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Coxsackievirus B1 infection in infants less than 2 months of age
1Department of Pediatrics, Veterans General Hospital-Kaohsiung and National Yang-Ming University, Taiwan.
Insights
Coxsackievirus B1 (CB1) can cause severe infections in infants, including meningitis and sepsis. Early diagnosis through viral culture is crucial for prompt treatment and improved outcomes in neonates.
Area of Science:
- Pediatrics
- Virology
- Infectious Diseases
Background:
- Neonatal enteroviral infections are typically linked to specific strains like Coxsackievirus B2-B5 and echovirus.
- Coxsackievirus B1 (CB1) is less commonly reported in neonatal infections.
Purpose of the Study:
- To describe the clinical features and outcomes of neonatal Coxsackievirus B1 infections.
- To highlight diagnostic challenges and emphasize the need for viral culture.
Main Methods:
- Retrospective analysis of 25 infants less than 2 months old with confirmed CB1 infection.
- Review of clinical presentations, laboratory findings (including CSF analysis), and patient outcomes.
Main Results:
- CB1 infection presented as aseptic meningitis (17 infants) or systemic sepsis (8 infants).
- Systemic sepsis cases showed impaired liver function and coagulation abnormalities.
- Cerebrospinal fluid analysis revealed polymorphonuclear cell predominance (62.5%) and hypoglycorrhachia (64%) in some cases.
- Meningitis-only cases resolved without sequelae; systemic sepsis had a 12.5% mortality rate.
Conclusions:
- CB1 infection presents non-specifically in neonates, mimicking bacterial infections.
- Physicians must consider CB1 in infants with meningitis or sepsis, especially during prevalent seasons.
- Prompt viral culture is essential for accurate diagnosis and management of neonatal enteroviral infections.
Abstract:
Most of the neonatal enteroviral infections reported in the literature are associated with Coxsackievirus B2-B5 and echovirus 9 and 11. We report a retrospective Coxsackievirus B1 (CB1) infection in infants less than 2 months of age. Seventeen patients had aseptic meningitis and 8 had systemic sepsis (multi-organ involvement including meningitis, impaired liver function, and abnormality in coagulation). The symptoms and signs were nonspecific and could not be distinguished with bacterial infection on clinical grounds. Virus isolation was mandatory for diagnosis. Impaired liver function and coagulation profiles were noted in patients with systemic sepsis, but not in patients with meningitis only. CSF examination showed some uncommon features of viral meningitis: predominance of polymorphonuclear cells (PMN) was noted in 62.5% of patients and hypoglycorrhachia in 64% of patients. The patients with only meningitis recovered completely without any sequela. One of the eight patients with systemic sepsis died with case fatality rate 12.5%. Physicians should be aware of the possibility of CB1 virus infection in young infants during prevalent seasons. Specimens should be sent for viral culture in patients with meningitis and sepsis to make a definite diagnosis.