hospital course). Viremia was a marker of disseminated disease in three patients with leukemia; two patients survived, but the third died with dual viral and gram-negative sepsis.…”

Section: Discussionmentioning

confidence: 59%

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Enteroviruses at a Tertiary Care Center in Saudi Arabia, 1989-1995

et al. 1997

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Enteroviruses (EVs) are among the most common viral pathogens affecting humans. Enterovirus (EV) infections occur worldwide in temperate climates with a marked summer/fall season and have a high year-round incidence in tropical and subtropical areas. In Saudi Arabia, the epidemiology of enteroviruses is unknown. Of the clinical specimens submitted for diagnosis during a six-year period (1989)(1990)(1991)(1992)(1993)(1994)(1995) at King Faisal Specialist Hospital and Research Centre (KFSH&RC) in Riyadh, a wide variety of diseases were associated with the isolation of enteroviruses. Among the diseases were herpangina, sepsis-like illness, hand-foot-and-mouth syndrome, laryngotracheitis (croup), aseptic meningitis, pneumonia, and gastrointestinal illness. During the six-year study, a variety of enteroviruses were isolated. Although epidemics were seen in mid-winter and early spring, EV which may cause sporadic diseases were isolated in each of the 12 months. Health care providers must become aware of the epidemic potential not only in mid-winter and early spring, but also throughout the year, as this will aid in the diagnosis and management of this illness.

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 59%

Enteroviruses at a Tertiary Care Center in Saudi Arabia, 1989-1995

et al. 1997

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“…[35][36][37][38] authors have documented language delays in infants who have had EV meningitis before 3 months of age. 36,38 PCR diagnosis followed by molecular typing could clarify which serotypes are most likely to produce CNS involvement and which infants, if any, may be at risk for neurodevelopmental delay.…”

Section: Discussionmentioning

confidence: 99%

A Polymerase Chain Reaction-based Epidemiologic Investigation of the Incidence of Nonpolio Enteroviral Infections in Febrile and Afebrile Infants 90 Days and Younger

et al. 1999

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ABSTRACT. Objective. Enteroviruses are important pathogens in infants, but their true contribution to febrile illness in infants <90 days old is unknown. The purpose of this study was to use the polymerase chain reaction (PCR) for diagnosis of enteroviral (EV) infection in febrile and afebrile infants <90 days of age to improve the understanding of the epidemiology of EV infection in this population.Methods. Patients included all unimmunized, febrile infants <90 days of age admitted to Primary Children's Medical Center (Salt Lake City, UT) for sepsis evaluation from December 1996 to December 1997. Blood, urine, cerebrospinal fluid, and throat swabs were tested for enteroviruses using a PCR assay (Roche Molecular Systems, Branchburg, NJ). Alternate PCR assays separated polio and nonpolio enteroviruses. Results of bacterial cultures, outcome, and hospital charges were obtained. Blood from afebrile, control infants <90 days old was tested for enteroviruses.Results. A total of 345 febrile infants were enrolled; 89 (25.8%) were positive for enterovirus. The incidence of EV infection ranged from 3.2% in January to 50% in August and October. Five EV-positive, febrile infants (5.6%) had concomitant urinary tract infections, and 1 (1.1%) had concomitant bacteremia. Infants with confirmed EV infection were significantly less likely to have bacterial infection than those who were EV-negative. All infants infected with an enterovirus recovered. Average length of stay was 3 days, average charges were nearly $4500. Eighty-six afebrile, control infants were enrolled; 6 (6.9%) were positive for enterovirus; 3 had received oral polio vaccine.Conclusions. Nonpolio EV infections commonly cause fever in infants <90 days of age. Rates of EV positivity are low in afebrile, unimmunized infants. The use of PCR to identify febrile infants with nonpolio EV infections may decrease length of hospital stay, unnecessary antibiotic administration, and charges. Pediatrics 1999;103(3). URL: http://www.pediatrics.org/cgi/content/ full/103/3/e27; enterovirus, PCR, febrile infants, bacterial infection, poliovirus.

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“…Although data on these outcomes are conflicting (11,46,122,134,161) (6). With modern antiviral therapy using acyclovir or vidarabine, mortality has been reduced to 10 to 57%, but up to 86% of the survivors still suffer neurologic sequelae (6).…”

Section: Enterovirusesmentioning

confidence: 99%

Role of the virology laboratory in diagnosis and management of patients with central nervous system disease

1989

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A number of viruses cause acute central nervous system disease. The two major clinical presentations are aseptic meningitis and the less common meningoencephalitis. Clinical virology laboratories are now more widely available than a decade ago; they can be operated on a modest scale and can be tailored to the needs of the patients they serve. Most laboratories can provide diagnostic information on diseases caused by enteroviruses, herpesviruses, and human immunodeficiency virus. Antiviral therapy for herpes simplex virus is now available. By providing a rapid diagnostic test or isolation of the virus or both, the virology laboratory plays a direct role in guiding antiviral therapy for patients with herpes simplex encephalitis. Although there is no specific drug available for enteroviruses, attention needs to be paid to these viruses since they are the most common cause of nonbacterial meningitis and the most common pathogens causing hospitalization for suspected sepsis in young infants in the United States during the warm months of the year. When the virology laboratory maximizes the speed of viral detection or isolation, it can make a significant impact on management of these patients. Early viral diagnosis benefits patients with enteroviral meningitis, most of whom are hospitalized and treated for bacterial sepsis or meningitis or both; these patients have the advantage of early withdrawal of antibiotics and intravenous therapy, early hospital discharge, and avoidance of the risks and costs of unnecessary tests and treatment. Enteroviral infection in young infants also is a risk factor for possible long-term sequelae. For compromised patients, the diagnostic information helps in selecting specific immunoglobulin therapy. Good communication between the physician and the laboratory will result in the most benefit to patients with central nervous system viral infection.

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Sequelae of Central-Nervous-System Enterovirus Infections

Cited by 140 publications

References 11 publications

Enteroviruses at a Tertiary Care Center in Saudi Arabia, 1989-1995

Enteroviruses at a Tertiary Care Center in Saudi Arabia, 1989-1995

A Polymerase Chain Reaction-based Epidemiologic Investigation of the Incidence of Nonpolio Enteroviral Infections in Febrile and Afebrile Infants 90 Days and Younger

Role of the virology laboratory in diagnosis and management of patients with central nervous system disease

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