Fatal Infections With Echovirus Types 6 and 11 in Early Infancy

Krous, Henry F.; Dietzman, Dale E.; Ray, C. George

doi:10.1001/archpedi.1973.02110190684022

Cited by 26 publications

(16 citation statements)

References 15 publications

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“…However, massive hepatic and adrenal necrosis has been reported mostly in newborns with echovirus 11 at autopsy (16) and is not a common observation in echovirus 6 infections. To our knowledge, only one case of hepatoadrenal necrosis in an echovirus 6 infection has been reported aside from our case (5).…”

Section: Discussionmentioning

confidence: 65%

“…Two cases were associated with a maternal history of upper respiratory tract infection, and in both patients, delivery was performed by caesarian sec- tion (5,6). This history of maternal illness and caesarian section delivery is similar to the patient we studied.…”

Section: Discussionmentioning

confidence: 99%

“…Of the 31 types of echoviruses, type 11 is the most frequent cause of serious neonatal morbidity and mortality, often presenting as fulminant hepatitis, infection of the central nervous system, or both (3). Echovirus type 6 infection is an uncommon cause of neonatal mortality, with only a few reported cases of severe or fatal neonatal infection (3)(4)(5)(6)(7). We present the case of a newborn infant with fatal echovirus 6 infection and describe the unusual pathologic findings.…”

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confidence: 96%

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Fatal Neonatal Echovirus 6 Infection: Autopsy Case Report and Review of the Literature

et al. 2001

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A full-term, healthy male neonate was delivered by caesarian section to a 26-year-old primigravida woman who had a history of fever and upper respiratory tract infection. On the fourth day of life, the neonate developed a sepsis-like syndrome, acute respiratory and renal failure, and disseminated intravascular coagulopathy. He died 13 days after birth. Postmortem examination revealed jaundice, anasarca, massive hepatic necrosis, adrenal hemorrhagic necrosis, renal medullary hemorrhage, hemorrhagic noninflammatory pneumonia, and severe encephalomalacia. Echovirus type 6 was isolated from blood, liver, and lungs. Although uncommon, echovirus type 6 infection may produce a spectrum of pathologic findings similar to those seen with the more commonly virulent echovirus type 11. Echoviruses are single-stranded RNA viruses of the genus Enterovirus of the family Picornaviridae that may occasionally cause overwhelming disease and death in neonates (1, 2). Of the 31 types of echoviruses, type 11 is the most frequent cause of serious neonatal morbidity and mortality, often presenting as fulminant hepatitis, infection of the central nervous system, or both (3). Echovirus type 6 infection is an uncommon cause of neonatal mortality, with only a few reported cases of severe or fatal neonatal infection (3-7). We present the case of a newborn infant with fatal echovirus 6 infection and describe the unusual pathologic findings. We also review the literature about severe neonatal echovirus 6 infections. CASE REPORTA full-term boy appropriate for his gestational age was born via caesarian section to a 26-year-old G 1 P 0 Latin American woman who had a medical history of a well-controlled seizure disorder for which she was receiving carbamazepine. She had received regular prenatal care, with negative prenatal serologic tests for human immunodeficiency virus, hepatitis B virus, and syphilis. Two weeks before delivery, she experienced fever and an upper respiratory tract infection. At birth, the infant weighed 3838 g and had an Apgar score of 9. The neonate was put under an oxygen hood, then was later slowly weaned from it. On his fourth day of life, the neonate developed fever (38.6°C) and was observed to have decreased activity. An area of hyperemia and swelling was seen on the right shoulder. This area of swelling and redness increased in size during the next few days. He received ampicillin, gentamicin, ceftazidime, and acyclovir after blood was collected for viral and bacterial cultures. Cranial ultrasonography results were normal.On the fifth day of life, the neonate experienced respiratory difficulty, which required intubation and mechanical ventilation. He remained febrile and developed oliguria that later progressed to renal insufficiency. Sepsis and disseminated intravascular coagulopathy were suspected, and blood and blood products were provided. On the ninth day of life, he suffered cardiopulmonary arrest twice and remained neurologically compromised thereafter. He was transferred to the University of Texas Medical Branch ...

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

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confidence: 96%

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Fatal Neonatal Echovirus 6 Infection: Autopsy Case Report and Review of the Literature

et al. 2001

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“…69,133). CNS disease sometimes occurs as a part of disseminated enteroviral infection, with viremia and involvement of heart, liver, kidneys, adrenal glands, and the blood coagulation system (14,26,56,71,75,77 Approximately 3,200 to 12,700 cases of aseptic meningitis were reported annually to the Centers for Disease Control between 1973 and 1983 (24), but its actual incidence is probably severalfold higher. Enteroviruses account for the majority of the identified agents causing aseptic meningitis, and yearly peak occurrences of the disease closely coincide with periods of most frequent enterovirus isolation (20,24).…”

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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“…Although being considered as a self-limited disease, echoviruses 6 and 9 have been found to cause deaths in children, especially in neonates. [5][6][7][8][9][10][11][12][13] …”

Section: Introductionmentioning

confidence: 99%