A newborn boy with fever and seizures

Enteroviruses are common causes of infections in neonates. Enterovirus infections can present with mild and nonspecific symptoms but may also cause more severe disease, such as sepsis-like illness and meningitis. Distinguishing enterovirus infections from bacterial infections can be challenging. Consequently, patients may be given unnecessary broad-spectrum antibiotics, which is particularly undesirable in neonates.

A newborn boy, healthy at birth, developed fever in his first week of life. His clinical course fluctuated over several days, ultimately culminating in seizures. Blood cultures and cerebrospinal fluid analysis did not reveal a bacterial aetiology. However, enterovirus RNA was found in both serum and cerebrospinal fluid by polymerase chain reaction, confirming a diagnosis of enterovirus meningitis due to Coxsackievirus B5. Anticonvulsant therapy was initiated, antibiotics were discontinued, and the infant recovered without complications.

This case illustrates that the clinical presentation of enterovirus infections in neonates can be difficult to distinguish from other viral and bacterial infections. Greater awareness of enteroviruses as potential causes of severe neonatal infections, along with knowledge of appropriate testing, may facilitate accurate diagnosis and help avoid unnecessary antibacterial therapy.