Severe Enterovirus Infections in Hospitalized Children in the South of England

Abstract

Background:Most enterovirus surveillance studies lack detailed clinical data, which limits their clinical usefulness. This study aimed to describe the clinical spectrum and outcome of severe enterovirus infections in children, and to determine whether there are associations between causative enterovirus genotypes and clinical phenotypes.Methods:Retrospective analysis of microbiological and clinical data from a tertiary children’s hospital in the South of England over a 17-month period (2012–2013).Results:In total, 30 patients were identified, comprising sepsis (n = 9), myocarditis (n = 8), meningitis (n = 8) and encephalitis (n = 5). Cases with sepsis or myocarditis were significantly younger than those with central nervous system disease (median age 21 and 15 days vs. 79 days; P = 0.0244 and P = 0.0310, respectively). There was considerable diversity in the causative genotypes in each of the clinical phenotypes, with some predominance of echoviruses in the meningitis group, and coxsackie B viruses in the myocarditis group. Thirteen cases required mechanical ventilation, 11 cases inotropic support, 3 cases dialysis and 3 cases extracorporal membrane oxygenation. The overall mortality was 10% (sepsis group, n = 1; myocarditis group, n = 2). Of the survivors, 5 (19%) had long-term sequelae (myocardial dysfunction, n = 2; neurological sequelae, n = 3). Patients with encephalitis had the longest hospital stay (median: 16 days), compared with 9, 6 and 3 days in patients with myocarditis, sepsis and meningitis, respectively (P = 0.005).Conclusions:Enterovirus infections, particularly enteroviral myocarditis and encephalitis, can cause significant morbidity and mortality. The results show that there are currently no strong associations between clinical phenotypes and particular causative enterovirus genotypes in the South of England.

Clinical and laboratory characteristics of enteroviral meningitis in children, including qRT-PCR and sequencing analysis

“…They cause mild respiratory and exanthematous diseases (e.g., hand-foot-mouth disease [HFMD] or herpangina). More serious infections (meningitis, encephalitis, paralytic diseases, myocarditis, acute transversal myelitis, acute cerebral ataxia, benign intracranial hypertension, respiratory failure, neonatal sepsis, or chronic infection) occur in some patients 3,4 . Several EV serotypes (e.g., CV A4, 7, 21, 24; EV 71, 76, 89) are associated with serious forms of diseases, including serious neuroinfection, paralytic diseases, and respiratory illnesses [3][4][5][6][7][8][9][10][11] .…”

Emerging Infections and Pertinent Infections Related to Travel for Patients with Primary Immunodeficiencies

“…More severe symptoms occur in infants and young children [ 227 , 228 ]. Acute flaccid paralysis [ 229 ], neonatal enteroviral sepsis [ 230 ], myocarditis/pericarditis [ 231 , 232 ], hepatitis, pancreatitis, pneumonia, and atypical hemolytic uremic syndrome [ 233 ] are severe manifestations seen in immunocompetent people. Chronic infections have been seen in immunocompromised patients [ 234 ].…”

A Non-Human Enterovirus A71 Brainstem Encephalitis in France In 2016

“…The presence of enterovirus-RNA is not always possible, and, for example, some cases of enterovirus brainstem encephalitis have already been described without any CSF positive enterovirus detection [3,15,18,19]. The detection of the virus in the nasopharyngeal and stool specimen and the absence of such detection in CSF confirm the necessity of peripheral sampling in order to extend the virological diagnosis.…”

“…Myocarditis/pericarditis [10][11][12][13], neonatal sepsis [14,15] but also a few cases of type 1 diabetes, pancreatitis, hepatitis [11], uveitis [16] have also been reported. In a few cases of hand, foot and mouth disease, Coxsackie B3 can also be found [17].…”